Over-Medicated and Under-Cared-for in Nursing Homes

Over-Medicated and Under-Cared-for in Nursing Homes

Testimonials Page 12-1 (Small)Over-medication is a common occurrence in nursing homes. When someone with Alzheimer’s disease or another dementia has to move into an institutional setting complete with rules they don’t understand and territory that is unfamiliar, anxiety and agitation are common reactions. As the disease progresses, changes in the brain can result in unwanted behaviors. To make it easier for staff to handle patients many nursing homes turn to drugs to calm patients down and make them quieter.

Anti-anxiety drugs might make sense if they are used for a few weeks during a difficult transition period and then gradually eliminated. The problem is that many of the drugs are the staff’s first line of action, and they are then continued because it is easier. Many of the drugs used are actually antipsychotics, such as Risperdal, Haldol, and Seroquel – approved for schizophrenia, bipolar disorder and other serious psychoses. None of these antipsychotic drugs are approved by the FDA for use in seniors with dementia. When used to keep patients calm and quiet they are called chemical restraints and this use is against federal law.

Yet nursing homes in Phoenix and around the country use antipsychotics for their dementia patients on a regular basis. The national average for antipsychotic use in nursing homes is 19% (that is, 19% of the patients in nursing homes nationally are given prescription antipsychotics); the Arizona average is just below that, at 18.8%. Many nursing homes in the Phoenix metro are well below the state average, and some are so far above the average, it’s scary.

We looked at data from 24 nursing homes in the Phoenix area (Source: NPR.org). There was no data available on 5 of the 24; 12 were below the state average and 7 were above the average. Of those seven, 5 used antipsychotics more than 10% more frequently than the state average. One home used them for 60.3% of their residents.

There are numerous dangers to seniors who are given these drugs in high doses.

  • Dementia patients who take antipsychotics nearly double their risk of death over those with dementia who are not taking them. Many of these unexpected deaths are from heart attacks, strokes, heart failure (sudden death for unexplained causes), and pneumonia.
  • Drug interactions can also cause problems, particularly if the patient is given more than one psychoactive drug at a time.
  • The risk of falls is highly increased. Many sedatives and antipsychotics make the patient dizzy and affect their balance. It’s one of the greatest dangers of their use in the elderly.

If you have a loved one in a nursing home (or even in their own or your home), watch for signs of over medication:

  • Sudden changes in personality and behavior
  • Extreme lethargy or confusion
  • Sleeping most or all of the day as well as all night
  • Increase in falls

The use of psychoactive drugs may be an indication that the nursing home has a staff shortage, because using them reduces the amount of patient interaction necessary, and thus allows them to keep a smaller staff. Also watch out for a “drug first” attitude. Hands-on care and a gentle but thorough assessment should always be the first response to behavioral problems in nursing homes. Non-drug therapies can be tried before any drug is used.

With dementia, it is sometime difficult to find the cause of the problem. The patient can’t always tell you what’s wrong, and it may take trying a number of potential solutions to find one that works. Medication may sometimes be the solution, but it should be the last one if a safer, gentler solution exists. The important thing is to stay alert and involved with your loved one’s care.

 by Peter Colten

Senior Caregivers at Greater Risk than their Younger Counterparts

Happy old couple Ian MacKenzie Flickr CC

Photo credit: Ian MacKenzie via Flickr CC

Sailing into the golden years alongside our loved ones is a dream for most of us. We want to see those special people live into their later years of life happy and healthy. The reality, though, is that most of us experience failing health as we age and eventually need someone to help us. We may shudder at the thought of relinquishing control of a loved one’s care to some kind of stranger.

“What if they’re too young, or unqualified?” “But they’re not family!” These are common concerns and many seniors take on the care of a loved one, particularly a spouse, because they feel it is their responsibility.

Yet other questions that are just as important can, at times, go unasked. Is there anyone inquiring about your own needs? Who is the advocate for the caregiver, who is also a senior? These kinds of questions are often ignored — thus leaving the older caregiver’s needs neglected.

Stress is an important factor to consider when deciding to be the primary caregiver for another senior. A recent Pennsylvania State University study showed profound positive effects in the lives of caregivers of elderly who participated in an Adult Day Health Care program. Caregiver participants in the Penn State study had their saliva measured on days where their care recipient was in the day care program and on days when they had not attended. Biological indicators of stress registered a lower reading on days when the care recipients attended, versus days when they had not. Older care providers can feel the burden of the stress of care giving disproportionately, more so than their younger counterparts.

The choice to put the essential care of a loved one into the hands of professionals can be a positive experience when you consider the real advantages it creates for everyone involved. Hiring in-home help or moving your loved one into a facility with proper resources and skilled staff is an excellent alternative to taking senior care into your own hands — it’s frequently a far more healthy option for both the caregiver and the recipient, not to mention other members of the family who worry about both of you.

Having access to information and scientific data is useful when trying to make an informed decision. Seniors accepting the role of primary care provider may be putting themselves and the person receiving care at increased risk. Consider some of the drawbacks to a senior’s being the primary caregiver to another senior.


Poor health patterns
Being a primary caregiver at an older age can result in an increased likelihood to abuse drugs, tobacco, and/or alcohol, as well as neglecting nutrition.


High blood pressure
Higher blood pressure readings occur for spouses in the presence of their elderly partner, when the spouse has assumed the full time care role.


Older caregivers (aged 66-96) have a 63% higher mortality rate than non-caregivers of the same age.


Sometimes it’s possible to care so much for another that you miss doing what is really best for both of you. The paradox is difficult: You want to do what is best for your loved one, but it may not be best for yourself. While providing the care is often something you wish to do, it’s not always advisable. For most people, the goal is optimum care, and you can still participate in that care even if you are not the primary caregiver.

 by Peter Colten

A Practical Approach to Choosing a Senior Care Facility

Safe and happy in a senior care homeThere are a number of reasons to decide it is time to look for a senior care facility. Many times a crisis, such as a fall resulting in injury or an illness, makes you realize Mom or Dad needs help; or perhaps you have taken them or an older relative into your home and the arrangement is less than ideal; or the arrangement may be OK, but you can no longer care for them yourself. You may visit them at home and notice one or more indications they are having trouble taking care of themselves:

  • Their home is no longer clean or well-maintained;
  • Their personal hygiene is not up to former standards;
  • They have lost significant weight, the refrigerator is empty, or it contains spoiled food;
  • Pets or plants are not well cared for;
  • They seem to have no friends or activities they enjoy doing;
  • Their finances are no longer in order, such as cutting back on expenses, bills not being paid, letters from creditors, being preyed on by scammers.

Finding the right place takes a lot of research and consideration. Many people find that the places they like are too expensive and they don’t like some of the ones they can afford. While you can’t remove your own emotional response to the situation, a practical, logical approach can make it feel less overwhelming.

We suggest the following steps:

  1. Discuss and write down the considerations – geographical area, level of care, lifestyle, reputation, etc. – that are most important to your loved one and other family members who are involved in the decision process.
  2. Start your research on the Internet and narrow your choices down. Keep in mind that every facility will make itself look wonderful on its own website. There are a number of sites that review facilities you might want to check out, as well.
  3. Call your top choices and make appointments for tours of the facilities. Visiting will narrow the field considerably, as you observe actual living conditions and learn about pricing options and additional fees that may not be mentioned on the website.
  4. Download our Facility Comparison Checklist and take it with you when you visit each place, so that you can compare features and pricing when you’re ready to make a decision.

Finding a new home for a loved one who can no longer care for themselves in their own home is a daunting task, but it doesn’t have to be a heartbreaking one. While it is emotionally difficult to accept a loved one’s declining abilities – whether physical or mental – an honest assessment of the kind of help they need is the best way to make sure they are safe as well as happy as they age. Knowing they are safe and well cared for goes a long way towards giving you peace of mind.


 by Peter Colten

Talking About End-of-Life Planning, Part II

Buenavante Close Up 1On Monday, we discussed starting the conversation of end-of-life planning. Today, we’ll talk about some specific documents and setting up advanced directives: instructions that doctors, lawyers, and estate planners can use to make sure your wishes are realized.

Advanced Care Planning is the process of discussing your options and sharing your decisions about how you want to be treated at the end of your life should you not be able to speak for yourself.  It also allows you the ability to choose a person or persons to speak on your behalf should you be unable to communicate your own wishes.

Developing Advance Directives

There are five parts to an advance directive in Arizona. Each individual may chose as many or as few of the documents to fill out, based on their values, medical conditions, and personal situation.

  1. Durable Health Care Power of Attorney. A health care power of attorney can be anyone you choose to make medical decisions on your behalf if you are ever unable to do so. This document also gives you the opportunity to decide which decisions the health care power of attorney, or agent, can and cannot make for you.
  2. Durable Mental Health Care Power of Attorney. This position is similar to the first one, but only has the ability to make decisions about your mental health care and nothing more. This agent may be the same person or a different person from the health care power of attorney. This can be a very important document if you have early signs of Alzheimer’s disease or related dementia, or if you know that it runs in your family.
  3. Living Will. This document specifies to family, friends, and physicians what type of live-sustaining care you would like in the event of a serious illness or irreversible coma. To fill this document out in its entirety, it is recommended that you talk to your physician about your medical conditions and possible situations that could result from them. Your physician can tell you what your options are so you can make the best decision for you.
  4. Letter to My Representative. This is a letter that is given to the person you choose to be your power of attorney. It lays what that person’s responsibilities are, what they can and cannot do as your power of attorney, and other important information.
  5. Prehospital Medical Care Directive (Do Not Resuscitate). While it’s recommended that everyone over the age of 18 have a living will, a Do Not Resuscitate (DNR) directive is not appropriate for all circumstances. This document informs emergency and medical personnel not to use life-saving measures such as CPR. Talk to your physician about whether a DNR is necessary for your situation.

There are many resources you can use to learn more about advance directives. Below are just a few places to start:

  1. Arizona Attorney General: This page has some more detailed information about life care planning as well as the five documents you can fill in if you chose not to write your own.
  2. Caringinfo.org: This .pdf answers many common questions about planning and various life-sustaining treatments.
  3. Put It In Writing by the American Hospital Association: This .pdf has more questions and has a glossary of terms to help you better understand the legalese.

When you are finished, you can give them your family members and physician, and also to the Arizona Advance Directive Registry.

It is a fact of life that we will all come to that day when forced to think about the end of our life.  Most people avoid the subject, living life as if there is no end in sight.  Like many difficult topics, we tend to put off any discussion to another day. Unfortunately, waiting until the last minute can be uncomfortable and distressing. If you wait too long then connections will be lost, questions unanswered and the burden of making important decisions will fall to the loved ones who most likely won’t even know what choices you would make. Remember, your choices and decisions are only as good as who you communicate them to; share them with your family, your physician and even your lawyer.

 by Peter Colten

Talking About End-of-Life Planning, Part I

Villa Close Up 1Many people fear that if you talk about death or difficult topics, the subject may become a reality. In fact, these last few weeks, months, or years can be the most powerful time in a person’s life and in that of their loved ones; a time review your life, conflict resolution, decision making and a time to say meaningful goodbyes.

Why We Need to Talk About It

It is so important to have a strong connection with your loved one who is nearing the end of their life. Nothing is worse than the type of grief we suffer when a loved one dies unexpectedly without getting a chance to say goodbye. “Please forgive me,” “I forgive you,” “Thank you,” and “I love you” are the four most powerful statements between loved ones and friends that can heal and strengthen relationships, according to Dr. Ira Byock, a prominent physician in the field of end-of-life and palliative care.

When To Start The Conversation

The best time to have a conversation about end-of-life is when your family member or loved one is active and healthy. These conversations can include finding out more about their choices, and to make your own wishes known. This is a time when you can connect with loved ones and share a discussion without as much of the emotional impact of the topic.

What Would We Need to Talk About?

If you were nearing the end of your life what would you want your loved ones to know about you, your feelings and your choices? And if you thought about your elderly parent, your spouse or your adult children and what would happen if they came to the end of their life because of illness or injury, what would you really want to know about them? Some common themes for discussion:

  • What someone is thinking and feeling about the ultimate end of their life.
  • Where do we go after death.
  • Regrets about life lived and opportunities missed.
  • Conversations and business unfinished.
  • Do you know that you were and are loved?
  • Choices for our care at the end of life.

How Do We Start The Discussion?

Someone just needs to start the conversation! Research has shown that most people do want to talk about what is happening to them or loved ones, but they are afraid to cause anguish or hurt feelings. Research has also shown that end-of-life conversations and choices made known ahead of time have a positive impact on relationships and on the emotional outcome of care.

Everyone should have this discussion, record their choices, and give copies to their loved ones, physician, and lawyer. Later this week, we will discuss legal and medical documents that need to be in place. In the meantime, learn more by visiting the National Institute on Aging and Family Caregiver Alliance

 by Peter Colten