Articles Posted in Psychotropic Drugs

A recent study has found that a class of drugs known as anticholinergics may increase the risk of dementia in patients aged 55 years and older. Commonly used in antidepressants, antihistamines, and antimuscarinics, the drugs have long been associated with side effects like confusion and memory issues. The new study, published in JAMA Internal Medicine, suggests more powerful side effects than medical professionals have previously understood.

As a report by the New York Times explains, anticholinergics encompass a variety of medications. Examples include clozapine, an antipsychotic; diphenhydramine, an antihistamine used in Benadryl, among other products; paroxetine, an antidepressant; tizanidine, a muscle relaxant; and scopolamine, an anti-nausea medication. Anticholinergics owe their wide range of applications to their function in blocking acetylcholine, a neurotransmitter involved in nervous system functions like muscle regulation, respiratory activity, digestion, and the opening and contraction of blood vessels. “Older adults are more likely to be prescribed many of these medications,” the Times explained, “simply because they tend to have more health issues.”

The JAMA Internal Medicine study examined 58,769 patients who had been diagnosed with dementia, with 225,574 matched control patients. Researchers examined dementia patients’ medical records, scrutinizing what medications doctor prescribed them between eleven years and one year before they were diagnosed with dementia. The study took into account 56 separate anticholinergic drugs, accounting for the dosage patients were prescribed and the length they were prescribed the drugs in question. What researchers ultimately discovered was a 50% increase in the risk of dementia in patients “who used a strong anticholinergic drug daily for about three years within that 10-year period,” according to the Times. This risk was strongest in patients who used anticholinergics to treat depression, psychosis, epilepsy, and bladder regulation issues. The study also found a stronger association between anticholinergics and dementia in patients who received their dementia diagnoses before they reached 80 years of age, and in patients with vascular dementia in comparison to those with Alzheimer’s disease.

Nursing homes are often under-staffed in an effort to maximize profits or because they are underfunded.  With the number of elderly people requiring care increasing at a record pace, some institutions use prescription drugs to make their residents more “manageable”.  Legal and ethical issues notwithstanding, the health implications of the use of chemical restraints are terrifying.

What Is a Chemical Restraint?

Put simply, a chemical restraint is when someone’s movement or actions are restricted through pharmaceutical intervention.  Types of drugs used as chemical restraints are:

Elder abuse in any form is strictly prohibited by California law. In addition to physical abuse and neglect, medication errors in nursing homes are considered a form of elder abuse. Unfortunately, due to insufficient staffing in many long-term nursing facilities, errors in the type and amount of medications administered to residents occur with alarming frequency. While in many cases there may be no detrimental side effects to an elder who is given the incorrect medication, or the wrong dosage; in many other cases, the error can prove fatal.

For example, if two patients’ medications are mixed up, and incorrectly administered, the outcome can be disastrous. A diabetic who is mistakenly given a fellow patients’ heart medication may not under normal circumstances have a negative reaction. However, if that heart medication happens interacts with other medications he or she is taking, or causes side effects that the patient can’t sustain; the mistake can result in death.

Other medications must be taken consistently in order for them to be effective. Therefore, missing a dose of the proper medication can have devastating consequences on the elder who has missed their dosage. Other medication errors that may occur in nursing homes include:

The use of physical and chemical restraints in California nursing homes is sometimes a necessary way of protecting patients from injuring themselves and others. When used excessively and, more importantly, without consent, the practice becomes outright abusive. Often this method is used not simply to protect the patient, but rather to make a staff member’s job easier. Overuse of restraints is exacerbated by the growing number of understaffed nursing facilities.

Physical restraints are used to keep patients from wandering around the facility, a potential hazard for the patient and others. A nursing home is required by law to have the resident’s consent before using a physical restraint. Symptoms of physical restraints include sores or bruising on the arms and legs, usually on the ankles and wrists.

Chemical restraints involve the administering of powerful psychotropic drugs to sedate and confine the patient by taking away his or her cognitive abilities. These drugs are not permitted under any circumstances unless the nursing care facility outlines a legitimate medical reason for their use and further provides the frequency and dosage. Because most people are not familiar with the side effects of psychotropic drugs, it can be more difficult to identify chemical restraints than physical restraints.

Each year, more than one in three seniors sustain falls, which result in serious injuries. In some instances, falls are the result of elder or nursing home abuse. But in other instances, falls are purely accidental. An experienced San Diego attorney specializing in elder abuse or nursing home abuse, to include neglect, can help you distinguish if an injury from a fall was an accident or caused by the negligence or wrongdoing of another.

As we age, the likelihood of being diagnosed with a medical condition or disorder requiring prescription medication(s) is almost guaranteed. Because of this, far too many elders run the risk of being over-medicated, or experiencing dangerous side effects which increases the risk that an elder may fall. Many seniors are prescribed medications that have dangerous interactions when taken in conjunction with other medications.

To reduce the risk of experiencing potentially dangerous prescription interactions, it is recommended that seniors use caution when taking prescriptions or even over-the-counter (OTC) medications.

In June 2015, the Alameda County Courthouse ruled on a case involving Health and Safety Code §1418.8. As of January 2016, a final judgment was ordered calling the outdated health code “unconstitutional.”

The Advocates

The case, brought by statewide, non-profit advocates CANHR (California Advocates for Nursing Home Reform), is a critical first step toward nursing home reform. CANHR, through advocacy, education, and legislation (and litigation when necessary) fights to “create a unified voice for long term care reform and humane alternatives to institutionalization.”

Society erroneously assumes prescription medication is only abused by the younger generations. Studies show, however, prescription drug abuse plagues men and women of all ages, including the elderly.

According to an article in the National Institute on Drug Abuse, “Persons aged 65 years and older comprise only 13 percent of the population, yet account for more than one-third of total outpatient spending on prescription medications in the United States.” The article goes on to suggest that there are several ways in which an elderly person can abuse prescribed medication, such as:

• Abusing medication prescribed to a friend or family member in order to save money.
• Alternatively, the elder person has his/her medication taken by a friend or family member and running out of his/her supply early.
• Taking the incorrect dosage or type of medication to do mental decline.

Awareness is everyone’s responsibility, so be vigilant. There are cues that family, friends, and caregivers can recognize in order to intervene and get help as early as possible.

What should we be looking for?

• A loved one is showing signs of an unhealthy relationship with their medication, such as:

– Frequently talking about medicine

– A fear of running out or not having enough medication

– Taking a defensive stance after you ask about the medication

– Taking more than the prescribed amount or taking more often than prescribed

– Hiding or hoarding pills

• A loved one’s behavior and mood is changing, even if it seems associated with “old age” or illness. This could be a sign of chemical dependency.

• A past history of drug/alcohol abuse can make a person more susceptible.

If you suspect a loved one is abusing prescription medication, take action and talk to someone about it. A good first step is to contact the doctor prescribing the medication. He or she can help verify and/or validate your concerns, allowing you to take further action, if necessary.
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An investigation by ABC 10 in Sacramento has unveiled that powerful tranquilizers are being over prescribed to nursing home residents who are diagnosed with dementia. In fact, studies by the Centers for Medicare and Medicaid Services in conjunction with the Government Accountability Office (GAO) show that 33% of elders in nursing homes, who are diagnosed with dementia are actually prescribed antipsychotic medication, in spite of the fact that the FDA has warned that certain types of these drugs can prove fatal to elders. Death is most often the result of heart failure/cardiac disorders.

All the same, the data from those studies shows that these powerful drugs are far too often prescribed when they are not warranted. This practice, known as chemical restraint, or over-drugging of elders in nursing homes in California is a form of abuse, and is illegal.
Chemical restraining of elders is most often done to sedate residents, but in worst cases has been utilized as a means of punishing and/or intentionally abusing elders.

Symptoms that an elder is being over-drugged, or prescribed an anti-psychotic inside a California nursing home include:

*Extreme lethargy, sleepiness, and/or confusion.

*Noticeable and extreme behavioral changes.

*Sudden unexplained changes in overall health.

Elder abuse in California is both a criminal and civil offense. Criminal elder abuse describes the willful infliction of physical or emotional suffering on an elder. Civil elder abuse includes any physical or financial abuse, neglect, or abandonment resulting in physical or mental harm.
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Elder abuse can take many forms including physical abuse, sexual abuse, financial abuse, neglect, and a form of abuse known as chemical restraint (over-drugging). Chemical restraint includes using powerful medications (including anti-psychotics) to sedate elders in nursing homes. In the worst cases, chemical restraint has been used as a means of punishing elder residents in nursing homes.

Also known as over-drugging, this practice is unfortunately all too common, though it is not always reported. However, chemically restraining elderly residents of nursing homes is absolutely illegal in California.

In particular, nursing homes have been accused in many instances of administering strong anti-psychotic medications to elderly residents who do not require them. In more than one instance, residents of nursing homes have died as the result of this form of elder abuse. Thankfully, legislators are beginning to take notice of the problem of over-drugging elders in nursing homes, and last year California nursing homes saw a reduction of unnecessary use of anti-psychotics by 8.5%. This is great news compared to 39 other states, but fell fall short of the goal of reducing the use of these drugs by 15%.

Elder abuse of any kind is a crime potentially punishable by prison time in California. The recent sentencing of the former Director of Nursing of Kern Valley Healthcare District’s nursing home to three years in prison for “convenience drugging” reminds us that elder abuse extends far beyond neglect, financial or obvious physical abuse.

Charged with chemically restraining patients under her care, while serving as Director of Nursing of Kern Valley Healthcare District’s nursing home, Gwen D. Hughes will spend the next three years in prison for drugging residents into submission using antipsychotic and anti-seizure medications. Ultimately, three patients of the facility died as a result of being over-drugged.

According to a press release from the California Attorney General’s office, “Hughes ordered the administration of psychotropic medications to 23 elderly residents of the skilled nursing facility not for therapeutic reasons, but instead to control and quiet them for the convenience of staff. The drugs were given to patients who were noisy, prone to wandering, who complained about conditions or were argumentative. The drugs hastened three patients’ deaths, according to the investigation, and all 23 suffered some form of adverse physical reaction as a result. Many of the patients were under care for Alzheimer’s or dementia.”

The charges in this case were brought against Hughes and three co-workers in 2009. Hughes was the final defendant to be sentenced and the only defendant sentenced to prison time for her role as the proverbial ringleader. Evidence indicated that Hughes directed the hospital’s director of pharmacy to write doctor’s orders for the unnecessary psychotropic medications.

According to Attorney General Kamala D. Harris “Elder abuse in skilled nursing facilities is a particularly heinous crime because vulnerable victims and their families have placed their trust in the facilities to provide quality care, preserve their dignity and enjoy a better quality of life. This defendant maliciously and dangerously drugged patients for her own personal convenience. This is clearly outrageous conduct that justifies a state prison sentence.”

According to a statement released by the California Advocates for Nursing Home Reform (CANHR), Patricia McGinnis, Executive Director of CANHR stated “three residents died as a result of being over drugged at Kern Valley Healthcare and many more suffered severely. Three years in prison is at least some retribution for their deaths, and hopefully Ms. Hughes’ sentence will be a warning to other facilities who think that drugs can substitute for adequate staffing.”

Elder abuse in California is both a criminal and civil offense. Criminal elder abuse describes the willful infliction of physical or emotional suffering on an elder. Civil elder abuse includes any physical or financial abuse, neglect or abandonment resulting in physical or mental harm.
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