Uncomfortably numb

Pam
Pam Frampton
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Commentary — A disturbing trend shows seniors, inmates often over-medicated

First in a two-part series

“Did you ever ask your aging parents how many prescriptions they are taking? The answer could surprise you.”  — Carolyn Rosenblatt in a blog post on Forbes.com

My father has often told me about the archaic conditions he witnessed when he worked at the Waterford Hospital more than 50 years ago as a psychiatric nurse’s assistant.

Very disturbed patients were often kept in small, stark rooms like prison cells, with a slot in the door for the food tray to be slid through.

Some would spend the night in utter agitation, ripping their only blanket into shreds, only to begin all over again the next day with a new bed covering.

Even today in mental hospitals, where treatments and attitudes have advanced greatly since the 1950s, isolation and physical restraints are still sometimes used.

In September 2011, CTV News reported that, according to the Canadian Institute for Health Information, one in four mentally ill patients hospitalized in Ontario  endured some form of restraint.

Of those, “about 20 per cent are held down or mechanically restrained, and another 20 per cent are temporarily put alone in a room,” the article noted.

But far too often, the restraint of choice is chemical.

In prisons, psychiatric institutions and nursing homes across North America and beyond, there is documented proof that powerful anti-psychotic drugs like Seroquel are being prescribed for purposes they were never intended for, such as behaviour control and mood modification.

I recently spoke to a family whose father was given Seroquel to combat dementia-related aggression, which rendered him practically catatonic for the last few days of his life.

Family members say because visiting hours did not start until the afternoon, they would find out after the fact that he had spent the whole day slumped in a chair, and when they put him to bed he would be stiffened in the sitting position. They are devastated that his last days ended that way.

In July 2012, the Salmon Arm Observer newspaper in British Columbia told the story of a woman who believes her father died in care as a result — at least in part — of having been prescribed Seroquel for his dementia symptoms.

During one visit, Dina Loeb was told by a care aide that “her dad had been ‘snowed’ because he had urinated in a corner.”

Loeb said she was told, “when they’re agitated, we give them more medication. Your dad peed in the corner so we snowed him.”

She said a nurse subsequently acknowledged both the term and the common practice.

On Monday, an exclusive report by The Canadian Press (CP) and CBC News discovered that “in August 2013, of 591 female federal inmates in five correctional institutions, 370 were being prescribed at least one psychotropic medication, drugs that impact mood and behaviour.”

Adam Miller of CP reported that, “Former prisoners and their advocates have been complaining for years about what they call the overmedication of inmates. They claim that quetiapine — an antipsychotic drug strictly recommended for the treatment of schizophrenia and bipolar disorder — is being prescribed to female prisoners as a sleeping aid.”

Quetiapine is dispensed under the brand name Seroquel. It is not meant to be used as a sleeping pill or as a means of quelling dementia symptoms.

 

Can be fatal

On Tuesday, a Toronto Star investigative team reported that “Ontario nursing homes are drugging helpless seniors at an alarming rate with powerful antipsychotic drugs, despite warnings that the medications can kill elderly patients suffering from dementia.”

One of those drugs is Seroquel.

In the United States, the National Institutes of Health has warned: “Studies have shown that older adults with dementia … who take antipsychotics such as quetiapine have an increased risk of death during treatment. Quetiapine is not approved by the Food and Drug Administration for the treatment of behavioral problems in older adults with dementia.”

BMJ, formerly the British Medical Journal, published the results of a 2005 study which showed “Quetiapine … is associated with accelerated cognitive decline” in people with Alzheimer’s disease.

Having heard from people in this province worried that their loved ones might be being medicated as a form of behavioural control, I wrote to the Department of Health in February to ask whether Seroquel is ever prescribed to dementia patients in public long-term care facilities. I also asked how many prescriptions for Seroquel for this purpose were issued in the past year.

The department replied that that level of detail is “not readily available.”

“All residents of long-term care facilities are under the care of a primary care physician with privileges in that facility,” a communications official wrote via email.

“During the assessment of care needs of residents, primary care physicians may prescribe medications to ease behavioral symptoms. In such cases, primary care physicians will consult with a psychiatrist or a physician with training in geriatric medicine to discuss appropriate medication options. …”

The department noted that of the 9,347 seniors who use the provincial foundation drug program — including government-subsidized residents in long-term care homes and personal care homes, and people on income support living at home — 1,058 were prescribed Seroquel in the past year.

“However,” the department noted, “we cannot determine if they are in a personal care home, long-term care facility or living at home, nor can we determine the reason for which the drug was prescribed.”

So, are those 1,058 people being given Seroquel for schizophrenia or bipolar disorder, or is it being used in some cases “to ease behavioural symptoms”?

A 2009 analysis by the Canadian Institute for Health Information of antipsychotic drug use among seniors suggests the latter.

The report notes: “Antipsychotics are used less frequently to treat schizophrenia and bipolar disorders in the elderly due to the lower prevalence of these disorders in this population. The majority of antipsychotic use in the elderly is to treat behavioural and psychological symptoms of dementia, including delusions, aggression and agitation.”

That’s despite the dire warnings from authorities against using drugs like Seroquel for this purpose.

If you don’t know which medications your elderly parents are taking, find out.

In other jurisdictions, investigations have revealed that some of the most vulnerable members of society are basically being warehoused and doped to the point of stupefaction; rendered docile and undemanding, isolated and immobilized in the iron grip of chemistry.

 

Pam Frampton is a columnist and

The Telegram’s associate managing editor.

Email pframpton@thetelegram.com.

Twitter: pam_frampton

Next week: an alternate approach

Organizations: Canadian Institute for Health Information, CTV News, Canadian Press British Medical Journal CBC News National Institutes of Health Food and Drug Administration Department of Health

Geographic location: Ontario, North America, British Columbia United States

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Recent comments

  • Derm English
    April 19, 2014 - 20:42

    On the ball are we? This has been the case for at least 15 years, probably longer. When I asked that my dad not be zombieized 15 years ago, I was told by the doctor, "Sure, that is your right, but then we have the right to not have him here, and ask that he leave!"

  • Alice
    April 19, 2014 - 11:54

    This is a well known issue with both with the homes that use this drug as a chemical restraint and a government that supports it through its drug programs for seniors. Why would a drug program cover such a limited use drug for such wide expanse of the population. BECAUSE it is cheap and because it reduces the number of care attendants required.

    • Craig
      April 20, 2014 - 12:23

      The answer to your question is actually that Seroquel is NOT a limited use drug. I have been on this particular drug for eight years and I neither suffer from Bi-polar or Schizophrenia. I have clinical depression and have had life long issues with sleep. This drug has been very effective in treating both. Seroquel normally puts me to sleep in about an hour. I get a normal full night's rest, it's not habit forming, It doesn't force my body to become dependent on it (I wouldn't be awake for days if I don't take it), nor does it make me feel even the slightest bit sluggish the next day as most conventional sleep aids would do. I take a dosage of 100mg. In comparison, someone with Bi-polar would take a minimum of four times that amount to treat their symptoms and a schizophrenic would receive, I'm told, eight to ten times that dosage to be effective. I can assure you this drug does not make me a zombie or less than human, and I lead a normal clear headed life. So, for Ms. Frampton to assert that all of these people are being irresponsibly treated with this drug and that it is necessarily causing more harm than good is perhaps a bit disingenuous and misleading. She doesn't even attempt to look at the fact that the drug is effectively utilized to treat other conditions and that dosage IS definitely a factor. Further more, her condemnation of restraining mental health patients lacks any elaboration on the context as to why this is often necessary. Unfortunately, it is an unavoidable reality when a very ill person is threatening to hurt / kill either themselves or the people around them. This is not the stuff of fiction. People who have had a psychotic break can and will do these things. If someone were going to throw a chair at you, wouldn't you want them to be restrained from doing so? If someone wanted to break the light bulbs to slash their wrists with the shards, wouldn't you also want to prevent them from doing so? I wouldn't go so far as to say that elder abuse is not a problem in this world. It is a serious and real problem. However, fear mongering by way of playing loose with the facts and omitting certain realities is just a poor way of going about making such a point. When your aim is to vilify the entire fields of mental and geriatric health with half truths and not fully researched information, you stand to put fear in the minds of those who may desperately need help. That fear may well become a road block to these people getting better or even surviving, for that matter. We say that everyone is entitled to their opinion, but when one's opinion is not fully thought out and it stands to directly cause someone harm, then at that point I have to respectfully disagree.