Uncomfortably numb

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

Pam Frampton pframpton@thetelegram.com
Published on April 19, 2014

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