Another COVID risk: overuse of drugs on seniors
Psychotropics on increase in care homes , Kim Samuel and Jane Buchanan write.
COVID-19 has had a devastating impact on older people in care homes across Canada. Yet serious concerns remain for a different kind of epidemic that may continue throughout the rollout of vaccines: loneliness and isolation, combined with some homes' dangerous increase in the use of psychotropic medications.
Older people and their loved ones are sharing devastating stories of separation and loss of connection during the pandemic. One woman in Alberta described to the CBC her mother's distress during the visitor bans: “She was very confused. She thought that my dad had quit coming to see her because either she was in trouble or he had died.”
Scientific research has shown the links between social isolation and loneliness and the deterioration in physical health, increased memory loss and mental health conditions such as anxiety and depression in older people. Social isolation and loneliness can contribute to the development of dementia, including Alzheimer's, and accelerate its effects. The absence of human touch, described by one psychologist as “the fundamental language of connection,” also deeply affects physical and emotional well-being.
The response of some care homes to changes in older people's emotional and cognitive states is equally concerning and likely to exacerbate the detrimental impacts of social isolation.
A recent scientific study found a dramatic increase in prescribing psychotropic medications to older people in Ontario's care homes, including antipsychotics, antidepressants, and benzodiazepines such as Valium or Klonopin.
Clinical studies in the United States have found numerous serious side-effects of antipsychotics, including nervous system problems, cognitive decline, strokes and increased risk of death in older people with dementia. Benzodiazepine use in older people is associated with increased falls, pneumonia and death.
The Ontario study linked the increase to “the effects of prolonged social isolation during lockdowns,” including restrictions on visits from loved ones and suspension of social activities and group dining. A November study in the United Kingdom similarly found increased prescribing of antipsychotics during the pandemic to people with dementia, concluding the increase was “probably in response to worsened agitation and psychosis” associated with COVID-19 restrictions.
By prescribing these medications in this situation, care homes may be adding serious risks to people already among those most in danger of complications and death from the virus itself.
Human Rights Watch has documented improper medication use in care homes well before the COVID -19 pandemic. Research from 2017-18 in the U.S. and in 2018-19 in Australia found that psychotropic medications were overused in nursing homes. The medication was typically used to make residents more compliant to the rules and regimen of the home.
Instead of turning to medication to calm a distressed person, staff should be using positive interventions such as exercise, music and redirection to a different activity. Medication for the purposes of controlling behaviour without a therapeutic purpose is known as “chemical restraint” and violates older people's rights, dignity and bodily integrity.
The inappropriate use of medications is closely linked to insufficient staffing, which has been made worse by the pandemic. Care facilities in Canada can have staffing levels well below what experts consider the minimum needed to provide appropriate care.
As national and provincial governments carry out their vaccination efforts, they should not ignore other dangers to older people in nursing homes related to COVID-19 restrictions, such as chemical restraint. It will be essential to prevent severe and potentially irreversible consequences for older people that result from lack of human contact.
Ultimately, society needs to develop a more humane, compassionate and effective way to support and care for our elders than the present form most homes take. In the interim, the government should ensure strong reporting requirements and oversight of care homes' prescribing practices as well as accountability for misuse of medication to deter such practices. Sensible visitor policies are also needed to nourish the irreplaceable presence of human connection for residents, their families and staff.