Advocating for your elderly loved one's quality of medical care may sooner or later become an issue for you when faced with circumstances that create the dilemma of whether neuroleptics are appropriate in the course of treatment. Some considerations you may wrestle with are:
1) Does a person have rights to live their life without chemical restraints?
2) Is it ethical for a doctor to prescribe medication to control undesirable behavior, and if so, when?
3) Who is the best person to decide what is "appropriate medication?"
4) Since, presumably the patient does not have the capacity to refuse or approve medications, can and should the doctor at the request of a nurse or institutional caregiver prescribe anti-psychotics?
5) What is the protocol for medicating an elderly person and do you have the right to refuse the medication on behalf of your loved one?
These are practical, ethical and moral questions that, ideally, you can think about long before the issue arrives at your doorstep.
An elderly person with dementia or Alzheimer's has plenty of challenges in making sense out of their unfamiliar surroundings. Anti-psychotics further contribute to the confusion.
Here is an all too familiar story: An elderly family member with an Alzheimer's disability was sent to hospital emergency room for a urinary tract infection. At the first sign of confusion the emergency room doctor ordered Haldol, a powerful anti-psychotic medication for him. This is typical, standard procedure in most hospitals. He became even more confused and fearful. He wanted to leave at which point the nurses tied him with physical restraints to the bed and gave him additional drugs. The restraints and the drugs caused so much confusion, he got delirium. This same man that could order off a menu the day before the hospital event, never recovered fully from the delirium. The resultant behavior became another reason to give him other anti-psychotics for 6 months (Seroquel, Depokate). Remember, this started with a UTI. Six months later the hospital psychiatrist said the anti-psychotics were the problem because his executive function was diminished...the confusion caused by the drugs pushed him over the edge to the point where no one could take care of him.
Here's another story: An elderly woman in a care home suffers a stroke that is unrecognized by the caregivers and they, without notifying the family, take her to the Doctor and complain about unusual behavior. The Doctor prescribes the anti-psychotic, Seroquel. Not only does the anti-psychotic cause major confusion for the stroke victim, but it suppresses the woman's cognitive abilities and keeps her from fully recovering from the stroke. The resultant behavior is chalked up by the doctor to "progressing dementia."
There are plenty of stories besides just these two. So what can you do and what are possible solutions? Hospitals could provide beds with higher railing to avoid worrisome falls. Families can try out-patient treatments for the elderly whenever possible. Sitters are available in hospitals when requested. Avoid anti-psychotics and protect the rights of the elderly at every opportunity. Have the important conversation with the staff and doctors about what is acceptable for your loved one and what is not.
Be educated about side effects and understand what treatments are available, which you want used and which you don't want used and possible consequences and signs of abuse. Stand firm in what you believe to be the best treatments for your loved one - and never be intimidated by health care professionals. Be kind but firm.
Try to focus on what is "possible" for your loved one, not just the disabilities. Work with the intention to maintain dignity and quality of life as much as possible.
Be well, Denise Williams, CLC
denisew@lifestylesols.com
