I’ve recently come across an article from the Manchester Guardian on this topic. The article is by Sarah Boseley, and is a review of a UK study in the Journal of the American Geriatric Society written by Aideen Maguire, C. Hughes, Chris Cardwell, and Dermot O’Reilly.
The researchers examined the Northern Ireland prescribing database and discovered that when people were admitted to nursing homes, the rate at which they were prescribed anti-psychotic drugs increased from 1.1% to 20.3%!
I am using the term anti-psychotic here because that’s the term used in the article. Personally, I prefer the older term, major tranquilizers, because that’s what they are. They slow people down and make them docile and easily “managed.”
This article reminds me of a client I worked with back in the 90’s. Let’s call him Jack.
It was in a nursing home, and he was a recent admission. He was 84 years old. He seemed to be depressed and to have lost interest in life. He showed little interest in food, and was losing weight. There was real concern that he might die. The nursing staff referred him to me. I found him very withdrawn. He answered my questions with monosyllables, if at all. He had severe tardive dyskinesia, and it was clear that he had taken a lot of major tranquilizers for an extended period.
I reviewed his record, and found, to my amazement, that he was still being prescribed a major tranquilizer – at a fairly hefty dose. Usually when you see this in a nursing home, it is because the individual has been violent or destructive, and the drugs are being used to keep him docile. This is not generally admitted, but it’s true.
Anyway, I asked the nursing director why Jack was taking these drugs. Her reply was that he had been taking them when he was transferred in from another nursing home, and they had just continued the prescription. I phoned the previous nursing home, and they told me that Jack had been taking the drugs on admission to their facility two years earlier, and they just continued it. They offered to find out what the earlier history had been, but called me back later to say that they hadn’t been able to learn anything new.
So I went back to the director of the nursing home, and asked if Jack had been violent. No. Destructive? No. Difficult to manage? No. So I suggested that she and her team sit down with the prescribing physician and give serious consideration to tapering this drug, while at the same time watching for any signs of restlessness, agitation, aggressiveness, etc…
Two weeks later I met Jack in the hall. “Good morning, Phil,” he said. I almost fell over. Prior to this, the best I had heard from him was “Uh,” or “Yeh.” Anyway, we had a nice talk, and I found that he had had a full and interesting life. He had worked on coastal vessels in the Gulf, and had been a keen amateur photographer. He spoke knowledgeably about these matters. He also began to socialize actively with other residents and was eating his meals.
In one of our chats I had mentioned that our older daughter was teaching in Africa with the Peace Corps, and would be coming home in about six months. Some time after this I changed jobs, and I didn’t see Jack until I paid a social call to the home about a year later. I encountered Jack in the hall. He shook my hand. “Hi, Phil,” he said. “Did your daughter get back from Africa OK?” This was the guy who had been so tranquilized that he could scarcely walk, and had lost interest in life.
Of course this was in the 90’s. Perhaps those sorts of things don’t happen any more.