I think think the issue is a lot more complex than they're describing. Serious dementia can be quite unpleasant, and as with physical pain, it's not clear that going light on drugs is the ethical thing to do.
Similarly, withholding meds from people in their 80s because those meds might shorten their life some seems dubious.
This makes a sort of sense, but only if you know little about the drugs in question - antipsychotic drugs, formerly known as neuroleptics - which do not target nor act on any demonstrated pathology, lesion, or abnormality. What the drugs do do, as much in dementia as in psychosis, is "make it so [you] can't think", as Walter L. tells us. To the extent that anyone, with any diagnosis, is helped because of these compounds, it's because of their extreme tranquilizing effects on both the mind and visible behavior.
You're right that the ethics of the whole thing aren't clear. But a fair discussion of the ethics of cautiously using these drugs for dementia in willing participants - much less rampant, off-label uses in contexts for which there's no empirical evidence of their effectiveness (no FDA indication for any of these drugs for any dementia) - would include an honest conversation about the historical uses of prescribed psychotropics, and of political and economic power in the mental health professions and medicine more generally. Such a historical look would show that stories like this one are far from an abnormality, and that coercion, to greater or lesser degrees, is the norm. Some proportion of people taking these drugs (for any reason) undoubtedly do so of their own volition, and some of these may even derive a benefit from them. I have no objection to this. But vast numbers of people have no such luck, and are forced to take these drugs for some reason or another.
Many of these people are difficult: they're old and agitated and their dementia's getting worse, or perhaps they're yelling to themselves in the street, half-naked, rambling incoherently and looking fairly menacing, etc. What do the rest of us want with difficult people? We want'em out of our way (in a nursing home, say) and we want'em nice and calm. The drugs in this article do exactly that. No one with enough time in the mental health professions, or in geriatrics, is under any illusions about this.
"They want docile" is exactly right. So any discussion about the ethics involved here should also ask: "what are the ethics of coercing people to calm down with drugs?"
> So any discussion about the ethics involved here should also ask: "what are the ethics of coercing people to calm down with drugs?"
My mother currently has dementia and my father had it before he died.
The confusion and unhappiness these people suffer from due to their illness should not be ignored. If they're in a nursing home, its even worse. In many cases it's quite humane to numb them up. Especially if they don't have loved ones to help them. There is no cure, there is no getting better. There is only getting worse and certain death. And they instinctively know something is wrong.
My mother is currently on two anti-depressant/anti-anxiety meds to help, and its made things much much better for her. No more worrying and confusion over everything, no more phone calls crying. She just goes about doing normal things without being upset.
Atypical antipsychotics have a huge positive impact for lots of people. And not on a difficult vs calm spectrum, on a "completely disorganized and unable to function" vs "doing things they enjoy" spectrum.
I don't think it's fair to assume that just because the drugs make patients easier to deal with, that that is why they are prescribed. Even less so the idea that the medical staff is routinely violating their medical duties.
No doubt this does happen, and these cases should be investigated. But as with opiates, locking onto one part of the situation without considering the whole picture can lead to monstrous results.
You might underestimate the agitation and distress that comes with dementia and the pain of infirmity. Nursing homes are a tough, sad place a lot of them time. It probably is easier for caregivers, but don't assume malice.
ps - Sorry for misreading. I completely agree with you about nursing home workers in general, and I'm sorry about your father.
I don’t assume malice. My father has dementia. He is not even aggressive but it takes incredible effort and patience to deal with him. Nursing home workers are probably the most under appreciated profession. They are understaffed, underpaid and do incredibly difficult and draining work. To me they are heroes.
My wife has been helping care for a dementia patient who is a really nice guy and easy to live with. He just doesn't remember how to get to the cafeteria or do many activities of daily living.
Other dementia patients are nasty and might try to strangle a caregiver that they don't recognize.
Heroes as in someone a little child aspires to? They are not part of that police, firefighter, teacher, scientist, sports figure group. Astronaut is probably the biggest.
Nursing home workers do a job that is important, few want to do or could do. Most do it for pay. Most do not aspire to the job but end up there for practical reasons
Their job is harder than any of the other jobs you mentioned. Some people maybe do it for the money and others probably out of compassion. But in the end it doesn’t matter. It’s a very tough and thankless job.
That is, in part, because many if not most nursing homes are understaffed. In Indiana, they always knew when they were getting inspected and forced overtime on folks those couple of weeks. Why the past month's payroll records aren't checked more often for staffing levels I never know.
Nursing care is expensive. Very expensive. No one wants to pay for it, either because people didn't or couldn't save enough for it prior to needing it, or government can't get the will together to properly fund it (Medicaid/Medicare aside) with taxes. People still end up in homes, caregivers continue to be chronically underpaid, and there's some occasional public concern or outrage over it so society can feel better about the situation. "Thoughts and prayers" over meaningful elder care reform.
“Nursing care is expensive. Very expensive. No one wants to pay for it, ”
My estimate would be that you probably need around 1 person for 5 people or less to do the job some justice. Plus doctors and other personnel. This would be freakishly expensive.
"This report, authorized by the Chairman of the Virginia Senate Committee on Education and Health, studies the provisions of Senate Bill 1125 of the 2001 Session of the General Assembly. Senate Bill 1125 requires Virginia nursing homes to implement minimum nursing staff standards of 5.2 hours per resident day (hprd). For Certified Nursing Assistants (CNAs), the Bill requires minimum ratios of 1:5 residents (day), 1:5 (evening), and 1:10 (night) or a total of 4.0 hprd, and minimum licensed nurse-to-resident ratios of 1:15 (day), 1:20 (evening), and 1:30 (night) or a total of 1.2 hprd. These minimum standards exceed those of all other states as well as those recommended by advocacy and research organizations. The fiscal impact on the Medicaid program is estimated to be an additional $91.2 million from the general fund annually."
Yes, very expensive. However, less than 5% of people end up in a nursing home for a significant length of time (>1 year).
It would be nice if we could all live to a ripe age, enjoy many years of retirement maintaining mobility and a lucid mind and then suddenly die in sleep. Unfortunately, it doesn't always turn out that way. Hopefully by the time many of us get to be that age, euthanasia will be a mainstream option.
I recently visited a nursing home and everyone had a TV in their room.
Instead of being calming, they were tuned to broadcast channels where the news channels announced the-world-is-going-to-pieces between loud advertisements.
My grandfather likes National Geographic, and was always into science programming. National Geographic and MSNBC are his channels. The last time he was in rehab, their cable subscription didn't have MSNBC, but it did have National Geographic, so I got to see a lot of it sitting with him...lo and behold, National Geographic, the channel associated with those amazing magazines I'd stack and read as a kid, now runs these weird one-sided fascist, xenophobic prison documentaries all. day. long. It's sick stuff.
I'm a millennial and I like to play video games on my spare time; usually puzzle, adventure, or platform ones. One thing I hope to imagine is that if/when I'm in an elderly care setting is if I'll be able to enjoy them in some ways like when I was a child.
I'm curious if video games being a more common (plus potentially social) activity will be more common in retirement home-like settings.
I may be cynical, but I don't see hospitals and nursing homes providing systems or connectivity for something like that in the future. If they do, it will be a service priced like airline wifi.
Maybe by that time we'll have personal VR setups with internet connections that route around health-care-system influence.
Agreed. It's extremely difficult to gauge "too much" or not enough, especially when the patient is less than reliable.
I watched my mother in law go through it for many years and I would find it hard to say anyone gave someone "too much" when in reality they had no way of knowing what too much or not enough was without simple trial and error.
Similarly, withholding meds from people in their 80s because those meds might shorten their life some seems dubious.