By Eleanor Pineau
Yesterday, CBC News released an article detailing the death of a man in 2013 that occurred in a nursing home. Allegations of resident-to-resident physical abuse were cited as possible contributing factors to this man’s death. After security footage was released, these allegations turned out to be true.
This case prompted further investigation into the rise of resident-to-resident physical abuse in nursing homes. In response, CBC News hired two statisticians to probe deeper. Unfortunately the outcome does no good for the population with dementia.
I was abhorred by the following statement: “They found that as antipsychotic usage went down, reports of resident-on-resident abuse went up.”
Without being able to analyze the methodology of their study, these results are absolutely useless and can lead the public down very dangerous alleyways. Anyone could conclude this outcome with very simple statistics.
This finding is not causative, meaning that the decline in antipsychotic use did NOT CAUSE an increase in resident-on-resident abuse. They could be related, but one does not cause the other. Therefore, increasing the use of antipsychotic drugs in people living with dementia will not reduce the incidents of resident-on-resident abuse.
To show you how ridiculous this finding is, here’s a famous example of a study that also had the same flaw: It was found that Switzerland has a very high breast cancer rate and they also have a very high consumption of fat. It was concluded that a high fat diet was causing this high rate of breast cancer. But this is not true. A high fat diet does not directly cause breast cancer. If it did, then many more Americans would have breast cancer than is currently present. The risk factors of breast cancer are quite numerous including age, genetics, early menstruation, low amounts of physical activity, being overweight or obese and more. With this last risk factor, consuming a diet high in fat may contribute to being overweight or obese. So in a roundabout way, a diet high in fat may increase the risk of breast cancer, but it does not cause breast cancer. More importantly, you also need other risk factors present like age and genetics to get breast cancer. A high fat diet alone is not going to cause breast cancer. This is the same conclusion we can draw about antipsychotic use and resident-on-resident abuse. A reduction in antipsychotic use has not caused an increase in resident-on-resident abuse, and there are many other factors at play contributing to the rise in abuse.
Let’s quickly look at why people living with dementia should generally not be prescribed antipsychotics.
(I say ‘generally’ because there are instances where the use of antipsychotics is appropriate such as when that person has both dementia and schizophrenia. But you must consult your psycho-geriatrician to ensure that these medications don’t cause serious side effects with other medications and co-morbid conditions.)
- Dementia is not a psychotic disorder.
- The use of antipsychotics to treat things like aggression is an “off-label” use that has not been studied for efficacy or safety.
- When you use an antipsychotic on a person living with dementia, you are restraining them – the same way as you would restrain someone by tying them down to a bed, except this time, you are using a drug.
- Antipsychotics used in people without a psychotic condition increases confusion, the risk of falls, and death. They cause tremors and involuntary movements.
- Antipsychotics used in people without a psychotic condition cause personality changes, increased fatigue, to the point where a person who used to be full of life starts to resemble a zombie. Trust me, it’s not a very nice sight.
Another part of this article that really upset me was the statement that one of the reasons behind increased abuse in nursing homes is the rise in the number of nursing home residents who have dementia. It is articles like these that perpetuate the “aggressive” stigma staining all people living with dementia. Without further explanation, this statement leads people to believe that people with dementia are aggressive, unpredictable people who should be restrained, whether physically or chemically.
People living with dementia get angry just like you and me. What happens when you are trying to tell someone you’re angry but they won’t listen? You might start to yell. But that doesn’t work either. Next you might throw the pillow or your phone. But that person still ignores you. Well by this time, your temper has boiled over and you might hit them…or want to. In this situation, there are a couple of differences between you and a person living with dementia:
- You are able to better communicate that you are upset and why. Someone living with dementia may have lost the ability to verbally communicate.
- When you are so angry that you want to throw or hit something/someone, you are able to restrain yourself and inhibit those desires. A person with dementia has a reduced ability to inhibit socially inappropriate behaviours. Remember, we were taught as children to use our words instead of our fists because that is what social norms dictate. But as a person loses those teachings/memories, they revert back to more natural processes – they hit.
Just like the relationship between antipsychotic use and the prevalence of resident-to-resident abuse, there are many other factors at play that are contributing to an increase in resident-to-resident abuse other than a rise in cases of dementia. Some other factors that are contributing to the rise in resident-on-resident abuse include: insufficient staffing ratios, poor dementia training of healthcare professionals, ineffective treatment of pain, overcrowding, and many more.
The humane treatment of dementia nor is dementia itself causes of increased resident-on-resident abuse. Dementia is not the problem. How we support people living with dementia is.
Please click the link to read the original article. “It’s a horror movie” – Nursing home security footage provides raw picture of resident violence problem
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