Articles Posted in Prescription Medication Misuse

Society erroneously assumes prescription medication is only abused by the younger generations. Studies show, however, prescription drug abuse plagues men and women of all ages, including the elderly.

According to an article in the National Institute on Drug Abuse, “Persons aged 65 years and older comprise only 13 percent of the population, yet account for more than one-third of total outpatient spending on prescription medications in the United States.” The article goes on to suggest that there are several ways in which an elderly person can abuse prescribed medication, such as:

• Abusing medication prescribed to a friend or family member in order to save money.
• Alternatively, the elder person has his/her medication taken by a friend or family member and running out of his/her supply early.
• Taking the incorrect dosage or type of medication to do mental decline.

Awareness is everyone’s responsibility, so be vigilant. There are cues that family, friends, and caregivers can recognize in order to intervene and get help as early as possible.

What should we be looking for?

• A loved one is showing signs of an unhealthy relationship with their medication, such as:

– Frequently talking about medicine

– A fear of running out or not having enough medication

– Taking a defensive stance after you ask about the medication

– Taking more than the prescribed amount or taking more often than prescribed

– Hiding or hoarding pills

• A loved one’s behavior and mood is changing, even if it seems associated with “old age” or illness. This could be a sign of chemical dependency.

• A past history of drug/alcohol abuse can make a person more susceptible.

If you suspect a loved one is abusing prescription medication, take action and talk to someone about it. A good first step is to contact the doctor prescribing the medication. He or she can help verify and/or validate your concerns, allowing you to take further action, if necessary.
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An investigation by ABC 10 in Sacramento has unveiled that powerful tranquilizers are being over prescribed to nursing home residents who are diagnosed with dementia. In fact, studies by the Centers for Medicare and Medicaid Services in conjunction with the Government Accountability Office (GAO) show that 33% of elders in nursing homes, who are diagnosed with dementia are actually prescribed antipsychotic medication, in spite of the fact that the FDA has warned that certain types of these drugs can prove fatal to elders. Death is most often the result of heart failure/cardiac disorders.

All the same, the data from those studies shows that these powerful drugs are far too often prescribed when they are not warranted. This practice, known as chemical restraint, or over-drugging of elders in nursing homes in California is a form of abuse, and is illegal.
Chemical restraining of elders is most often done to sedate residents, but in worst cases has been utilized as a means of punishing and/or intentionally abusing elders.

Symptoms that an elder is being over-drugged, or prescribed an anti-psychotic inside a California nursing home include:

*Extreme lethargy, sleepiness, and/or confusion.

*Noticeable and extreme behavioral changes.

*Sudden unexplained changes in overall health.

Elder abuse in California is both a criminal and civil offense. Criminal elder abuse describes the willful infliction of physical or emotional suffering on an elder. Civil elder abuse includes any physical or financial abuse, neglect, or abandonment resulting in physical or mental harm.
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According to the Centers for Medicare & Medicaid’s Open Payments Website:

“Sometimes, doctors and hospitals have financial relationships with health care manufacturing companies. These relationships can include money for research activities, gifts, speaking fees, meals, or travel. The Affordable Care Act requires CMS to collect information from applicable manufacturers and group purchasing organizations (GPOs) in order to report information about their financial relationships with physicians and hospitals. Open Payments is the federally run program that collects the information about these financial relationships and makes it available to you.”

In other words, if you’ve ever wondered whether or not a physician caring for your loved elder is the recipient of payments from a specific type of medical device, or a specific medication, you can now research that information online through the Open Payment website.

In addition to the Open Payments website, ProPublica, a non-profit newsroom has created Dollars for Docs (which incidentally shows that 3 of the top 20 highest paid physicians are based in San Diego.)

Consumer advocates who fought for such public disclosures had argued that physicians’ relationships with various drug companies affected their prescribing practices. If you’re interested to find out what payments your physician or a physician caring for a loved elder in California has received from various companies, you may search for this data by clicking here.
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A new study has been released which concludes that “Nearly one in five Medicare patients are victims of medical injuries that often aren’t related to their underlying disease or condition,” according to research conducted by the Gerontology Program at Towson University in Maryland.

The medical injuries span the spectrum from patients being given the wrong medication, to allergic reactions to medications, to even receiving treatment that further complicated existing medical problems.

For the study, data was collected from more than 12,500 Medicare patients with an average age of 76 who made claims between 1998 and 2005. Men, elders, and low income patients were found to have greatest risk for a medical injury. 19% of those included in the study experienced at least one adverse medical event, with 62% taking place during outpatient care. Disturbingly, but not surprisingly, the death rate among those who had experienced a medical injury was nearly twice as high when compared to those who hadn’t had one. While there is no failsafe way to prevent a medical injury, you can do your best to safeguard against this by reviewing tips provided by the National Patient Safety Foundation.

Elder abuse in any form is strictly prohibited by California law. In addition to physical abuse and neglect, medication errors in nursing homes are considered a form of elder abuse. Unfortunately, due to insufficient staffing in many long term nursing facilities, errors in the type and amount of medications administered to residents occur with alarming frequency. While in many cases there may be no detrimental side effects to an elder who is given the incorrect medication, or the wrong dosage; in many other cases, the error can prove fatal.

For example, if two patients’ medications are mixed up, and incorrectly administered, the outcome can be disastrous. A diabetic who is mistakenly given a fellow patients’ heart medication may not under normal circumstances have a negative reaction. However, if that heart medication happens interacts with other medications she is taking, or causes side effects that the patient can’t sustain; the mistake can result in death.

Other medications must be taken consistently in order for them to be effective. Therefore, missing a dose of the proper medication can have devastating consequences on the elder who has missed their dosage. Other medication errors that may occur in nursing homes include:

Elder abuse can take many forms including physical abuse, sexual abuse, financial abuse, neglect, and a form of abuse known as chemical restraint (over-drugging). Chemical restraint includes using powerful medications (including anti-psychotics) to sedate elders in nursing homes. In the worst cases, chemical restraint has been used as a means of punishing elder residents in nursing homes.

Also known as over-drugging, this practice is unfortunately all too common, though it is not always reported. However, chemically restraining elderly residents of nursing homes is absolutely illegal in California.

In particular, nursing homes have been accused in many instances of administering strong anti-psychotic medications to elderly residents who do not require them. In more than one instance, residents of nursing homes have died as the result of this form of elder abuse. Thankfully, legislators are beginning to take notice of the problem of over-drugging elders in nursing homes, and last year California nursing homes saw a reduction of unnecessary use of anti-psychotics by 8.5%. This is great news compared to 39 other states, but fell fall short of the goal of reducing the use of these drugs by 15%.

The use of physical and chemical restraints in California nursing homes is sometimes a necessary way of protecting patients from injuring themselves and others. When used excessively and, more importantly, without consent, the practice becomes outright abusive. Often this method is used not simply to protect the patient, but rather to make a staff member’s job easier. Overuse of restraints is exacerbated by the growing number of understaffed nursing facilities.

Physical restraints are used to keep patients from wandering around the facility, a potential hazard for the patient and others. A nursing home is required by law to have the resident’s consent before using a physical restraint. Symptoms of physical restraints include sores or bruising on the arms and legs, usually on the ankles and wrists.

Chemical restraints involve the administering of powerful psychotropic drugs to sedate and confine the patient by taking away his or her cognitive abilities. These drugs are not permitted under any circumstances unless the nursing care facility outlines a legitimate medical reason for their use and further provides the frequency and dosage. Because most people are not familiar with the side effects of psychotropic drugs, it can be more difficult to identify chemical restraints than physical restraints.

Psychotropic drugs are administered to nearly 60% of all California nursing home patients, a 30% increase since 2000, according to a report by California Advocates for Nursing Home Reform. A May 2011 study by the Office of Inspector General in the U.S. Department of Health and Human Services found that 305,000, or 14%, of nursing home patients had Medicare claims for atypical antipsychotic drugs. The study was requested by a member of Congress concerned by the number of drugs being prescribed unnecessarily and the cost to taxpayers. The study also determined that 22% of the atypical antipsychotic drugs associated with the claims were not administered in compliance with standards established by the Centers for Medicare and Medicaid Services.

Some common psychoactive drugs are:

  • Anti-Psychotics: These drugs are prescribed for psychosis, schizophrenia, and bipolar disorder. Nursing homes often prescribe anti-psychotics to dementia patients despite the FDA’s strong warnings that they can be fatal to residents with dementia. Haldol, Seroquel, and Zyprexa are common antipsychotics.
  • Anti-Depressants: Common brands are Prozac and Zoloft. Nursing homes have been known to over-prescribe these medications. They can have dangerous side effects such as impaired motor skills, which increase the risk of a patient falling while under a nursing home care.
  • Anti-Anxiety drugs: These drugs also tend to be over-prescribed, and lead to impaired motor skills. Ativan and Valium are popular anti anxiety drugs.
  • Sedatives/hypnotics: Restoril and halcyon are brands commonly administered to patients.

These drugs can be helpful to your loved one’s condition, but it is important that you thoroughly research any prescribed medication and thoroughly interview the prescribing doctor as to why the drug is being prescribed and what its potential side effects are.

If a doctor recommends psychoactive drugs for your loved one, a few questions you will want to ask are:

  • What is the medical condition that necessitates the use of this psychoactive drug?
  • What is the frequency with which the drug will be used?
  • Over what period of time will the drug be used?
  • What are the possible side-effects?
  • Are there any reasonable alternative treatments?
  • What are the interactions with other drugs being used?

Signs of possible psychotropic drug use are: fatigue, impaired motor abilities, unexplained changes in weight, mood swings, deterioration in mental skills, and hallucinations, among others.

If you see these symptoms, and have not given consent to the use of psychoactive drugs, you should consider making inquiries to your doctor and nursing home staff. You or your loved one can refuse medical treatment, or revoke prior consent to any medical treatment. It is important to note that nursing homes are forbidden by law from threatening to evict patients for refusing chemical or physical restraints.
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With the aging of America, more and more older people will be living in nursing homes than ever before. According to available data, there were 39.6 million people in 2009 who were 65 years of age or older. That represented nearly one out of every eight Americans or almost 13% of the U.S. population. Estimates are that there will be roughly 72 million of these older Americans by 2030, causing concerns about the type and extent of prescription medications that are administered to nursing home residents.

Naturally, as we age it is necessary to take various medicines for heart conditions, high blood pressure, high cholesterol levels, diabetes, Parkinson’s and Alzheimer’s, among other things. Because of this most people 75 years of age or more take over 11 different prescription medications during any given period of a year, according to the American Association of Retired Persons (AARP). This requires a committed nursing home staff to see that medications are administered timely and properly.

Problems are encountered when undertrained and undersupervised staff give the wrong medication, an incorrect dosage or overmedicate their residents, leading to often catastrophic results. An unintentional but common error is the mixing up one patient’s medication for another’s during a hectic shift. These mistakes can result in serious drug interactions and even death. Another medication issue is the consistency with which it is administered. Many prescription medications require a consistent, rather than sporadic, dosage, in order to be effective and safe for the patient. Finally, there is an overall tendency in nursing homes across the country to overmedicate those who call these facilities home. Sometimes it is caused unintentionally by undertrained and underqualified staff members, and unfortunately sometimes it is intentional in order to calm and restrain a disoriented or combative resident. The use of prescription medication in the form of anti-psychotic drugs to calm or restrain the elderly can be illegal, but studies have shown that roughly 25% of all nursing home patients are given them. Unfortunately, the Food and Drug Administration (FDA) has reported that more than 15,000 nursing home patients die on an annual basis due to the unnecessary administration of these anti-psychotic medications. For others, the administration of these medications serves to diminish the quality of their life as they remain in a drug induced daze.
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The Department of Health and Human Services recently released a report revealing the excessive amount of “potentially lethal” antipsychotic drugs that nursing homes are dispensing to their residents. Aside from being a huge waste of taxpayer money (Medicare paid and estimated $116 million in unnecessary drugs, during a six-month period in 2007), it presents a dangerous health risk to our elderly population – particularly those who suffer from dementia.

Psychoactive drugs, also referred to as antipsychotic or psychotropic drugs, contain powerful chemicals that affect the brain and have dangerous side effects. These drugs essentially sedate the individual, which directly affects the individual’s personality, behavior and mood. Psychoactive drugs typically fall into four major classes, including: (1) antipsychotics such as Zyprexa and Haldol; (2) anti-anxiety drugs such as Ativan and Valium; (3) anti-depressants such as Prozac and Zoloft; and (4) sedative/hypnotics such as Halcion and Restoril. They are particularly appealing to the nursing home industry because they can serve as a substitute for the individualized care the person truly requires.

Elderly patients with dementia are particularly vulnerable to dangerous side effects, including death. Nevertheless, many nursing home residents with dementia continue to receive psychotropic drugs that are not designed or approved for their condition. According to California Advocates for Nursing Home Reform, it is presently estimated that nearly 60% of California nursing home residents are given psychoactive drugs. The problem has become so critical that the U.S. Food and Drug Administration (FDA) issued a “black box warning” that antipsychotic drugs can cause individuals with dementia to die.

As with any approved drug, its use is not always harmful and the benefits can outweigh the risk. That said, if your loved one is presently taking these drugs, or if their use is being proposed, you have the right to better understand the risks and to decline the drug if you choose. Psychoactive drugs cannot be prescribed without first obtaining informed consent. In California, the key informed consent regulations are found within Title 22 of the California Code of Regulations, sections 72528 and 72527(a)(4-5). Essentially, the health care provider must explain any proposed treatment. This discussion should include the benefits versus risks of the proposed treatment as well as the reason for its use and reasonable alternatives. Furthermore, the resident or legal representative must agree to the treatment. Giving these drugs without first obtaining informed consent is a form of elder abuse and neglect and a direct violation of patient’s rights.
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