13 ms·

Nursing Homes in the US Overmedicate People with Dementia (2018)

154 points by apsec112 7y ago

notadoc 7y ago
Compared to other nations, is the US overmedicated in general?
- Ididntdothis 7y ago
  I would say yes. I am in my 50s and it seems pretty unusual for people of my age not to have a long list of prescriptions they take. But other countries seem to be catching up.
- TallGuyShort 7y ago
  Don't know how it compares to other countries, but the US is definitely overmedicated in general. Not really my place, since at least with prescriptions they are being distributed by people who are by definition more qualified than me, but it's widely known that doctors will often prescribe antibiotics "just in case", even though tests for specific bacteria have all come back negative, and the use in livestock adds to that. The opioid epidemic is another clear sign that it's being prescribed more than is warranted. Far more subjective and anecdotal, but the number of people I know who take prescriptions for anxiety or other ongoing mental health concerns but who have never tried therapy is scary. Treating with drugs is clearly solution #1 for a lot of our culture.
  - Broken_Hippo 7y ago
    Therapy is a complicated beast. Not everyone can afford it (generic prozac is fairly inexpensive per month, a therapist is usually more than $20 per month). Even if the insurance is good, not everyone can get off work to go - which is a real issue if you work "doctor hours". And to make it all worse, so many therapists have a waiting list and patients are queued depending on need. And some folks need the drugs just to talk to someone! So yeah, drugs is often the go-to. A family doctor is a lot more available than a therapist.
    - TallGuyShort 7y ago
      Fair enough, but I live in a very wealthy area and most of the examples I'm thinking of are stay-at-home moms whose kids are now old enough to be in school most of the day. But they're still at anti-depressants like they're poisoned and it's the antidote. Not saying everyone should be seeing a therapist, these aren't the only 2 possible solutions to whatever they're suffering, but it looks to me like overmedication is for sure happening in a lot of cases.
      - cookiecaper 7y ago
        Once you pop, you can't stop. Washing out anti-depressants and allowing your body to return to a natural homeostasis is frequently a massive ordeal entailing physical fatigue, wild mood swings, serious hopelessness and despair, among other things. Adults can be quite dangerous to themselves and others during that process and it's important to have a patient and disciplined caretaker around to babysit for the duration of the weeks-long washout. Most people are not apprised of this when they start a medication -- they're just naively following doctor's orders. Consider that psychiatry is a racket where the conventional understanding is that any psych willing to mess with insurance companies is a hack, that every cash-only doc within 50 miles of a significant population has a 3-month waiting list and is generally choosy about their patient base anyway, and that family practitioners aren't willing to do anything slightly unconventional because the DEA will start breathing down their necks, and we have quite the mess on our hands. I'd suggest that you don't judge those SAHMs too harshly. It's a tough gig on its own, and throwing in "risk becoming totally non-functional" is usually not something that people can just pencil into their schedule.
    - nxc18 7y ago
      Yeah, I've tried to get a therapist here in SoCal and it is an absolute nightmare. Its one of those things where clearly I don't _need_ it, but I'd probably be a lot healthier and happier with it. But even thought I have good insurance and could definitely afford it, there just isn't availability at all. I've called around and no one is taking new patients. Saying 'therapy not drugs' is all fine and dandy until you consider that for probably 99% of people therapy just isn't an option and may never be.
- fzeroracer 7y ago
  Considering the amount of people that end up with medical issues because they can't afford basic medication, I'd say no. We're overmedicated in opiates because of the corrupt drug industry and corporations pushing pills for profit (see: the various articles and stories detailing the rampant corruption behind Purdue) and likely undermedicated in everything else.
- deleted 7y ago
  [deleted]
- fian 7y ago
  Australia recently had a Royal Commission into the Aged Care sector: https://agedcare.royalcommission.gov.au/Pages/default.aspx https://agedcare.royalcommission.gov.au/Pages/default.aspx One of the 3 major issues identified in the interim report is: to respond to the significant over-reliance on chemical restraint in aged care,including through the seventh Community Pharmacy Agreement
throwaway5752 7y ago
Make a living will and think through a DNR, so that you are not kept alive against your wishes for a care facility's income stream (or even in the case of well meaning caregivers) against your quality of life interests. I'm serious, by they way. Almost everyone on this forum (over the age of 18 in the US) should consider getting a relatively inexpensive living will drawn up with advanced medical directives.
- zrail 7y ago
  Living will is fine and good and everyone should have one. The problem is that dementia, by itself, is not a direct cause of death. You can live for years with severe dementia but be otherwise completely healthy. Two members of my family lived out their last years like that. My wife and I are moving to a state that allows assisted suicide after our kids are out of the house. Neither of us want to live like that or be remembered like that.
  - yulaow 7y ago
    Here in europe, for what I know, there is a serious problem for getting assisted suicide (in the states that legalized it) for something like dementia because when you have still few effects related to it they can't accept to eutanize you because you are not in a quality of life threating condition, and once the sympthomes are more brutal you cannot get eutanized either because you are no more legally considered capable of making conscious decisions and you must be capable of it _at the moment_ of the procedure, it's not valid to give the authorization before.
    - m0xte 7y ago
      Also if you do manage to commit suicide no one pays out on life insurance or pension. Best option I think is to start with nothing and end with nothing. The above problem is void then. That fortunate bit in the middle needs to be distributed to your children then if they need it.
      - lotsofpulp 7y ago
downerending 7y ago
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.
- Ididntdothis 7y ago
  I think it’s just easier for the people working there if patients are kept calm with medication.
  - Broken_Hippo 7y ago
    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.
    - toomuchtodo 7y ago
      The system is built to be this way. 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.
      - Ididntdothis 7y ago
        “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.
omgwtfbyobbq 7y ago
This is unfortunately my experience in any custodial care setting. Providers (Hospitals, SNFs, Board & Cares, Day Programs, etc...) will use whatever they can get away with prescribing that has a sedative effect, not just antipsychotic drugs. I imagine a significant number of people diagnosed with dementia likely do not have it. The providers just want people to be docile and lie in bed. Having to monitor and manage people who may get up at odd hours and act in ways we aren't used to requires a lot of other people, which gets expensive. The worst part is that the combination of over medication and lack of suitable care can lead to someone exhibiting symptoms similar to dementia even if they don't have it. To be fair, funding likely isn't sufficient for many providers to do a sufficient job monitoring and working with their patients, but that's a separate conversation.
- munificent 7y ago
  > I imagine a significant number of people diagnosed with dementia likely do not have it. I don't think it's as dire as you imagine. People don't just randomly drive themselves to nursing homes for no reason. Like you and I, few who are capable and willing to live independently would want to be in one. By the time you end up in a nursing home, the odds are good that you require significant care and are unable to function independently. If that's true and you're in a nursing home and not a hospital or hospice, it's probably because the thing incapacitating you is mental — dementia. However, if you do have dementia and end up in a nursing home... it sucks. Our culture and medical systems just aren't equipped to compassionately take care of fragile, dying people, who are confused, have trouble eating, shit themselves, etc. Caring for someone with dementia is brutal, heartbreaking work. Most people wouldn't want that job, and there's not enough money to pay well and compensate, so you get short-staffed or unhappy caregivers.
  - robryk 7y ago
    > If that's true and you're in a nursing home and not a hospital or hospice, it's probably because the thing incapacitating you is mental — dementia. You can have musculoskeletal issues that prevent you from performing everyday activities. You might also have neurological issues that don't affect thinking or speech (e.g. as a result of stroke). I'm unsure if vision problems acquired at old age can confine one to a nursing home: it's harder to learn to compensate (e.g. because you have worse medium-term memory and poorer senses other than sight).
batt4good 7y ago
Personally, if I ever become a victim of alzheimers, especially if it's to the degree of a family member of mine (all mirrors had to be removed from her home since she could no longer recognize herself and was startled by her own reflection) I would sure hope I was medicated out of my mind or sedated. I plan to have my will reflect that I had no intent of treatment for this kind of disease, hopefully willful euthanasia is legalized in the U.S. soon. If I was diagnosed with early onset forms of dementia (prior to age 50) I would certainly book a hotel room and blow my brains out. I've seen the horrors of this disease and have no intent to "fight" it.
omgitstom 7y ago
My dad passed away with dementia in 2019, spent a lot of time in nursing homes and also making decisions about the care of my father. I actually got to see this first hand with his caregivers in his facility. The requests to put him on different drugs required me to do a lot of research, validation and getting out of pocket advice from a medical professional that wasn't associated with the care facilities. As someone that has gone through this, there is a fine line to walk between doctors operating under their Hippocratic oath, caregivers, and patient wishes. My dad was prescribed meds that weren't helping his quality of life and had really bad side effects mentally and physically through the the mid-stages of dementia.
mirimir 7y ago
It's the same deal for troublesome kids. For the old folks, why not morphine or heroin? That, I've heard, is at least pleasant. As long as the supply is assured, anyway. Anti-psychotics aren't so much fun. And if that seems outrageous, please say why.
- mayank 7y ago
  How about dignity and care instead?
  - mirimir 7y ago
    That should go without saying, as I see it. But the problem is that people with dementia can hurt themselves and each other.
  - glangdale 7y ago
    Because people can't afford dignity and care, for the most part? It sounds good, but if you've ever cared for a severely demented person who can no longer safely walk, you will have to make the choice between (a) strapping someone to a bed or (b) paying for 24/7 care (or, to some pro-rated amount, giving up your own time) to ensure that they don't get up, fall, and break something.
    - mirimir 7y ago
      I do agree. I've been there, with an aged relative who lived with us. And my wife and I are headed there, with no kids. Me, I will die before going to a nursing home. And neither my wife nor I have life insurance, so suicide isn't problematic.
- cookiecaper 7y ago
  We're in a huge pickle in general because every simple, effective drug gets blacklisted pretty quickly, because people realize there's a simple, effective option for treatment that doesn't make them dependent on our horrifically broken medical system and start buying it without funneling through the racket. This upsets the racketeers and they work to clamp down on it. In the rare case where a simple, effective drug gets into medical practice, it magically ends up becoming "not recommended" about 20 years after it hits the market when the pharmaceutical company's patent runs out. MAOIs work much better for depression than SSRIs, for example, yet the clock runs down, a few widely-publicized cases of serotonin syndrome caused by careless ER doctors hit the press, and suddenly anyone prescribing those drugs comes under scrutiny, and we all need to switch to the newly-patented option.
Fede_V 7y ago
A nice compliment to that article, via Dylan Matthews of Vox News: https://drive.google.com/file/d/1d6vYu_uN9keb9iiT2R5UJihA_61K0Fce/view https://drive.google.com/file/d/1d6vYu_uN9keb9iiT2R5UJihA_61... Short version: paying CNA more increases lifespan and quality of life for people in retirement homes because they are more motivated and you can hire better staff.
catalogia 7y ago
After witnessing family members with dementia, I've decided that unless a true cure is developed, the only 'treatment' I ever want should I get dementia is to be swiftly euthanized. I just hope that by the time that may happen, I don't have to travel far to find a way to get that done legally.
- patall 7y ago
  Most people think similar when that is still far away. However the closer you get, the more likely you are going to think: 'Nah, its not that bad yet, lets wait another 5 years, lets wait another 2 years, lets wait another 6 months' and so on. The will to live seems to be much stronger for short term decisions. (It is similar probably for other things like sports, living on your own etc. When I am older I do not think I will want an SUV for convenience but who knows how I will think then)
Gatsky 7y ago
It is a matter of resources. Young children or adults with severe behavioural problems are managed without antipsychotics and sedatives, but it takes a dedicated and skilled care team and a highly functional family. Even then, the drugs still often get used. Behavioural problems in dementia are very hard. Male patients in particular can be quite strong and mobile. They can easily hurt staff or other residents. They are also a risk to themselves. The coroner in my state published two cases of patients with dementia that highlight this: one swallowed the napkin on his dinner tray and choked, another got put of the facility and died trying to climb a fence. The reality is that there are few viable alternatives.
- ZhuanXia 7y ago
  I hope when I get that degraded I will live in a society kind enough to euthanize me, rather than slowly torture, drug and humiliate me, while extending my demented, horror-show 'life' to the maximal possible extent in order milk my children, savings, and/or the state. Soylent green is a utopia compared to what we have now. Dr. Scott Alexander writes well here on how we treat the demented: http://slatestarcodex.com/2013/07/17/who-by-very-slow-decay/ http://slatestarcodex.com/2013/07/17/who-by-very-slow-decay/ "And now every time I hear that phrase I want to scream. 21st century American hospitals do not need to “cultivate a culture of life”. We have enough life. We have life up the wazoo. We have more life than we know what to do with. We have life far beyond the point where it becomes a sick caricature of itself. We prolong life until it becomes a sickness, an abomination, a miserable and pathetic flight from death that saps out and mocks everything that made life desirable in the first place. 21st century American hospitals need to cultivate a culture of life the same way that Newcastle needs to cultivate a culture of coal, the same way a man who is burning to death needs to cultivate a culture of fire."
  - Gatsky 7y ago
    I have to say it is unlikely there will be sanctioned euthanasia for age related decline or dementia. The practicalities of implementing such a system are probably prohibitive, the primary problem being ending the life of someone without the capacity to tell you that is what they want. This is in some ways insurmountable, because although your 50 year old fit and happy self would definitely want to be euthanised if they had severe dementia, how do we 'know' that this same person who now has severe dementia also wants to die? It is similarly unlikely there will be a test which can predict imminent dementia well enough that you would be happy to euthanise yourself while you still have decision making capacity. As others have said, what you can do is have some legal document which explains your wishes if you lose capacity to make decisions, where you specify the avoidance of life prolonging therapies, intensive care, resuscitation etc. The other thing which is important is having someone that will take over medical decision making whom you trust will act according to your wishes, in the event you lose decision making capacity. Another aspect of this is making sure friends and family are aware of your wishes. This is a kindness to them as much as anything, so that when the time comes to withhold or withdraw medical treatment, they don't have to ruminate on whether it is the right thing to do.
coldtea 7y ago
Makes sense. The staff are not so enthused workers. They don't care for these people, they don't have any special ties with them (e.g. like family), and if they could dispose them and keep the money they would. Keeping them sleepy and docile removes them from most of their day, and makes their jobs easier.
elchief 7y ago
Same in Canada. My dad has dementia and is in a home in Vancouver. They had him pretty zombified until I intervened. He's a bit of a pain in the ass, so it's easier for the staff to drug him up...
- stevespang 7y ago
  Dementia aside, nursing homes drug up EVERYONE who is a pain in the ass, SOP. American children of families with enough money would typically rather someone else deal with their aging parents rather than they have to.
NLE106 7y ago
Well that wont work for you bro.
Causality1 7y ago
Do you know what it's like to have to explain to your mother every day that her parents are dead? That her first and second husbands are both dead? Spend a month watching her soul break anew every single day, sometimes twice a day, and then tell me drugging her until she doesn't think about it is worse than that because I fucking guarantee you there is nothing worse than that.
teekert 7y ago
Let me guess, the nursing home is sponsored by a Pharma company? This is how US's opioid addiction came into being. Screw the socialists, right? Profit above everything. I get sick when I see the jokes they make on Big Bang Theory about Penny's job, she's basically a criminal (in many countries literally.)
deaps 7y ago
Gosh -- just the premise of the title alone -- really makes me think about what happened to my Grandma back in late 2016-2017. I won't go into details, but suffice to say, either we got her into the nursing home at the exact right time where she absolutely needed it, or they started over-medicating her right away. Once she stepped foot through those doors, she was never the same again. Her admittance coincided with the hospitalization and subsequent death of my Grandpa, who was her primary caregiver at the age of 92 (WWII veteran and atomic engineer, btw - smartest guy I ever knew). Long story short, we started off getting them a two-person room where they were supposed to reunite once my Grandpa was checked out (a room which my Grandpa never made it to). Within a month, we had to move her into a one-person room. She never put two and two together (they were married for 70 years). I was the only person she recognized. But she was never the same again once she checked in. And it was immediate.

154 points by apsec112 7y ago

notadoc 7y ago

Compared to other nations, is the US overmedicated in general?

Ididntdothis 7y ago
I would say yes. I am in my 50s and it seems pretty unusual for people of my age not to have a long list of prescriptions they take. But other countries seem to be catching up.
TallGuyShort 7y ago
Don't know how it compares to other countries, but the US is definitely overmedicated in general. Not really my place, since at least with prescriptions they are being distributed by people who are by definition more qualified than me, but it's widely known that doctors will often prescribe antibiotics "just in case", even though tests for specific bacteria have all come back negative, and the use in livestock adds to that. The opioid epidemic is another clear sign that it's being prescribed more than is warranted. Far more subjective and anecdotal, but the number of people I know who take prescriptions for anxiety or other ongoing mental health concerns but who have never tried therapy is scary. Treating with drugs is clearly solution #1 for a lot of our culture.
- Broken_Hippo 7y ago
  Therapy is a complicated beast. Not everyone can afford it (generic prozac is fairly inexpensive per month, a therapist is usually more than $20 per month). Even if the insurance is good, not everyone can get off work to go - which is a real issue if you work "doctor hours". And to make it all worse, so many therapists have a waiting list and patients are queued depending on need. And some folks need the drugs just to talk to someone! So yeah, drugs is often the go-to. A family doctor is a lot more available than a therapist.
  - TallGuyShort 7y ago
    Fair enough, but I live in a very wealthy area and most of the examples I'm thinking of are stay-at-home moms whose kids are now old enough to be in school most of the day. But they're still at anti-depressants like they're poisoned and it's the antidote. Not saying everyone should be seeing a therapist, these aren't the only 2 possible solutions to whatever they're suffering, but it looks to me like overmedication is for sure happening in a lot of cases.
    - cookiecaper 7y ago
      Once you pop, you can't stop. Washing out anti-depressants and allowing your body to return to a natural homeostasis is frequently a massive ordeal entailing physical fatigue, wild mood swings, serious hopelessness and despair, among other things. Adults can be quite dangerous to themselves and others during that process and it's important to have a patient and disciplined caretaker around to babysit for the duration of the weeks-long washout. Most people are not apprised of this when they start a medication -- they're just naively following doctor's orders. Consider that psychiatry is a racket where the conventional understanding is that any psych willing to mess with insurance companies is a hack, that every cash-only doc within 50 miles of a significant population has a 3-month waiting list and is generally choosy about their patient base anyway, and that family practitioners aren't willing to do anything slightly unconventional because the DEA will start breathing down their necks, and we have quite the mess on our hands. I'd suggest that you don't judge those SAHMs too harshly. It's a tough gig on its own, and throwing in "risk becoming totally non-functional" is usually not something that people can just pencil into their schedule.
  - nxc18 7y ago
    Yeah, I've tried to get a therapist here in SoCal and it is an absolute nightmare. Its one of those things where clearly I don't _need_ it, but I'd probably be a lot healthier and happier with it. But even thought I have good insurance and could definitely afford it, there just isn't availability at all. I've called around and no one is taking new patients. Saying 'therapy not drugs' is all fine and dandy until you consider that for probably 99% of people therapy just isn't an option and may never be.
fzeroracer 7y ago
Considering the amount of people that end up with medical issues because they can't afford basic medication, I'd say no. We're overmedicated in opiates because of the corrupt drug industry and corporations pushing pills for profit (see: the various articles and stories detailing the rampant corruption behind Purdue) and likely undermedicated in everything else.
deleted 7y ago
[deleted]
fian 7y ago
Australia recently had a Royal Commission into the Aged Care sector: https://agedcare.royalcommission.gov.au/Pages/default.aspx https://agedcare.royalcommission.gov.au/Pages/default.aspx One of the 3 major issues identified in the interim report is: to respond to the significant over-reliance on chemical restraint in aged care,including through the seventh Community Pharmacy Agreement

throwaway5752 7y ago

Make a living will and think through a DNR, so that you are not kept alive against your wishes for a care facility's income stream (or even in the case of well meaning caregivers) against your quality of life interests. I'm serious, by they way. Almost everyone on this forum (over the age of 18 in the US) should consider getting a relatively inexpensive living will drawn up with advanced medical directives.

zrail 7y ago
Living will is fine and good and everyone should have one. The problem is that dementia, by itself, is not a direct cause of death. You can live for years with severe dementia but be otherwise completely healthy. Two members of my family lived out their last years like that. My wife and I are moving to a state that allows assisted suicide after our kids are out of the house. Neither of us want to live like that or be remembered like that.
- yulaow 7y ago
  Here in europe, for what I know, there is a serious problem for getting assisted suicide (in the states that legalized it) for something like dementia because when you have still few effects related to it they can't accept to eutanize you because you are not in a quality of life threating condition, and once the sympthomes are more brutal you cannot get eutanized either because you are no more legally considered capable of making conscious decisions and you must be capable of it _at the moment_ of the procedure, it's not valid to give the authorization before.
  - m0xte 7y ago
    Also if you do manage to commit suicide no one pays out on life insurance or pension. Best option I think is to start with nothing and end with nothing. The above problem is void then. That fortunate bit in the middle needs to be distributed to your children then if they need it.
    - lotsofpulp 7y ago

downerending 7y ago

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.

Ididntdothis 7y ago
I think it’s just easier for the people working there if patients are kept calm with medication.
- Broken_Hippo 7y ago
  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.
  - toomuchtodo 7y ago
    The system is built to be this way. 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.
    - Ididntdothis 7y ago
      “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.

omgwtfbyobbq 7y ago

This is unfortunately my experience in any custodial care setting. Providers (Hospitals, SNFs, Board & Cares, Day Programs, etc...) will use whatever they can get away with prescribing that has a sedative effect, not just antipsychotic drugs. I imagine a significant number of people diagnosed with dementia likely do not have it. The providers just want people to be docile and lie in bed. Having to monitor and manage people who may get up at odd hours and act in ways we aren't used to requires a lot of other people, which gets expensive. The worst part is that the combination of over medication and lack of suitable care can lead to someone exhibiting symptoms similar to dementia even if they don't have it. To be fair, funding likely isn't sufficient for many providers to do a sufficient job monitoring and working with their patients, but that's a separate conversation.

munificent 7y ago
> I imagine a significant number of people diagnosed with dementia likely do not have it. I don't think it's as dire as you imagine. People don't just randomly drive themselves to nursing homes for no reason. Like you and I, few who are capable and willing to live independently would want to be in one. By the time you end up in a nursing home, the odds are good that you require significant care and are unable to function independently. If that's true and you're in a nursing home and not a hospital or hospice, it's probably because the thing incapacitating you is mental — dementia. However, if you do have dementia and end up in a nursing home... it sucks. Our culture and medical systems just aren't equipped to compassionately take care of fragile, dying people, who are confused, have trouble eating, shit themselves, etc. Caring for someone with dementia is brutal, heartbreaking work. Most people wouldn't want that job, and there's not enough money to pay well and compensate, so you get short-staffed or unhappy caregivers.
- robryk 7y ago
  > If that's true and you're in a nursing home and not a hospital or hospice, it's probably because the thing incapacitating you is mental — dementia. You can have musculoskeletal issues that prevent you from performing everyday activities. You might also have neurological issues that don't affect thinking or speech (e.g. as a result of stroke). I'm unsure if vision problems acquired at old age can confine one to a nursing home: it's harder to learn to compensate (e.g. because you have worse medium-term memory and poorer senses other than sight).

batt4good 7y ago

Personally, if I ever become a victim of alzheimers, especially if it's to the degree of a family member of mine (all mirrors had to be removed from her home since she could no longer recognize herself and was startled by her own reflection) I would sure hope I was medicated out of my mind or sedated. I plan to have my will reflect that I had no intent of treatment for this kind of disease, hopefully willful euthanasia is legalized in the U.S. soon. If I was diagnosed with early onset forms of dementia (prior to age 50) I would certainly book a hotel room and blow my brains out. I've seen the horrors of this disease and have no intent to "fight" it.

omgitstom 7y ago

My dad passed away with dementia in 2019, spent a lot of time in nursing homes and also making decisions about the care of my father. I actually got to see this first hand with his caregivers in his facility. The requests to put him on different drugs required me to do a lot of research, validation and getting out of pocket advice from a medical professional that wasn't associated with the care facilities. As someone that has gone through this, there is a fine line to walk between doctors operating under their Hippocratic oath, caregivers, and patient wishes. My dad was prescribed meds that weren't helping his quality of life and had really bad side effects mentally and physically through the the mid-stages of dementia.

mirimir 7y ago

It's the same deal for troublesome kids. For the old folks, why not morphine or heroin? That, I've heard, is at least pleasant. As long as the supply is assured, anyway. Anti-psychotics aren't so much fun. And if that seems outrageous, please say why.

mayank 7y ago
How about dignity and care instead?
- mirimir 7y ago
  That should go without saying, as I see it. But the problem is that people with dementia can hurt themselves and each other.
- glangdale 7y ago
  Because people can't afford dignity and care, for the most part? It sounds good, but if you've ever cared for a severely demented person who can no longer safely walk, you will have to make the choice between (a) strapping someone to a bed or (b) paying for 24/7 care (or, to some pro-rated amount, giving up your own time) to ensure that they don't get up, fall, and break something.
  - mirimir 7y ago
    I do agree. I've been there, with an aged relative who lived with us. And my wife and I are headed there, with no kids. Me, I will die before going to a nursing home. And neither my wife nor I have life insurance, so suicide isn't problematic.
cookiecaper 7y ago
We're in a huge pickle in general because every simple, effective drug gets blacklisted pretty quickly, because people realize there's a simple, effective option for treatment that doesn't make them dependent on our horrifically broken medical system and start buying it without funneling through the racket. This upsets the racketeers and they work to clamp down on it. In the rare case where a simple, effective drug gets into medical practice, it magically ends up becoming "not recommended" about 20 years after it hits the market when the pharmaceutical company's patent runs out. MAOIs work much better for depression than SSRIs, for example, yet the clock runs down, a few widely-publicized cases of serotonin syndrome caused by careless ER doctors hit the press, and suddenly anyone prescribing those drugs comes under scrutiny, and we all need to switch to the newly-patented option.

Fede_V 7y ago

A nice compliment to that article, via Dylan Matthews of Vox News: https://drive.google.com/file/d/1d6vYu_uN9keb9iiT2R5UJihA_61K0Fce/view https://drive.google.com/file/d/1d6vYu_uN9keb9iiT2R5UJihA_61... Short version: paying CNA more increases lifespan and quality of life for people in retirement homes because they are more motivated and you can hire better staff.

catalogia 7y ago

After witnessing family members with dementia, I've decided that unless a true cure is developed, the only 'treatment' I ever want should I get dementia is to be swiftly euthanized. I just hope that by the time that may happen, I don't have to travel far to find a way to get that done legally.

patall 7y ago
Most people think similar when that is still far away. However the closer you get, the more likely you are going to think: 'Nah, its not that bad yet, lets wait another 5 years, lets wait another 2 years, lets wait another 6 months' and so on. The will to live seems to be much stronger for short term decisions. (It is similar probably for other things like sports, living on your own etc. When I am older I do not think I will want an SUV for convenience but who knows how I will think then)

Gatsky 7y ago

It is a matter of resources. Young children or adults with severe behavioural problems are managed without antipsychotics and sedatives, but it takes a dedicated and skilled care team and a highly functional family. Even then, the drugs still often get used. Behavioural problems in dementia are very hard. Male patients in particular can be quite strong and mobile. They can easily hurt staff or other residents. They are also a risk to themselves. The coroner in my state published two cases of patients with dementia that highlight this: one swallowed the napkin on his dinner tray and choked, another got put of the facility and died trying to climb a fence. The reality is that there are few viable alternatives.

ZhuanXia 7y ago
I hope when I get that degraded I will live in a society kind enough to euthanize me, rather than slowly torture, drug and humiliate me, while extending my demented, horror-show 'life' to the maximal possible extent in order milk my children, savings, and/or the state. Soylent green is a utopia compared to what we have now. Dr. Scott Alexander writes well here on how we treat the demented: http://slatestarcodex.com/2013/07/17/who-by-very-slow-decay/ http://slatestarcodex.com/2013/07/17/who-by-very-slow-decay/ "And now every time I hear that phrase I want to scream. 21st century American hospitals do not need to “cultivate a culture of life”. We have enough life. We have life up the wazoo. We have more life than we know what to do with. We have life far beyond the point where it becomes a sick caricature of itself. We prolong life until it becomes a sickness, an abomination, a miserable and pathetic flight from death that saps out and mocks everything that made life desirable in the first place. 21st century American hospitals need to cultivate a culture of life the same way that Newcastle needs to cultivate a culture of coal, the same way a man who is burning to death needs to cultivate a culture of fire."
- Gatsky 7y ago
  I have to say it is unlikely there will be sanctioned euthanasia for age related decline or dementia. The practicalities of implementing such a system are probably prohibitive, the primary problem being ending the life of someone without the capacity to tell you that is what they want. This is in some ways insurmountable, because although your 50 year old fit and happy self would definitely want to be euthanised if they had severe dementia, how do we 'know' that this same person who now has severe dementia also wants to die? It is similarly unlikely there will be a test which can predict imminent dementia well enough that you would be happy to euthanise yourself while you still have decision making capacity. As others have said, what you can do is have some legal document which explains your wishes if you lose capacity to make decisions, where you specify the avoidance of life prolonging therapies, intensive care, resuscitation etc. The other thing which is important is having someone that will take over medical decision making whom you trust will act according to your wishes, in the event you lose decision making capacity. Another aspect of this is making sure friends and family are aware of your wishes. This is a kindness to them as much as anything, so that when the time comes to withhold or withdraw medical treatment, they don't have to ruminate on whether it is the right thing to do.

coldtea 7y ago

Makes sense. The staff are not so enthused workers. They don't care for these people, they don't have any special ties with them (e.g. like family), and if they could dispose them and keep the money they would. Keeping them sleepy and docile removes them from most of their day, and makes their jobs easier.

elchief 7y ago

Same in Canada. My dad has dementia and is in a home in Vancouver. They had him pretty zombified until I intervened. He's a bit of a pain in the ass, so it's easier for the staff to drug him up...

stevespang 7y ago
Dementia aside, nursing homes drug up EVERYONE who is a pain in the ass, SOP. American children of families with enough money would typically rather someone else deal with their aging parents rather than they have to.

NLE106 7y ago

Well that wont work for you bro.

Causality1 7y ago

Do you know what it's like to have to explain to your mother every day that her parents are dead? That her first and second husbands are both dead? Spend a month watching her soul break anew every single day, sometimes twice a day, and then tell me drugging her until she doesn't think about it is worse than that because I fucking guarantee you there is nothing worse than that.

teekert 7y ago

Let me guess, the nursing home is sponsored by a Pharma company? This is how US's opioid addiction came into being. Screw the socialists, right? Profit above everything. I get sick when I see the jokes they make on Big Bang Theory about Penny's job, she's basically a criminal (in many countries literally.)

deaps 7y ago

Gosh -- just the premise of the title alone -- really makes me think about what happened to my Grandma back in late 2016-2017. I won't go into details, but suffice to say, either we got her into the nursing home at the exact right time where she absolutely needed it, or they started over-medicating her right away. Once she stepped foot through those doors, she was never the same again. Her admittance coincided with the hospitalization and subsequent death of my Grandpa, who was her primary caregiver at the age of 92 (WWII veteran and atomic engineer, btw - smartest guy I ever knew). Long story short, we started off getting them a two-person room where they were supposed to reunite once my Grandpa was checked out (a room which my Grandpa never made it to). Within a month, we had to move her into a one-person room. She never put two and two together (they were married for 70 years). I was the only person she recognized. But she was never the same again once she checked in. And it was immediate.