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The transition from living in your home to inhabiting a “ care ” facility can be a rocky road. Elders give up their familiar surroundings for a “ institutional environment ” that many perceive as threatening and confusing. The trauma is enhanced when an elder has dementia requiring the caregivers to support this transition with careful guidance. At some point in this move and even after, there may be confusion, violence, and anger especially if the resident feels a real violation of his rights has taken place. I can't imagine what it must be like to be imprisoned in your mind, feeling words one cannot speak. How natural it would be over the course of residency to become suspicious and combatant.

The question is why don't all people living with Alzheimer/Dementia express their agitation in these places. But everyone reacts differently to these circumstances even without the added influence of these health conditions. Toronto Star's April 15, 2014, editorial stated it was merely “ the lack of staff ” to nurture and care for those elders requiring extra time that made acclimatising difficult.

Based on the need for safety of all residents and staff, antipsychotics seem to be the most used panacea in helping to keep the inhabitants' behaviour manageable with minimum staff present. Health Canada warns that advanced aged residents with dementia treated with atypical and typical antipsychotics, face a 60% increase risk of death compared to those without medication. The Star article hints at the high possibility that many of these people are incapable of making decisions about their treatment and are administered antipsychotics without consent from or consultation with next of kin or families. Doing this is in violation of the Canada Health Act.

Guidelines say that staff must measure the potential benefits of antipsychotics against the significant risks such as cerebrovascular adverse events and mortality. But experts say only 10% to 15% of dementia residents are in this risk category suggesting far more elders than necessary are on these drugs. Some homes are listed as high as 73% resident use of these drugs. 53% of seniors living in long-term care were using five or more medications at the same time. However, they reported that 13% of Canadian seniors (445,000) living in households were using five or more medicines concurrently.

In spite of the warnings, half the residents of 40 homes across the province are on antipsychotic drugs, 631 nursing homes in the first semester of 2013 averaged 33%. Ontario's Long Term Care Association acknowledges it needs to do better and I say, and it needs to treat seniors better. The government is concerned but hasn't done anything.

In our discussion of safety and health some of us look to a future where our environments will help guide us on our journey and make our ways clear. We want to be safe and feel safe at all times. Will our environments be pleasant or hostile? Will our surroundings be close to nature or isolated from it? Will there be human beings to assist us or an automated machine? At a certain point in time, it won't matter to me what my condition is; especially when I am no longer able to self-care. But I need to be able to trust my caregivers. If I have Alzheimer's Disease and at some stage, it brought me to distress will there be that “ Bridge Over Troubled Water ”. Will future medications bring comfort instead of chaos? Even more: Will there be the touch of a human hand? ©

Resources
Canadian Seniors Using Medicines (archived)

Our Safety is our Health

Date

April 15, 2014

Author

James Kershaw

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Jim Kershaw says

December 23, 2016

I strongly suspect that in 5-8 years there won't be enough staff to manage special care elders. Where are the personnel?

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