Substance Abuse with the Elderly in Assisted Living Facilities - Research Paper Example

 Substance Abuse with the Elderly in Assisted Living Facilities Name: Course Name: Course Instructor: Date of Submission: Substance Abuse with the Elderly in Assisted Living Facilities Data reveals that as we old, the urge of us needing prescription medication escalates. However, most illnesses can occur at any age, stroke, cancer, and heart disease are the three major killers of the elderly people. These three diseases necessitate plentiful medications and attention while taking the medication (Goodwin, 2015). Moreover, diabetes, high blood pressure, Alzheimer's disease, Parkinson's disease and other dementia are well-known illnesses in which elderly individuals prescribe medication. As a matter of fact, Americans aged 75 years and above take on approximately over 11 various medications over the year according to AARP (Goodwin, 2015). According to the study, it reports senior families in the United States encompass 13 percent of the whole population. These families account for just about 35 percent of all packed prescriptions. Nearly 90 percent of all beneficiaries in Medicare use prescription medication. This essay discusses on abuse of prescribed drugs by the elderly in assisted living facilities and long term care. Having laid these facts on the table, one would hope that managing patient medication appropriately is a high urgency in assisted living facilities such as nursing homes. In high quality, well-organized nursing homes, staff members make certain that the proper measures are being applied when occupants are issued their medications. Awkwardly, various forms of abuse in nursing homes occur frequently through providing patients the incorrect medication and by overdosing them with poorly functioning and ill managed nursing homes (Goodwin, 2015). It is one of the foulest dread we have for our loved ones or for ourselves that we, or they, will end up in an assisted living facility, sedated into a stupor. The anxiety is not completely irrational because nursing home facilities are not the best place to be, especially given the recent bad reputation it has gained over the years. There are nearly 300,000 nursing facilities where patients are presently getting antipsychotic medication, typically to overwhelm the anxiety or hostility that can go with Alzheimer's disease and other dementia (Goodwin, 2015). However, antipsychotics are permitted primarily to treat severe mental illnesses such as bipolar disorders and schizophrenia. When it comes to patients with dementia, the medication has a black box warning, stating that they can escalate the danger of infections, heart failure and death. Health Care Fraud In the past recent years, settlement of criminal and civil allegations against Johnson & Johnson for off-label marketing of Risperdal for nursing home residents brought public attention to the subject of abuse of antipsychotic medication in nursing homes.  A number of individual campaigned to decrease the wrong use of antipsychotic drugs in nursing facilities. Recently, the group of residents’ addressed a joint Statement about the settlement. Recent statistics from the Centers for Medicare & Medicaid Services (CMS) shows that nursing homes have fallen far short of the objective agreed in July 2012 for decreasing the wrong use of antipsychotic drugs (Goodwin, 2015). As a result of sequestration, the Inspector General cancelled a research program of use of antipsychotic drug in nursing facilities. The CMS' verdict did not to necessitate to consultant pharmacists counsel which is required by the federal Nursing Home Reform Law. Instead the CMS were sovereign of long-term care pharmacies and pharmaceutical manufacturers (Goodwin, 2015). Serious challenge of the misuse and overuse of antipsychotic drugs in nursing homes have been recognized in the past few decades.   In the year 2007, an article in the Wall Street Journal by Lucette Lagnado stated "Prescription Abuse Seen in U.S. Nursing Homes; Powerful Antipsychotics Used to Subdue Elderly; Huge Medicaid Expense " focused on common antipsychotic drugs (Goodwin, 2015). In this report, Lagnado revealed that the drugs were planned for only a small share of the population, were frequently used instead as a substitute for enough nurse staffing ranks.  The Office of Inspector General investigated the use of common antipsychotic drugs in nursing homes and found that in 2011 more than 90% of the common antipsychotic drugs consumption broke one or more federal laws. They violated the law of prescribed off-label which is illegal (Goodwin, 2015). The Abuse of this sort can take different methods. In a scenario where the nursing home has very few personnel, the nurses might be overworked and eventually make blunders by becoming tired. Consequently, one resident may be given the prescribed drugs of another resident. The complications are however serious, if one patient obtains other patients with high-blood-pressure medication and as a replacement for of her own diabetic condition. Not only are both patients lacking to be treated for their current medical conditions, but they also have the possibility of daring contacts and side effects from the drugs they were not intended to be medicated (Goodwin, 2015). Moreover, some drugs necessitate fixed, unswerving usage in order to be operational and secure. Missing doses on a couple of occasions may render the medication obsolete. On a regular basis, a regular nursing facility patient takes numerous different kinds of drugs every day. Short-staffed and overworked personnel, unlucky, they may get medications mixed up when attending the sheer amount of medication that patients require on a daily basis (Goodwin, 2015). Although the earlier stated situation is definitely risky, getting patient medications tangled is commonly accidental abuse. This, however, is still unlawful and is well-thought-out as a form of frequent nursing home abuse. There is also a more disturbing behavior in which staff members deliberately overdose patients to knock them out or other hidden agenda. Devious staff members and caregivers may deliberately hand patients’ medication they have not been prescribed or powerful prescriptions of the ones they have in order to subdue them (Goodwin, 2015). According to a study performed by the Centers for Medicare and Medicaid Services (CMS) in the year 2010, an estimated 17% of nursing facility patients in the United States is given more than the mandatory amount of antipsychotic drugs for each day. For instance, in California only, the figures are even greater, with at least 25% of all state’s nursing facilities patients getting more than the mandatory amount. Another case scenario, in Florida, however, the CMS research showed that an outrageous 71% of the statewide nursing home patients were being overindulged with antipsychotic drugs to subdue them (Goodwin, 2015). Even more alarming is that in many scenarios, wicked administrators may disregard or even embolden such act if it benefits the facility to soothe what they contemplate disorderly and disruptive patients. For instance a case scenario of a nursing home administrator of the Kern Valley Nursing Home in California was indicted with "chemically restraining" patients in 2010 according to ABC World News (Goodwin, 2015). Nursing administrative Gwen Hughes gave residents in the nursing facility, and in some cases mandated them to take higher antipsychotic drugs when she considered behavior as unruly or disruptive. Miserably, at least three residents in the institution were murdered at Kern Valley as a consequence using powerful drugs as a chemical restraint. This felony was not taken kindly by the authorities. Hughes was sentenced to three years in 2013, in state prison for the crime of elder abuse. Unfortunately, both overdosing and using powerful chemical restraint drugs among the patients in nursing facilities is very common in the United States and continuing to gain popularity. However, physically confining patients with belts and straps is currently illegal except in unusual condition if a patient is violent and attack other patients or staff members. Some specialists propose that medication is being used in its place when nursing facility staff member feel the urge to control challenging patients. Whereas it is illegal to administer medication meant to chemically restrain a patient, such exercises are admitted to be extensive. The outcome can be a disastrous reduction in quality of life or even death. According to the Food and Drug Administration (FDA) at least 15,000 nursing home patients pass away every year due to excessive antipsychotic medication (Goodwin, 2015). Antipsychotic drugs alter or blunt patient’s behaviors. Antipsychotic drugs can be used for sedation purposes. However, antipsychotic drugs increase their danger for falls. Majority of scenarios, the antipsychotic drugs are not essential. To get to the very fundamental bottom line, why should someone pay for something that they do not require? However, patients or their guardians may not know that the medication is not required. In most cases, they are hardly ever told about the severe dangers of the antipsychotic drugs. The Food and Drug Administration give out a black box warning on usage of the drugs for patients suffering from dementia in the year 2005 (Goodwin, 2015). However, the FDA stopped short of prohibiting such consumption. Administrators stated that they give doctors the flexibility to prescribe the medication if they think it will assist this complicated-to-treat population. Some doctors are now switching back to older, cheaper antipsychotics, such as Haldol, the FDA says. The older drugs had fallen into disuse, but don't have a black-box warning. Now, the FDA says it's weighing putting a black-box warning on those drugs, too. The misuse of antipsychotic drugs as chemical restraints is one of the most common and long-term, but avoidable, practices instigating severe damage to nursing facility patients today. Once a nursing home turns away funds from the facility of patient with commercial overhead and profits, the human toll is big (Goodwin, 2015). What needs to be done? Fortunately, an escalating amount of nursing facilities have started to search for more operational and civilized techniques of taking care of patients. Quality training for caregivers is core mission. An organization on behalf of nonprofit amenities for older patients, nursing facility staff can be qualified to deal with behavior matters considerately and artistically without embarking to drugs, according to Cheryl Phillips, M.D at LeadingAge (Goodwin, 2015). She quotes an example of a male patient who was spending his days in a loud nursing facility activity room. On one occasion, he grew more and more aggressive and stumble an aide with his cane. To cool him down, the staff in charge took him to his private confinement. Over the following days, his behavior in the activity room became increasingly assertive. He began indiscriminately knocking out caregivers and fellow counterparts. Every time, he was taken away to spend time in his room the staff primarily thought he had become vicious and required an antipsychotic drug. Eventually they understood that the disharmony in the activity room was stressing him out. Caregivers involuntarily satisfied him by giving him quiet time in his room, which is what he wanted. When they did it repeatedly, they covered his aggressive behavior. Once the staff talked over the issue and began finding diplomatic activities for the patient, the challenge was resolved and therefore no drugs required (Goodwin, 2015). Substance Abuse with the Elderly in Long Term Care The specific percentage of elderly people with drug abuse is challenging to evaluate. One cause is that numerous signs and symptoms of abuse and misuse reflect typical signs of aging in general. Freshly published figures show clear hints at a growing epidemic of drug abuse in the long term care among the elderly (Lorman, 2015). It is important to make a differentiation between drug misuse, which is shared among seniors, and drug abuse which is a little predominant among the older individuals. The majority of elderly who become reliany on treatment medication are being treated for genuine homeopathic problems such as pain, nervousness, misery or restlessness. They may escalate their quantity against therapeutic instruction in order to seek more relief from their disorder. This is known as drug misuse. Drug abuse is less typical among elderly, but is a large concern nevertheless. Abuse entails the continued and deliberate habit of taking drugs for the tenacity of pleasure, delight and exhilaration but does not include the recurring use of drugs for medical functions. This discrepancy is vital to note. Seniors who are abusing prescription drugs for recreational function may be doing so because their current medicinal instruction strategy merely isn’t operational in dealin with their needs.  Abuse or overuse can be managed if physicians reassess prescription alternatives so that patients do not depend on more drugs than prescribed in order to get full liberation (Lorman, 2015). Drug abuse on the other hand can be more difficult to get under control, and may require drug treatment. Just as there is a distinction between misuse and abuse, there is a dissimilarity between reliance and addiction. Many treatment drugs are substantially addictive, such as opioid painkillers such as Percocet or Vicodin. Anti-anxiety, Sedative, and insomnia drugs like Xanax and Valium can also result to substantially reliance when consumed daily, even as recommended drugs by a physcian. Even without any abuse or misuse, a patient who is substantially reliant will go through bumpy drug withdraw symptoms phase, if they stop all over sudden taking the prescribed drugs. If a patient halts prescription that they are reliant on, their doctor will frequently recommend slowly reducing medication doses to decrease uneasiness (Lorman, 2015). Furthermore is more frequent the consequence of drug misuse. Elderly addicts, are typically not only physically reliant on the medication or drugs they are consuming, but also take them clearly habitual and hazardous manner. As the National Institute on Drug Abuse states in their report that, habitual misuse of prescription drugs regardless of harmful results is characterized by an incapability to halt using a drug (Lorman, 2015). Habitual misuse of drugs is also characterized by disappointment to meet personal duties, social or family responsibilities. Treatment drug misuse and abuse are much further of matter of concern for elderly than abuse of hard street drugs such as heroin or cocaine. Being conscious of the main categories of medicines that lead to addiction or dependance can be insightful. Prescription Addictive Drugs Opioids: The types of drugs are used to treat pain disorder. Common opioids include oxycodone (an active constituent in Percocet and Oxycontin), hydrocodone (an active element in Vicodin and Norco) and many other correlated medicines such as fentanyl, hydromorphone, codeine and morphine. Opioids are an important tool for pain relief, but carry clear hazardious of reliance and addiction. The figure of lethal opioid over doses has intensely increased over the last decade (Lorman, 2015). Benzodiazepines: These are a category of drugs mainly used to treat insomnia , panic disorders, anxiety and can also be prescribed to bipolar and even epilepsy patients. Common benzodiazepines contain lorazepam (Ativan), clonazepam (Klonopin) , diazepam (Valium)and alprazolam (Xanax). This type of drug can be extremely pattern forming and hazardous when combined with other sedatives prescription. Sudden withdrawal can cause seizures and other major medical complication in patients (Lorman, 2015). Alcohol: Alcohol is certainly a drug, however not a prescription to any elderly patient in long term care facility or at home. Nevertheless it’s reflected as a socially acceptable drug can be misused or abused among the elderly with alcohol complications. Alcohol abuse or misuse can cause to dementia, liver failure, and other hazardous possibly fatal health problems which should not be taken lightly. Further more, alcohol affects elderly individual more intensely than younger individuals, so elderly should be specifically careful with alcohol consumption especially those with other complications (Lorman, 2015). Stimulants: Stimulant drugs are frequently recommended to younger people for attention deficit hyperactivity disorder (ADHD), such drugs comprises of Ritalin or Adderall. However these stimulants can occassionally be prescribed to the elder individuals for complications such as obesity and narcolepsy. Stimulants can be pattern making and stimulant abuse can be extremely hazardous to health, especially among the elder generation under care facilities (Lorman, 2015). Alcohol and Drug Abuse in Erderly Long Term Care The Abuse of alcohol and other drugs has continuously believed to be an issue for young people, but such issues have no age boundaries. We used to consider that elder individuals quit drinking too much or using prohibited drugs (Lorman, 2015). Conversely, present-day figures does not fully uphold these facts, which may arise as a shock to family members caring for a parent who may live at home or in an assisted living facility. It’s not categorically clear whether misuse of drugs and alcohol in elder individual signifies a pattern of constant consumption. a return to use after a period of abstinence, new onset of use, or a combination of each of these patterns. One argument that has been internalized in freshly exploration studies is that elder individual abuse and misuse a range of substances. For example, a huge number of the elderly take prescribed drugs (occassionally not as instructed) for physical and psychiatric illnesses. Through buy over-the-counter prescription which they may occassionally take according to directions or report their use to a main health supplier. They drink alcohol, smoke cigarettes, and use illicit drugs such as marijuana (Lorman, 2015). Studies also show that there is a escalating figure of elderly using heroin and cocaine. Another issue of consumption of prescribed drugs involves borrowing drugs from a friend or relative as a replacement of seeking physcian counsel. The major challenge here is that all prescription and drugs misuse and abuse may react with each other producing harmful reaction against the patient health. This eventually results to side effects and both physical or psychological effects after short or long-term use. In the long ran, there are more hostile consequences which typically result the person to consume even more prescription to cancel out these nasty withdrawal symptoms (Lorman, 2015). Conclusion As a society, we tend to disregard, vindicate or reduce the effects of drug abuse on the elderly especially those who live in assisted facilities. Whenever we observe amnesia, sadness, an unstable gait and the like, we have a habit of blamming the aging progression rather than scrutinize the prospect of drug problem. A parable found in the medical society is the erroneous view that the ‘window of risk’ of emerging drug issues is closed by age 50. Major health care providers won’t frequently converse the consumption of unlawful use of prescription drugs with their patients, hence creating a cover of secrecy to the society. Another success story is the Beatitudes nursing home in Phoenix, which dramatically transformed its way of treating patients with dementia. What happens here is not for the systems or for convenience, but for the people we care for the director of education and research at the Beatitudes. People with dementia have troubles in their sleeping and waking patterns, therefore we let them be relaxed and choose when they want to sleep or eat. A typical fact is that a lot of nursing facilities abuse occurrences pass by unreported and unnoticed by any authority (Goodwin, 2015). Subsequently, it is imperative for relatives to watch out for the cautions signs that something is about to go wrong. Usually side-effects and cautioning signs of overdosing patients comprises of rare fatigue and exhaustion, disorientation, unusual withdrawal symptoms, oversleeping and memory lapses. References Goodwin, J. (2015). Antipsychotics Overprescribed in Nursing Homes - AARP. AARP. Retrieved 25 March 2015, from http://www.aarp.org/health/drugs-supplements/info-2014/antipsychotics-overprescribed.2.html Lorman, D. (2015). Alcohol & Drug Use Among the Elderly. Griswold Home Care. Retrieved 29 March 2015, from http://www.griswoldhomecare.com/blog/alcohol-drug-use-among-the-elderly/ Read More