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Jenna Moening

Professor Barnes

ENG 1201

24 March 19

The Elderly Are Being Harmed By Over Medication

Fig. 1. A comic showing a spoonful of different medications being shoved towards an

elderly man. (​Nilsson-Maki)

I have worked as a certified nursing assistant for nearly two years in a specialized

Alzheimer’s/Dementia long term care facility​.​ At work recently, I watched as a coworker

became very frustrated with one of the residents who was getting anxious, frustrated, and slightly

combative and instead of calmly reassuring the resident and distracting to try to calm them down,

they immediately marched into the nurse's station and asked that the nurse gives the resident

whatever medication they could have to calm them down so they would be tolerable to take care
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of​.​ After the nurse had administered the medication, within thirty minutes the resident had

calmed down so much they could not respond without slurring their words or not at all making

sense in response to the questions being asked to them, and even started to shuffle in their walk

and almost tripped a few times​.​ Another thing that I have noticed is that some nurses simply

immediately administer the strong sedative medications even if the patient is not anxious or

combative to prevent the behavior occurring should the patient become agitated on their shift​.

Beyond working as a CNA, my grandfather was affected by Alzheimer’s disease and was placed

into a care facility towards the end of his life, and I noticed how the nursing staff would medicate

him almost immediately when he would start to get anxious or combative with them​.​ After

witnessing this in my employment and watching my close relative go through this, I thought that

this would be the perfect topic to research to learn more about and possibly even educate some of

my coworkers about the harmful effects which over medication has on the elderly patients we

take care of​.​ I have now come to see different views on this topic​.​ While there are times that

there are no other choices but to administer medications to sedate or relax a patient, there are

way more harmful effects than benefits to the elderly being over medicated with strong dosages

and it is necessary people are educated about these effects​.

Over medication can happen to anyone in a variety of ways​.​ It can occur by taking

unnecessary drugs or from taking too many drugs for the body to handle​.​ Healthcare providers

can overmedicate intentionally or unintentionally​.​ Sometimes, healthcare providers within

different specialities do not communicate with each other and there are drugs that are prescribed

that is not really needed. Over medicating the elderly is a growing problem that is happening all
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over the United States in nursing facilities and even within home care services​.​ With the increase

in medications that the elderly are taking, there is a higher risk for dangerous drug interactions to

occur inside their body, and the side effects could lead to more problems within their health

(Gorman)​.

Elderly patient’s bodies do not respond to medications like younger patients​. ​According

to Dominick Bailey, a clinical pharmacist who specializes in geriatric care, when you give an

elderly patient a drug with a very long half-life, that drug is going to last even longer in their

bodies and systems (Gorman)​.​ In a video by SLUCare, ​Polypharmacy In An Aging Population,​

Dr. Milta Little states that the elderly do not need as high of medication dosages as they might of

once taken because the organs of the body work differently when you are over the age of 65​.

With this, the elderly patient may experience different side effects or interactions between the

medications​.​ According to Dr. Angela Sanford, when the patient has been prescribed so many

medications, it affects the way they will think or move​.​ She states that she tends to find that

elderly patients fall more and will get light headed or dizzy, along with the fact that their

thinking will become slower​.​ In this same video, Dr. John Morley tells of his colleague in

Australia who did studies and found that “when you are older, if you are taking more than five

drugs, the sixth drug you have has a twenty five percent chance of making you better or a twenty

five percent chance of making you worse” (SLUCare)​.

Laws against over medicating the elderly are in place, but they are just not being

enforced​.​ In a speech by Daniel Levinson, Inspector General in the Department of Health and
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Human Services, he states that facilities are violating federal standards for unnecessary

administration of medication and that a lot of the institutions do not abide by the federal

regulations that are put in place to prevent over medication from happening​.​ In an FDA study,

they found that “for one in five residents, nursing homes dispensed these drugs in a way that

violated the government’s standards for their use”(Levinson)​.​ An example of this is if the

prescribed dosage was too high or if the residents were on the medication for far longer than they

were supposed to be​.​ In a Human Rights Watch report, author Hannah Flamm, a New York

University School of Law fellow at Human Rights Watch, said that it is fairly impossible for a

facility to achieve good quality care in compliance with the law without having a well-trained

staff​. ​Along with this, Flamm said that healthcare staff defend administering antipsychotic drugs

by saying the see urgent signs of pain or stress as disruptive behavior that needs to be handled or

sedated immediately (Stockwell)​.

Elderly patients who have spoken up about their own personal stories of being over

medicated gives an inside look at what happens behind closed doors​.​ One patient’s nightmare

includes the story of retired preschool teacher, Aleah Davis​. ​In a KCETSoCalConnected

Youtube video, a reporter named ​Val Zavala​ interviews Davis and asks her questions pertaining

to her story with over medication​. ​Davis tells that she had hallucinated and felt like she was at

the bottom of a stairwell on the floor​.​ She recalls that during her hallucination, a doctor had told

her that she was alone, no one was coming to help her, and for her to give up trying to fight the

staff​.​ She explained that she was being over medicated to the point that she was not even aware
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of what was going on or even if she was sitting upright or not​.​ Zavala states in the video that

many times that these sedative drugs are being medicated, it is mainly to keep the patients

obedient​.​ Davis had a friend, Jill, who did not take long to realize that something was going on

when she discovered that Davis did not have any history of dementia or mental problems​.​ Yet,

she was confused and unable to communicate which did not make any sense​.​ Jill asked to be

given the list of drugs that Davis was being given and realized that the drugs, one being

Haloperidol, which is a power antipsychotic used for schizophrenics, was being administered to

Davis without any reasonable explanation​.​ These strong medications need a doctor’s prescription

and with the permission from the patient or the patient’s representative​.​ However, this step is

often skipped in nursing facilities and the medication is given without consent​.​ For Davis, no one

had asked for her permission or her representative, Jill​.​ The doctor that Davis had did not come

and evaluate her or even come to see her in person before prescribing the medications she was

being given​. ​Davis ended up getting a lawyer to sue the nursing facility she was living in during

the time she was over medicated (KCETSoCalConnected)​.

Among the medications that are frequently seen in the prescriptions of elderly patients

who are over medicated, Haloperidol makes its way to the top of the list​.​ Haloperidol, also

known as Haldol, is used to treat psychotic disorders in patients who have trouble deciphering

what is reality and what isn’t actually there​.​ It can be used to treat motor or verbal tics in adults

or children who have Tourette’s​.​ The medication is used to treat behaviors that are aggressive or

in hyperactive children that other medications/therapy does not work on​.​ Haloperidol is
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classified in a group of medications called conventional antipsychotics which works by

decreasing abnormal excitement within the brain​. ​On the warning label of Haloperidol, it states

that “studies have shown that older adults with dementia (a brain disorder that affects the ability

to remember, think clearly, communicate, and perform daily activities and that may cause

changes in mood and personality) who take antipsychotics (medications for mental illness) such

as haloperidol have an increased chance of death during treatment”(Haloperidol)​.​ The FDA does

not approve of elderly patients suffering with dementia and behavior problems to take

Haloperidol​.​ There are many different side effects that could occur if the elderly patient is taking

this drug​.​ Some include​:​ blurred vision, loss of appetite, blank facial expression, agitation,

nervousness, dizziness/feeling unsteady, headache, difficulty urinating, or diarrhea/constipation​.

Symptoms of an overdose with this medication include loss of consciousness, sleepiness, stiff or

weak muscles, slowed breathing, or unusual, slowed, or uncontrollable movements of any part of

the patient’s body(Haloperidol)​.

A second video found on Youtube discussed how nursing facilities can not use physical

restraints to hold a elderly patient down in their chairs or their beds​.​ In a HumanRightsWatch

video, ​United States​:​ Oversedation in Nursing Homes​, one of the narrators, Hannah Flamm, with

Human Rights Watch, tells about how nursing staff members administer chemical restraints to

make more convenience for themselves and make their lives easier on their shifts even though

there are laws and prohibitions on the mistreatment of the drugs being given​.​ In the video,

Flamm gives the statistic that, “In an average week, in nursing homes across the United States,

over 179,000 older people, most with dementia, are given antipsychotic drugs, often
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inappropriately and without their informed consent”(HumanRightsWatch)​. ​Within this same

video, Tony Chicotel, with California Advocates for Nursing Home Reform, informs the

audience of the video that the FDA does approve antipsychotic drugs for the treatment of

psychosis, however they are used in nursing homes to keep patients, majority with dementia,

calm and easy to manage​.​ Chicotel also states in the video that these antipsychotic drugs have an

FDA warning label stating that if the person taking the medication is elderly and suffering with

dementia, by taking the drug they almost double the risk of death​.​ The former president of the

American Medical Directors Association explains that not only do the antipsychotic drugs not do

what the doctors are prescribing them to do, but the medications do more harm to the patients

that are taking them (HumanRightsWatch)​.

Fig. 2. A comic depicting a doctor

prescribing a woman some type of

medication that will not make her feel

better at all but would only benefit the

people around her that are tired of her

whining, just like what nurses do in a

nursing facility when a patient is acting

out and the staff does not want to deal

with them (Glasbergen)​.

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Not only is over medication affecting the elderly patient’s body, but it is also hurting their

wallets​.​ According to a 2014 action plan by the U​.​S​.​ Department of Health and Human Services

“older adults account for about 35 percent of all hospital stays but more than half of the visits are

marred by drug-related complications” and “such complications add about three days to the

average stay”(Gorman)​.​ The Institute of Medicine determined in a 2006 study that “at least

400,000 preventable ‘adverse drug effects’ occur each year in American hospitals” and this can

result from the wrong medication being administered to them, or the wrong dose amount given to

them, which in turns “push health care costs up annually by about $3.5 billion (in 2006

dollars)”(Gorman)​.​ In a FDA report, they found that “about 14 percent of nursing home

residents, or nearly 305,000, had Medicare claims for antipsychotic drugs but a little more than

half of the antipsychotic drug claims for which Medicare paid should not have been covered

because the claimed drugs were not used for medically accepted indications or not documented

as provided to patients”(Levinson).

Even though tough situations occur that involve combativeness or aggression in a elderly

patient and it seems that there is no other options but to medicate to calm them down,

administering such strong medications actually do more harm than good to the elderly body and

in the worst of cases, cause death​.​ Over medication should be taken seriously as drug adverse

effects could occur when taking so many drugs together​.​ The elderly patient’s body reacts a lot

different compared to a younger patient with the drugs prescribed​.​ Family members of those who

are or have been over medicated have spoke out and showed the effects that the medications and
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dosages did to their relative​. ​They tell how much their friend, parent, or grandparent has changed

due to taking all the medications they are already prescribed and including the strong doses of

Haloperidol or other related antipsychotics​.​ There are multiple symptoms to look out for when

telling if a loved one or patient is being over medicated​.​ It’s so important as a healthcare

professional to watch the patient incase a reaction to another drug occurs or if they start to

decline due to the medication so that it’s quick to action if something were to happen​.​ Just

because physical restraints have been banned within the healthcare facilities, chemical

restrictions are happening everywhere.

In the United States, the elderly are being negatively affected by the misuse of

prescription medications. Such an exploit is not only immoral but is often in direct violation of

governed laws. Individuals should educate themselves on how to redirect aggressive patients

rather than relying on the application of powerful drugs.

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Works Cited

Glasbergen, Randy. “Pharmacy Cartoons.” ​Randy Glasbergen - Glasbergen Cartoon Service​, 19

May 2011, www.glasbergen.com/pharmacy-cartoons/nggallery/page/3.

Gorman, Anna​.​ “Has Overmedicating Seniors Become 'America's Other Drug Problem'?​.​”

PBS,​ Public Broadcasting Service, 30 Aug. 2016, “Haloperidol: MedlinePlus Drug

Information.” ​MedlinePlus​, U.S. National Library of Medicine, 15 July 2017,

medlineplus.gov/druginfo/meds/a682180.html.

“Haloperidol: MedlinePlus Drug Information.” ​MedlinePlus​, U.S. National Library of Medicine,

15 July 2017, medlineplus.gov/druginfo/meds/a682180.html.

HumanRightsWatch, director​.​ United States​:​ Oversedation in Nursing Homes ​.​ YouTube,

YouTube, 5 Feb​. ​2018, www​.​youtube​.​com/watch?v=rVm0xPYoFYM​.

KCETSoCalConnected​.​ “Overmedicated and Misinformed​.​” YouTube, YouTube, 1 Oct​. ​2014,

www​.​youtube​.​com/watch?v=CcROGhtu33w​.

Levinson, Daniel R​.​ “Overmedication of Nursing Home Patients Troubling​.​” Work Plan |

Reports & Publications | Office of Inspector General | U​.​S​.​ Department of Health and

Human Services, U​.​S​.​ Department of Health and Human Services , 9 May 2011,

oig​.​hhs​.​gov/newsroom/testimony-and-speeches/levinson_051011​.​asp​.
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Nilsson-Maki, Kjell​.​ “Medication​.​” ​Medicate Cartoons and Comics - Funny Pictures from

CartoonStock,​ CartoonStock Ltd​.​, 30 Nov​.​ 2005,

www​.​cartoonstock​.​com/directory/m/medicate​.​asp​.

Stockwell, Serena​.​ “Nursing Homes Are Overmedicating People With Dementia​.​” AJN,

American Journal of Nursing, vol​.​ 118, no​.​ 5, May 2018, p​.​ 14​.​,

doi:10​.​1097/01​.​naj​.​0000532816​.​04585​.​bb​.