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Under Medication in Nursing Homes

It is the responsibility of nursing home staff to make sure that residents are taking the prescribed doses of their medications. Under medication occurs when patients are receiving less than the prescribed dose or are receiving their medication less often than prescribed.

This can happen for a variety of reasons. Sometimes there is confusion regarding the medication, or it is caused by caregiver error due to understaffing and inadequate individual attention. In extreme cases, it is also possible that the patient is intentionally reducing his doses or one of his caregivers is misallocating or stealing a portion of the medication. Though under medication is a common problem in nursing homes, it can lead to serious health problems. A nursing home that is intentionally under medicating is violating its duty to its patients, and this behavior cannot be tolerated.

Harmful Effects of Under Medication

There are many different potential health consequences if a nursing home resident is being under medicated, and it often depends on what prescription he is receiving to determine exactly how his body will respond. Obviously, most medications are prescribed by doctors to address certain physical and mental health issues, and without receiving treatment, these problems will continue unabated. Possible consequences include:

  • Chronic and extreme pain
  • High blood pressure
  • Dementia and cognitive decline
  • Vomiting or diarrhea
  • Organ failure
  • Reduced immune response
  • Higher levels of fatigue
  • Emotional volatility
  • Ineffective rehabilitation

Effects Stemming from Chronic Pain

Some patients desperately need medication to deal with intense and consistent bodily pain. When they don’t receive their medication or receive it in smaller doses than they require, the increased pain can cause several problems. For example, the patient may suffer severe extreme emotional distress and have difficulty breathing or sleeping. Chronic pain can also prevent improvement of health and can cause mental disorders to develop within the patient.

Effect of Under Medication on Dementia

Some studies suggest that under medication for the treatment of cardiovascular diseases can contribute or hasten development of dementia and other cognitive disorders. Though this connection is still being researched, it is possible that a weaker cardiovascular system is less able to provide oxygen for the brain. It’s very important that those with diseases such as heart disease, diabetes, and hypertension receive appropriate levels of medication in order to prevent lasting cognitive damage.

Preventing and Detecting Under Medication

Prevention of under medication and recognizing it while it’s happening can be very difficult. As an elderly patient or family member, the best thing you can do is be knowledgeable about all of the prescriptions and dosages. Be observant and monitor how often and how much of the prescription is being administered, and don’t be afraid to talk with the caregivers to confirm that the medication orders are being followed.

It is not always easy to detect if you or your loved one is not receiving the proper amount of medication. If you notice any of the harmful effects described above, you will want to work with the caregivers and physician to determine what is happening, and you might discover that it is due to under medicating. Generally, if the patient’s condition is not improving as it should under the drug, you should investigate whether the drug is being administered incorrectly or if it is simply not working. You should look for any symptoms of under medication such as:

  • Higher levels of pain than normal
  • Abrupt worsening in condition
  • Mood swings and aggression

If you discover that under medication is happening, immediately alert the caregivers, your physician, and supervisors at the facility. Under medicating a patient is a clear form of negligence and intentional misallocation of prescription drugs can be illegal, so nursing facility staff will be more careful in the future if you demonstrate that you are paying attention.


“Elder Abuse and Neglect.” HelpGuide.org. HelpGuide.org, n.d. Web. 2 Mar 2014. <http://www.helpguide.org/mental/elder_abuse_physical_emotional_sexual_neglect.htm>.

Lopponen, Minna, Ismo Raiha, et al. “Dementia Associates with Undermedication of Cardiovascular Diseases in the Elderly.” Dementia and Geriatric Cognitive Disorders. 22.February (2006): 132-141. Web. 2 Mar. 2014. <http://www.karger.com/Article/Pdf/93739>.


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