Chemical Restraints on Elderly

In 1987, Congress passed regulations and reforms for the nursing home industry in the Omnibus Budget Reconciliation Act. These reforms were aimed at protecting nursing home residents of their rights. The use of chemical restraints and unnecessary medications were specifically prohibited. More than 25 years later the problem has not gone away and over-medicating in nursing homes continues to get big headlines. Nursing home residents and their families must be vigilant and make sure their rights and their health are protected from chemical restraints.

What Are Chemical Restraints?

Chemical restraints are drugs that are used for discipline or convenience instead of medical purposes. Most often, chemical restraints are used in nursing facilities to sedate and pacify patients whose behavior is too aggressive or unruly for the staff. When medications are used to treat illnesses or protect the safety of a patient, they do not qualify as chemical restraints. They only qualify if they are used to punish patients or to make them easier for staff to control. This usage of chemical restraints is a violation of federal law.

Any type of drug that has calming or disorienting effects can be used as a chemical restraint. Some of the most common types of drugs used for this purpose are:

  • Antidepressants
  • Antipsychotics
  • Mood stabilizers
  • Anxiolytics
  • Sedative-hypnotics

The Harmful Effects and Risk of Chemical Restraints

Chemical restraints are incredibly dangerous. Using powerful psychotropic drugs has clear risk on a person’s physical and mental health, and should only be used when absolutely necessary. Chemical restraints on the other hand are used when there is no clear medical purpose. Because the users are elderly and are often taking more than five medications already, the risk of harm is greatly increased. According to the FDA, unnecessary use of antipsychotic medication kills 15,000 nursing home patients every year.

Of all the drugs used as chemical restraints, antipsychotics are the most widespread and may be the most dangerous. The federal government has spent years warning facilities about their dangers, especially the damage they can do to the heart and cardiovascular system of someone with dementia. Despite these warnings, more than 88% of the antipsychotic drugs used in nursing homes are used on patients who have dementia.

Using these drugs unnecessarily will expose a patient to a number of other risks and harmful effects including:

  • Increased dependence and functional decline
  • Loss of memory
  • Agitation
  • Withdrawal and depression
  • Orthostatic hypotension
  • Loss of mobility and strength
  • Increased risk of accidents and falls
  • Low blood pressure
  • Muscle disorders
  • Adverse drug effects

Unnecessary Use of Drugs

According to federal law, each patient has the right to be free from unnecessary medication. If you believe that your family member is being unnecessarily medicated in a nursing facility, you should examine their drug regimen and consult with a physician. The federal government defines unnecessary drugs as any drugs used:

  • In excessive dosages
  • For excessive lengths of time
  • Without a clear medical purpose
  • Without adequate monitoring
  • That may cause serious adverse effects or interactions

Physician’s Order and Informed Consent

Psychotropic drugs cannot be administered legally without a doctor’s order. The doctor’s order should specify the medical reason for the drug, the conditions in which it will be administered, and the length of time that the prescription will last. The facility must also obtain informed consent of the patient or the family before they can legally administer the drug.

Theoretically these protections should prevent the use of chemical restraints, however, that is not always the case. Some patients and families are not given adequate information about the effects and risks of suggested medications, therefor provide consent in situations where they would not if they had been provided correct information. Always get as much information as you can before approving the use of a new drug. Find out what it’s medical purpose is as well as what risks it poses to you or your loved one.

Sources:

Hughes, Rhidian. “Chemical restraint in nursing older people.” Nursing Older People Apr. 2008: 33+. Academic OneFile. Web. 1 Mar. 2014.

Kidder, Samuel W. “The Chemical Restraint Debate.” Geriatric Times 1 May 2002: 40. Academic OneFile. Web. 1 Mar. 2014.

Yu, Chieh-Chen, and Hui-Chi Huang. “Chemical Restraint and Nursing Care in the Intensive Care Unit. [Chinese].”Journal of Nursing 57.6 (2010): 83-88. CINAHL Plus with Full Text. Web. 1 Mar. 2014.

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