A friend told me recently about her father, who has dementia and lives in a care home.
Once the most gentle of men, he now has spells of frustration and aggression. A couple of weeks ago he grabbed the hand of a care worker, and in the tussle that ensued two of her fingers were broken. His daughter knows he did not mean to hurt this woman, although he was plainly reacting violently to something - real or imaginary - that was upsetting him. Now he has been put on sedatives, to make sure such an episode does not happen again.
In this instance, one can just about understand why a doctor might feel the need to medicate and modify his behaviour. Yet the thought of this man, already befogged and confused by dementia, being further removed from reality and his old self by the chemical equivalent of a straitjacket, is truly distressing.
If only his were a unique case, but sadly it is not. A deeply worrying report has been published which shows that almost half of over-65-year-olds living in Scottish care homes are on powerful psychotropic and sleep-inducing medication. Now, I don't know if the sedation my friend's father is on falls into this category, which includes a battery of antidepressants and tranquillisers. Either way, the problem remains. One begins to suspect that troublesome residents are being kept in line, simply to make life easier for those in charge of them.
Evidence seems to bear this out. While only 12.1% of this age group who live at home are given psychotropic drugs, that figure rises to 41.6% for those in care, with more men being prescribed such pills than women. Those in care might, of course, be more anxious or unhappy, their conditions more advanced, or their mental defences lower. And some of the elderly living at home might themselves benefit from the use of such drugs, if judicially prescribed.
Even so, nightmarish images from One Flew Over The Cuckoo's Nest are hard to banish, as one thinks of vulnerable inmates in the power of those who might not have their best interests at heart. People with dementia often cannot describe their symptoms or feelings accurately to a doctor. The testimony of an overworked or fearful carer or nurse is likely to be taken as a more rational assessment, and accorded greater weight, than the less coherent or agitated resident's statement. Given the appalling treatment we know some of the elderly have endured in homes and hospitals in recent years, the idea of authority being abused, or scores settled by those with power, cannot be ruled out. Already one's faith in the quality of treatment of elderly patients in care is diminished, following recent news that in seven out of 10 cases, their medication is wrongly administered.
A shiver ran down my spine on reading a senior care worker's comments on the revelations about psychotropic drugs. It was, he said, "an unavoidable treatment to ensure the health, safety and welfare of the individual and the wider resident group". More sinister still, he said budgetary restraint "can limit options available to GPs and care-home managers".
It could be a line from 1984, or one of Margaret Atwood's apocalyptic novels. Clearly, in certain medical or managerial circles muffling the moods or minds of their charges is justified if it helps meet budgets or cut down on work.
Anyone who has been in a care home is familiar with the torpid, underwater atmosphere. Their lounges are like dentists' waiting rooms, walls lined by people in chairs staring silently into space, waiting their turn, though for what nobody but Samuel Beckett could say. Whenever someone raises their voice, a carer hurries to quieten them. Often the television is turned up loud, less for the deaf, one suspects, than to inhibit any sort of interaction, in case someone grows disruptive, or homesick.
Research may one day show that residents prescribed this high-powered medication represent a serious danger to themselves and others, or would be unbearably miserable without them. Until then, one harbours the sickening fear that many are being subdued to save the time and effort proper care and concern would entail. By this measure, the elderly are no longer seen as people but only as a problem. That is a bitter pill to swallow.
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