While medical professionals are well-trained to deal with crises, there is relatively less emphasis on managing patients who are experiencing a gradual decline or transitioning into long term care.
Dr. David Oliver, National Clinical Director for Older People, Department of Health, UK
Consequently many people in nursing homes receive an excess number of medications, which can lead to falls, admissions to hospital and even a shortening of life in the case of some antipsychotics used to treat behavioral problems in dementia1. The use of medications should be determined by the goals and wishes of the individual and the other available care and support. For example, when treating Parkinson’s disease there is a trade-off between lucidity and mobility; this balance may change when a person moves from his or her own home to a long term care facility. Sedation, statins, antipsychotics, beta-blockers and supplemental feeds all require similar consideration.
Long term care professionals need more training in the culture and specifics of care, with a stronger emphasis on well-being (as opposed to cures), to help patients achieve personal goals rather than simply biomedical indicators such as blood pressure.
Many healthcare practitioners fail to recognize or treat conditions in the elderly that are often reversible, mistakenly believing that little can be done. A systematic approach to assessment can make a huge difference; incontinence, ‘failure to cope’ and falls are not diagnoses but consequences of underlying conditions and require proper investigation. Pain control is also often managed poorly for older people.
Dr. Clive Bowman, Medical Director, Bupa Care Services, UK
Relatively few randomized control trials include either the very elderly or people with multiple conditions, so an increase in research should reveal more about the longer term impact of multiple medications on these groups. Since trials are expensive, longer term studies should be established, with nursing and care homes contributing by providing data on their prescribing practices and outcomes.
1Antipsychotic drugs used to treat dementia shorten life, News Medical
Accessed 18 January 2013.