Disclaimer:
“We must be mindful that for many people, specific and individual symptom relief, or treatment, requires medications that alleviate suffering for that person.
This may include the prescription of psychotropics.
Medications for the ‘right’ reasons and in the ‘right’ circumstances may be crucial to well-being.
Chemical restraint is determined to be abusive when:
- No medically identifiable condition is being treated.
- Where the treatment is not necessary for the condition.
- Used to overtreat a condition.
- Part of the intended pharmacological effect of the medicine is to intentionally sedate the person for convenience or for disciplinary purpose. Elder abuse is one of the most heinous and vilest indicators of ageist discrimination within our current civilization. Whilst the concealed ignominy of elder abuse has recently grown in visibility, it remains an area that is poorly examined and rarely resolved. Chemical restraint, one of the manifestations of elder abuse, when misused, remains an extremely contentious and provocative topic.
It should be questioned why this subject remains so controversial when the answers are undeniable. Let us today, scrutinise chemical restraint, and hopefully conclude that this outrageous practice is routinely structured in a manner that blithely overlooks malicious, abhorrent misconduct, and corruption. In the residential aged care sector, federal law stringently forbids the use of chemical restraint for reasons such as convenience, castigation, or any non-medical motive. Supposedly there is an alleged understanding that medicating people is not acceptable unless, during catastrophic occasions where a person’s changed behaviour severely endangers him or herself, or the safety of others, and the risk of harm is considered extreme. Is this the case in general? I believe not! It is also implied that, even within these specific circumstances, the use and extent of the prescribed chemical restraint must then be transparently defined. Is this occurring?
Again, there is little evidence of this. It has been indicated for years that management of stress related responses and changed behaviour displayed by people living with dementia, relies essentially on medications that sedate.
This is despite significant data that establishes these types of pharmaceuticals have inadequate usefulness and are often the source of substantial negative and mortiferous side effects.
Correspondingly, there is little to no verification, demonstrating that when cognitively aware people exhibit the very ‘same behaviour’ in day-to-day life, they receive the same inappropriate and obnoxious treatment.
Vulnerable prey:
Stereotypical perceptions, stigma, and ageist attitudes may mislead those that care for people with dementia, fostering a narrowminded harmful interpretation that no longer focuses on the person, their strengths, capabilities and worth, but instead dehumanises them, defining them purely as a diagnosis of dementia.
We additionally tend to habitually disregard the fact that majority of people with dementia have lived rich, full, rewarding, symbolic realities, just as we have or do, and the only variation in their present reality, is a change in cognition.
No medical condition, physical or cognitive, can, nor should ever, remove a person’s basic and fundamental sense of self.
Only society can achieve this by debasing another through vicious pernicious cycles that consist of prejudicial bias, marginalisation, ostracization, and segregation, in line with the disquieting anecdotes and real-life encounters as described by countless people with dementia.
It could be debated then, that this type of degradation may technically be regarded as intimidation and discrimination in its highest form.
Why do we continue to conveniently ignore and address the inherent need for justice here?
The flawed postulations presented by many, regarding what changed cognition supposedly looks like, has likewise become the impetus to a disturbing and unequal dynamic between people with dementia and others, especially when interacting and attempting to connect.
We seem eternally reluctant to adapt to the challenges faced by a person with dementia, when they are perhaps unable to articulate or ‘verbally’ communicate their needs are not being sufficiently met, or if they are not given opportunities to express specific individual preferences or may have difficulty discussing incidents that make them feel uncomfortable or defenceless.
Hence, people with dementia may often be portrayed and treated as if they have lost their humanity, and it can be wrongly assumed they are unable to make any independent decisions in relation to themselves.
When we make uninformed assumptions about people without even bothering to perceive life through their lens and condemn them for endeavouring to divulge a message to us through normal responses we label as “behaviour”, we are essentially and calculatedly silencing and gagging them indefinitely.
I cannot imagine the core suffering, torment and anguish that would result from such ongoing victimisation and bullying.
It has therefore become glaringly apparent that people living with dementia, especially those residing within certain residential aged care establishments, may be exceedingly prone to becoming covert targets for the rampant misuse of chemical restraint, as a consequence of this distorted and toxic dogmata.
The prevalence and overuse of psychotropics in some aged care homes, still appears to be utilised with a worrying, and predictable intent to chastise, or suppress a person’s right to speak up, conveniently justified under a concealed, rationalised, and shameful guise that suggests it is a ‘reasonable’ necessity for the management of an ‘alleged’ changed behaviour.
There is scant evidence to support how, why, and when, preying on the most vulnerable became a normalised approach to caregiving, and how this then became a catalyst to people with dementia becoming exposed to ongoing, abusive, contrived situations where they are stripped of their free will, rendering them powerless to negotiate a situation or be insistent on a particular level of care.
Even more concerning, is the so-called, convincing advice offered to informal care partners within the home environment, in which they are consistently misinformed, their ignorance taken advantage of, and they are cajoled into believing medicating relatives and/or friends is viewed as ‘common practice’.
Unfortunately, due to lack of support, advice, and guidance, the abusive practice of chemical restraint pervades the lives of people with dementia before they even enter into a residential aged care home, and ergo generates a status quo where ‘everyone’ may be easily influenced into medicating any person they may care for.
Consequently, it should be concluded at this point, that the prominent, undesirable implications of chemical restraint, are, in majority of cases, detrimental to positive ageing for any person living with dementia, denying them an appropriate level of care, disabling them, and expunging all opportunities to live a productive and fulfilling existence.
We must ensure every person with dementia retains the same and distinct civil liberties as they always have, are listened to, and are given a voice to demand, and receive, a continuation of life as they know it and choose.
The abnormal has become accepted as normal:
The common thread identified, in relation to chemical restraint, has thereupon become one of acceptance.
“Dosing people up” has subsequently become the ‘norm’ in way too many cases and is at times, perpetuated and encouraged by numerous aged care professionals.
When medicating one another for ‘being different’, becomes admissible and tolerable, and remains unquestioned, then we truly must look inside ourselves and challenge this process for the deplorable, degrading, inhumane process that it truly has become.
To that end, the consistent prescribing of sedatives, tranquilisers, anti-psychotics, mood stabilisers, and anti-anxiety medications (psychotropics), galvanised for the ‘management’ of changed behaviour, demands serious enquiry, and should be confronted as sickening, undesirable and objectionable because of the grievous and detrimental repercussions connected to the exploitation of these medications.
The numerous adverse effects associated with the misuse of psychotropics, are such that none of us would choose, nor enjoy, having thrust upon us so unjustly and reprehensibly.
It is commonly discussed that medications used as a form of restraint, create decline in health status, endorses disrespect, condones ruthless removal of choice, and may likely place a person with dementia in a position of life-threatening risk.
This includes, and is not limited to the following: stupor, lethargy, physical deterioration, drowsiness, poor mobility, increased risk of falls/serious fall related injury, debility, incapacity, loss of independence, malnutrition, dehydration, decreased cognition, annihilation of personal identity, and evident destruction of all that keeps us whole.
May I add that risperidone, (the most frequently prescribed atypical anti-psychotic used in residential aged care), has a black box warning printed on the outside of the packaging that prominently states:
WARNING: INCEASED MORTALITY IN ELDERLY PATIENTS WITH DEMENTIA RELATED PSYCHOSIS. Elderly patients with dementia related psychosis treated with antipsychotic drugs are at an increased risk of death. Risperidone is not approved for use in patients with dementia related psychosis.
Further it is discussed that the dangers directly linked to prescribing risperidone for people with dementia related psychosis, may result in: CVA, (stoke), Neuroleptic Malignant Syndrome, (muscle rigidity, altered mental state, irregular pulse and BP, cardiac disease, elevated creatine, and acute renal failure), Tardive Dyskinesia, (a syndrome of potentially irreversible, involuntary, dyskinetic movements – muscle twitches and fatigue), Hyperglycaemia (high blood sugar) and Diabetes, Orthostatic Hypotension, (blood pressure that drops suddenly when standing causing dizziness, faintness, confusion and blurred vision), potential for exacerbation of cognitive and motor impairment, dysphagia, (difficulty swallowing), and seizures.
Oh my god!!!!! Are you kidding me?
Thus, it could be argued that by condoning the use of chemical restraint we are deliberately exacerbating and amplifying enfeeblement and infirmity, directly correlated to our evident and seemingly thoughtless negligence.
Moreover, by manipulating the use of psychotropics for unsubstantiated grounds, we induce an expanse of incremental complications and co-morbidities of which we consistently whinge and whine loudly about.
Basically, when we mindlessly, and blatantly “benumb and bomb people out”, we may inflame and aggravate further changed behaviour, creating, and generating a further evil spiral of carnage inclusive of triggering the onset of clinical deterioration in the context of acute delirium, (a medical emergency). and depression.
Of course, we may then haphazardly continue over-medicating individuals, based on amplified and more frequent responsive behaviour, as they endeavour to inform us that these accumulative and incremental noxious pharmaceuticals are propagating complications that are crucifying their very existence.
In turn, by not ‘listening’ to these exchanges we may be intrinsically demolishing a person’s entire spirit, and everything that represents their self-image.
And all because we just don’t get it! Or just don’t care enough to change.
What are we doing people?????
This is a moral outrage.
As educated people we should know better.
Overuse and mismanagement of chemical restraint is a pertinent indication of elder abuse:
I question this tyrannical, disheartening, and destructive attitude of drugging a populace, who, are, simply attempting to honestly send a message to us in the very best way they can.
When a person with dementia exhibits changed behaviour, they are clearly demonstrating to us that they legitimately feel their needs are not being met.
They may feasibly be in pain or discomfort (physically and/or emotionally), may be frustrated, or experiencing suffering associated with crippling, desolation, and despair, depleting them of the will to continue.
Yet those in the supposed ‘care giving industry’ lack the perspective, and compassion to appreciate how eternally formidable this must be.
Honestly, would we all not be resistant if treated in a disrespectful and undignified manner? Or if a person made us feel uneasy or distrustful? Or we were not given adequate pain relief, and were being dragged out of bed whilst our stiff aching joints screamed out in agony? Or, if our personal choices were not adhered to? Or if we were hungry? Or if our environment was unfamiliar, terrifying, and confusing? Or if we were grieving? Or if we had unfair expectations imposed upon us? Or if people kept changing our recognisable customs and routines? Or if we had a bad night’s sleep? Or if every single aspect of our life was ripped from us, leaving us in a position where we had no control, purpose nor links to our own lived truth? Or if no one ever bothered to meaningfully engage with us ever again, possibly for decades? Or if we were frightened? Or lonely? Or if we felt invisible? Or if we were prescribed a cocktail of medications that made us feel absolutely crap?
How are such devastating and soul-destroying experiences not regarded as logical and rational justifications for behaviour that is apropos to unfulfilled need?
Equally, and herewith, how disgustingly condescending for us to even presume that only people with dementia display changed behaviour when we all quite evidently and vociferously convey, through our own behaviour, those moments when we feel our rights have been flagrantly overlooked.
Do we not get annoyed, angry, irritable, frustrated, anxious, sad, unhappy, and cranky, flip out at our relatives or friends, screech at our kids, throw things, or slam doors??
Would we drug our children for having a hissy fit down the street? Does our workplace sedate us for having an assertive opinion or standing up for our rights in a meeting? Do teachers tranquilise students for misbehaving in class??? Does a shopkeeper retrain a client who becomes angry over poor service? Do people medicate us for strolling down the street aimlessly for 2 hours, window shopping?
Why then, when a person with dementia acts in the exact same manner, do we immediately run to the medication trolley to shove yet another handful of pharmaceuticals down their throat?
How dare we declare this an altruistic and caring attitude?
Arguably, I must emphasise again, that medicating people because you do not understand them is viewed as premeditated, deliberate scandalous behaviour on ‘our’ part and is without doubt considered “elder abuse”.
Conversion of societal inhumanity:
Accountability is now required, with a weighty change in culture and philosophies that cease demonising, judging, and labelling a person living with dementia as a ‘condition’ or as a ‘behaviour’.
The predominance of overuse and abuse of psychotropic medication, when caring for people with dementia, must ultimately, be challenged and gravely reflected upon.
May I again reinforce, the frequency of changed behaviour is most often related to ‘our’ behaviour and condemnatory attitudes towards people with dementia?
It is time we consciously acknowledged that it is our own subjective cognitive expectations that often provoke majority of stress related behaviour in another.
In fact, it’s as if we choose to intentionally misunderstand the rhetoric behind expressing oneself through behaviour.
Conjointly, health professionals and care partners often make the mistake of catering to their own needs first, which directly impacts on the care of a person living with dementia.
We again have everything upside down, because as I see it, we are supposed to be the ones delivering the service here, not the other way around.
It is time to remove our heads from the sand and moved forward from these old archaic, negative care philosophies.
If we could only adjust ourselves, and become more flexible in our approaches, then the preponderance of changed behaviour would possibly be entirely eradicated.
All persons have the right to speak up about their frustrations in the most sincere, genuine way they know how whether verbally or through their behavioural responses, or by other means of effective interaction.
We, as cognitively aware individuals should contemplate reaching into ourselves, utilise our powers of empathy, ‘listen’ to the meaning behind changed behaviour, and learn the language of dementia.
Surely this should not be so eternally difficult for us??????
Learn the language of dementia:
Dementia strips people down to the essence of their being and frees them to be in direct touch with their emotions. They tend to communicate with greater authenticity than our customary conventional reliance on controlled emotive expression.
Some people living with dementia may also find that dementia conveys experiences and potentialities that those of us without the condition cannot even imagine, and furthermore, there are most probably no specific ways for them to articulate this verbally.
Sadly, our dependence on the dialectal aspect of language appears to have become extremely uncompromising and rigid, and indeed, we seem to be enormously disinclined to recognise, encourage, and rejoice in differing abilities related to imparting a message.
This unfortunately may deprive every one of us.
It could even be professed that we penalise and punish people with dementia for their alternate and quite ingenious method of informing us how they are feeling through both verbal and non-verbal means, and person to person contact.
What right do we have, to remove a persons’ autonomy and personhood, effectively rejecting and dismissing their methods of interaction, through over-medicating them, just to make our own task orientated little worlds easier?????
This level of heartlessness is merciless, unacceptable, immoral, and intolerable.
Conclusion:
Chemical restraint is a crucial area requiring urgent responsiveness and action, to ensure people with dementia no longer suffer at the hands of those who demean and abuse their human rights, when they are defenceless and exposed.
Stereotypes become part of how we think, how we believe one should act at certain times of their life and how older persons should behave. When interrelating with people living with dementia, we may erroneously make unfitting choices for them by permitting our tainted biases to take preference, thereby misrepresenting their personal and individual characteristics, and undermining and impinging upon their dignity.
This hideous shrouded process of exploiting psychotropics when caring for people with dementia, remains ominously alarming, given the misuse of these medications are routinely discounted, ignored, or expediently deemed unimportant.
Coupled with the emergence of a seemingly massive unequal power play between care providers and people with dementia, many caregivers are sanctioned and often empowered to over-medicate.
We are witnessing a despicable culture deeply embedded within a false façade that secretly implies it is okay to dope a person up if they are classified as ‘displaying a changed behaviour’.
The continual and repeated excuses, and the pathetic whitewashing we hear, endorses an obvious and definite lack of benevolence and sensitivity, shaping damaging tactics that are not viewed as acting in a person’s “best interests”.
Thus, it remains the responsibility of all authorities, to establish methods of monitoring and preventing this ‘dirty little secret’ from ravaging and disempowering those who are exceedingly susceptible and at high risk of having their constitutional freedom abused.
Sitting in an armchair for the remainder of your lifecycle, drooling, is not enhancing a person’s health and welfare. It is an utter travesty and disservice that is radically considered gross neglect pure and simple!!!!!
How dare we force this indignity on any human being, as a result of our own unbecoming inadequacies, and wretched limitations!!!
The task of caring for another is a privilege that we must take seriously, for are we not supposed to ‘care’ and ‘honour’!! This inherent code adheres to benefiting mankind, not sabotaging it.
Should we not, as care partners, be adhering to a code of ‘compassionate care’, and therefore vehemently speak up on behalf of people living with dementia?
Additionally, and judiciously, it should be determined preferable to reduce the use of any psychotropic medications, since they are related to such a high degree of harm, henceforth destroy quality of life.
This is a no brainer!
The criminal justice system does not presently have sufficient avenues to control or prevent elder abuse, so it is time for society to take a stand.
However, we have an obligation to demonstrate how inherently abominable chemical restraint is and make it clear this will no longer be tolerated.
We must, accordingly, cease breaching our duty of care by mistreating those who are most vulnerable, and who are often forced to agonize through elder abuse at its worst and most cowardly.
We are the ones who instigated the use of restrictive practice, so we are conversely, the ones who can easily reverse it.
Recognising that this concern is very ‘real’, and admitting that even in todays’ civilisation, this type of malignant contempt for a person with dementia continues to occur, is the first step to approaching and navigating this issue.
Accountability and culpability is a must!
The next initial stage requires a devotion to, and solemn investigation into the evil actuality of chemical restraint.
Henceforward this truth ought to drive the development and application of recommendations and rigorous frameworks that dictate zero tolerance towards any abusive or restrictive practice, whilst elucidating and clarifying professional responsibilities.
It is proposed this should comprise of and encompass stringent information systems and services, encompassing mandatory training in which we equip health care workers with the skills required to provide care that is responsive to people with complex physical and cognitive care needs, and involves fostering enabling and inclusive societies in which people with dementia continue to thrive and flourish.
It is paramount that active prevention of elder abuse, and chemical restraint, is avowed and declared publicly through informative awareness, and a statement of commitment from all health professionals, to the public and our community, uniting the world to fight against this foul attitude.
As a collective, humankind must be motivated to transform their penchant for fearmongering, partisan intolerance, and conditioned, preconceived bigotry towards people with dementia, espousing this with changed behaviour, thus uphold a integrated voice of activism that defends individual autonomy, supports well-being, and acknowledges each person’s right to equality and “Freedom of Expression”.
This may then provide a foothold in which we may build upon to promote responsive interventions that establish and restore balance within this deranged dynamic.
Once attained, the valuable facilitation of person-centred “partnerships” may finally develop into norms that are socially meaningful and personally significant to us all.
Let us advocate for those who have been violated and forced to endure this atrocious cruelty in silence, and deliver a loud, powerful, and courageous voice, showing strength in the face of such sadistic, vicious negligence, thrust upon those who cannot fight for themselves.
Shame on us!!!
I rest my case.