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Geriatric care from loved ones will clear the “fog of psychotropic drugs” 02/19/2011

Posted by ALT in Alternative Lifestyles, Mental Health of the Elderly.
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This recent piece from the NY Times shed a few rays of light on the issue of psychotropic drugging  in nursing homes (they call it the “fog of psychotropic drugs”). It’s a subject not often talked about—but the elderly make up a very significant (and growing) chunk of the market for psychotropics. In 2004 a national survey found that 25% of nursing home residents were taking psychotropic drugs, many of them on potent cocktails of 2-4.

A nursing home which made an attempt to step down the medication of its patients (and with excellent results) was the feature in the Times. This is encouraging, especially in light of some disturbing statistics about the harm over-medicating the elderly can cause:

  • 10-20% of adults over the age of 65 who go to the hospital do so because of prescription medicines that have been taken improperly.
  • 1 in 3 elderly hospital patients becomes sicker during hospitalization because of prescription drugs.
  • Up to 140,000 seniors die each year because of problems with medications—three times as many people as die from breast or prostate cancer, which are both considered public-health emergencies.
    (from the research of Dr. Andrew Duxbury)

Now, geriatric professionals claim that psychotropic medications are necessary because: 1. the all-too-common condition of clinical depression in the elderly is best addressed with SSRIs 2. the early stages of so-called “dementia” involve a lot of disruptive behavior that is not conducive to institutionalized “order” nursing home staff generally require.

In short, psychotropic medications are a way to suppress the feelings (quite legitimate, in my mind) of some “residents” that they don’t want to be there, they don’t like the way they’re being treated, and that something is very wrong with a world where the elders are left to finish out their days in an institution, cut off from the rest of society that is so desperately in need of their wisdom.

When there aren’t nursing homes

Not every country is quite as “advanced” as the United States when it comes to geriatric care; in a lot of places the elderly are cared for by their children (not professionals, and with no official “certification”), at home.

I had the privilege to witness this personally. In the summer of 2008 I spent about two months in Oaxaca, Mexico — one of the poorest states in the country; it also had the second highest indigenous population. Much of that time was spent in a small village, called “Totontepec,” high up in the mountains. The folks there were from an indigenous group called the “Mixe” (pronounced MEE-hay), and nearly everyone was bilingual, speaking both Mixe and Spanish.

Totontepec

The Gomez family – Vidal and Eusabian (husband and wife), Eusabian’s sister Maura, and their mother (we just called her “Mama”) – welcomed me with open arms. They showed me their life together, subsisting mostly off the food they grew in their milpa, working and laughing together most of the day. I will never forget their kindness…

Maura (left) and Eusabian (right)... sisters

Mama, happy at home.

Mama had Alzheimer’s, and it had progressed to the point where she didn’t always recognize everyone, had trouble bathing herself, was sometimes incontinent, and was telling the same jokes every 5 minutes or so (I gather she was quite the humorist in her younger years!). But she was cared for in house, not as a favor or duty, but as a matter of course.

At that point in my development, I didn’t question the necessity for nursing homes. Elderly people need to have somewhere to go, right? And their children are likely too busy with their careers to take care of them. So it makes sense that they should go to nursing homes!

But in Totontepec, the number one priority is taking care of family. That is your career. You walk the mountain road to the milpa in the morning for the family. You grind the corn into masa and cook tortillas on the metate for the family.

And you have a grand time doing it, laughing the day away with smiles and love and compassion, with the ones you love!

Through halting dialogue (my Spanish at the time was atrocious), I tried to express my admiration for them, for the care they gave their mother. They really couldn’t understand it, because they couldn’t conceive of another way. So I tried to explain about nursing homes. I’m not sure how much I conveyed, but I read expressions of dismay and perhaps horror on their faces. What a place! God, save us.

From my Oaxaca journal:

July 1, 2008
But the thing is, these people are letting their mother, who has Alzheimer’s, can’t remember a blessed thing, and hockers incessantly, live with them; they’re taking care of her, and not grudgingly, either. They love her, and she knows she’s loved. She can’t be left alone, so someone is always home to take care of her. She sleeps in Maura’s bed – sometimes (3 or 4 times since I’ve been here, I think) she wets the bed. They just laugh it off!

As it is with the young, so it is with the old – the best caregiver will always be the one who feels an unconditional love for you, the one who shares that bond. Love of this kind makes the caregiver infinitely sensitive, considerate, and compassionate. What Mama needed in order to be comfortable and cared for was, above all, unfettered/uninstitutionalized human contact, the hand of her daughter on her shoulder telling her that she’s loved.

What I learned that July: I will be that daughter someday. Happily, and with all my heart.

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