2.1.2.2 Supply of medication
The commissions have repeatedly found that there are deficits in
nursing homes regarding prescription of medication, informed
consent and measures that deprive people of liberty by way of drugs
as defined in the Nursing and Residential Homes Residence Act.
Persons with dementia often experience increased restlessness,
disorientation or high activity levels in the late afternoon and evening.
With the progression of the disease, it often happens that those
affected wake up several times during the night and want to get up.
Sleep is interrupted for a lengthy period of time by activity resulting
from night time disorientation. Those affected become lost as to time
and place, believe it is time to get up and want to undertake work that
they had been accustomed to in the past. They forget that they were in
bed, they no longer know where they are, and want to go home. The
lack of sleep at night is compensated by increased phases of sleep
during the day.
Currently, residents of nursing homes are frequently in their beds by
late afternoon, having been given sedating medication. However,
sleep disorders in persons with dementia cannot be treated by way of
drugs alone. Rather, medication to improve sleep must be combined
with treatment of the dementia (e.g. with anti-dementia drugs),
treatment of physical or psychological secondary illnesses and nondrug treatments.
The too uncritical use of sleeping pills and tranquilisers has serious
negative health consequences and significantly restricts the mobility
and quality of life of the elderly. The commissions have objected to this
many times and recommend a quarterly regular inspection of drug
plans in order to make the use of medicinal products safer. The
commission saw the lack of psychiatric diagnoses by specialists as the
main reason for prescriptions and doses of psychopharmacological
medications that did not appear transparent, but also the fact that the
general practitioners practicing in nursing homes often refused to
consult psychiatrists.
Doctors who treat behavioural changes and the psychological
consequences of dementia must be very aware not only of the effects
of certain psychopharmacological medications and their particular
impact on seniors, but also of any harmful side effects they may
produce in the elderly. They must also know how behavioural and
mood disorders can be created and changed by social and
psychological conditions. This requires concepts that promote
structuring the day by creating stimulating living spaces, needs-based
mobilisation, communication, participation in the community, etc. This
includes scheduling opportunities to access the outdoors during the
day.
33
Non-drug treatments
are important
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