In our health-care system with limited personnel, medications have become the standard for treating dementia instead of education, training and support.
Hospitalized older adults living with complex care needs and dementia have limited control of their lives.
The current crisis in Canadian health care negatively impacts older adults’ lives more than any other demographic.
Older adults living with complex care needs often require hospitalization, many times followed by transition to long-term care. Accessing the hospital or long-term care can be a challenging experience in the current system.
Older adults who require hospitalization and can no longer return to their homes may wait months for a move to long-term care.
Suppose that person lives with dementia and happens to express themselves with protective responses such as restlessness or antagonism. In that case, their wait time often becomes even longer.
Hospitalization is stressful and may trigger increased protective responses. A person living with dementia is soon labelled as a “difficult patient,” someone to be afraid of, and a person whose behaviour should be managed through antipsychotic medications as a condition for their transition to long-term care.
Antipsychotics are used with the intent to stop persons living with dementia from wandering into other people`s rooms or from saying or doing “inappropriate” things. However, these medications do not prevent someone from wandering, entering other people’s rooms, or calling out.
In this context, antipsychotics are being used as a sedative, putting the person living with dementia at risk for falls, decreased hydration and decreased calorie intake. More importantly, antipsychotics significantly increase the risk of stroke, pneumonia, and mortality (Holmlund et al., 2024).
Often, the use of these medications reduces their quality of life by making it difficult to communicate with family members and friends.
When appropriate, antipsychotic medications used with persons living with dementia can improve their quality of life. The problem occurs when antipsychotics are used as a chemical restraint to force a person to fit into a system.
Families of a person who is in the hospital exhibiting protective responses feel they must be at the bedside the entire time for fear their family member could be restrained to the bed or that care may not be provided because staff feels threatened.
Are we managing protective responses for persons living with dementia, or are we using chemical restraints?
In the current health-care system operating with limited personnel, medications have become the standard instead of investing in education, training, support and integrating family caregivers into care teams.
As a society, we have accepted treating persons living with dementia as if they were less of a person. Not knowing that as we grow older, the person living with dementia may become us.
Mariana Ribeiro is a PhD candidate with the College of Nursing at the University of Saskatchewan. Roslyn Compton is an associate professor with the College of Nursing at the University of Saskatchewan. They write on behalf of the Interprofessional Experiential Education Long-Term Care Consortium.
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