The Use and Abuse of Antipsychotic Drugs in the Elderly

The use and abuse of antipsychotic drugs, particularly in the elderly, is a widespread problem.

Physical restraints are generally illegal, especially in the aged and frail because it is so easy injure them using physical bed restraints (tying them to the bed!) They have frail bones and its easy to tear their delicate skin. Not to mention it is degrading and inhumane.  We just don’t tie people up in nursing homes anymore.

Nevertheless, institutions are often horrifically understaffed and those on staff are overworked. So institutions have figured out ways to control their sometimes unruly residents by tying them down invisibly. Particularly those residents suffering from Alzheimer’s or other forms of dementia. Chemical restraints. Specifically, medications that sedate and  make the residents more docile, or simply sleep through the day. The most commonly prescribed of these are antipsychotic drugs – Seroquel, one of the newer class of antipsychotics is one example. Haldol, an older class of antipsychotics is another. There are long lists of these and similar drugs that the FDA has warned should NOT be used in the elderly or dementia patients.  Indeed Seroquel, Haldol and their many “cousins” are dangerous for the elderly and dementia patients especially. So much so that the FDA has mandated a “black box” warning about the use of such drugs. in the elderly.

If you are looking after or advocating for an elder, particularly if they are living in an Assisted Living Facility or Nursing Home, you should be aware of this issue and be on the lookout for it. It is a very widespread problem.

There are people in our community better versed in this topic than I.  Recently, some good friends and colleagues recorded a TV program on the use of antipsychotic drugs in the elderly. I highly recommend it to anyone dealing with an aging loved one. It features:  Elder Law Attorney Claire Curry,  Dr. Mary Evans, geriatrician and president of the Virginia Association of Medical Directors, nurse Love Berkley, long term care specialist, and Emily Chewning, whose father suffered from dementia, was subjected to the misuse of antipsychotic drugs.


This is a widespread problem and happening in our own community every day.  If you suspect your loved one is improperly being prescribed antipsychotic drugs, please contact me and I will be happy to help you sort through what can be done or refer you to an appropriate agency that you can work with to make sure your friend or family member is safe and being appropriately medicated.

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Driving Me MAD!

old car
Mom or Dad drivin’ their old jalopy still?

It’s a constant battle. What do you think the most difficult conversation we have is with aging parents?  About the Will? Power of Attorney? Moving in with us? Nope. Perhaps the single most contentious subject is when we have to take Mom or Dad’s keys away from them.

And you may want to have that conversation. But understand that driving – or loss of driving privileges – is a brutal blow to someone’s independence. No longer free to come and go as we please, can’t just run out and get groceries, a gallon of milk, stop in to get a trim or pick up a book of stamps; no quick trip to the bank, stop over to play cards or have lunch with the girls; go to choir practice or Sunday school without major planning just to accommodate transportation. No, now we must ask someone to help us do every little thing.  It is a major, very unsettling change and it serves to make one as dependent on others as a small child. Very upsetting.

Well, I have good news for your parents and bad news for you. You don’t really have the right to take someone’s driving privilege. Not EVER.

The only folks who can take Mom or Dad’s driving privileges away from them are the same people that gave them to them in the first place:  the Department of Motor Vehicles (DMV).

That’s right. No matter how bad their driving, their eyesight, their reaction time, their general health or mobility – you cannot take Mom & Dad’s keys away.

One strategy you might take is to refer Mom or Dad to the Virginia “Granddriver” program.  At a minimum, encourage them to take the Granddriver assessment to get a more objective view of the driving ability (instead of the opinion of their smarty pants grown children!)   Take the Granddriver test here

Convinced that Mom or Dad shouldn’t be driving?  There is one avenue open to all of us who care about an elder person’s safety and well being – not to mention the safety and well being of everyone else in the Commonwealth!  You can – anonymously even – advise the DMV that you believe a driver is a danger to themselves or others on the road. The DMV will then contact the driver and require them to set an appointment with their doctor for a medical assessment of their ability to safely operate a motor vehicle. If they don’t comply, they lose their license. If they are not fit to drive, same.  I think that the most useful part of this process is that while the doctor probably knows the person pretty well, they are able to be far more objective about their actual ability than we, family members and caregivers, are able to be.  To report a driver you believe to be unsafe, download or fill out online the DMV Medical Review Request Form (PDF link) and send it in.

There’s a couple of important points to consider before going to this extreme.

First, occationally, the inability to drive is a temporary condition. For example, I know someone who was having trouble regulating their blood sugar and would have serious swings upward and downward. There was the possibility he might black out behind the wheel and we made a decision – together – that he would just not drive just for the time being. That is to say, until he got his blood sugar under control again. This compromise served two purposes:

a)      it kept him (and everyone else on the road!) safe

b)      incentivized him to take the steps needed to make changes and do something very important for his health – start testing and get his blood sugar stabilized.

Secondly, it is possible to negotiate limitations that keep driving a safe option and lengthen the time that an elder is able to remain independent. Good for them, good for their family and caregivers. My own mother (now 83 and recently widowed) has always been an excellent driver. But she has some limitations now – her eyesight is not what it was and neither is her reaction time. Sometimes she gets confused or is easily distracted; fatigue is often an issue. To keep her both safe and independent, we agreed that she would limit her driving to familiar places – to and from grocery store, bible study, bank, post office, nearby friends. All these are short trips with routes she knows very well. Allowing her this freedom (as if I had a choice?) keeps her able to do the things she needs to do to stay at home as well as remaining socially active instead of isolated at home  She also agreed not to drive at night or long distances.  The other plus for us is that she drives a big, heavy, Mercedes station wagon. God help the person she hits because nothing is happening to her in that tank!

Like so many issues that arise when dealing with aging parents, its important to remember that they there are all kinds of choices. It is also important to remember that unlike us – forever mewling teenagers to our parents –  our parents are NOT children. They are entitled to their independence, respect and to make the choices – however ill-advised or foolish – how and when they wish.

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Prosecuting Elder Exploitation in Virginia

Sheriff's Department
We need all the tools at our disposal: Law enforcement, prosecutors, APS, private parties reporting suspicious circumstances to curb financial exploitation of our elders.

The Virginia State Crime Commission recently completed its task of reporting on efforts to enact laws to protect vulnerable elders from financial exploitation.

You can read their easy to read and understand report here

Only recently issued on November 13th it includes a really nice summary of what’s happening in OTHER states and what has been introduced in Virginia’s Legislature regarding laws to protect vulnerable adults from financial exploitation. None have successfully been enacted into law in Virginia. Yet.

My personal opinion is that it would be nice to have some criminal laws with a bit more “teeth” in them to go after perpetrators of financial exploitation against the elderly. I would sometimes like to take a baseball bat to them, but that would probably land ME in jail so that’s out.  But at a bare minimum, heightened sentencing for elder-swindling seems worth considering.  We do it for other forms of “aggravated” crimes.

Also, I thought it was interesting that they found that “An exploitation that involves a power of attorney appears to be easier to prosecute than one where there is no fiduciary duty between the parties.”    Plenty of that kind of exploitation going on around here! One of the issues might be to look at who is writing the PoA’s and who honored them – even when they suspected foul play.  I recently had a new client tell me that another attorney told her that her husband, recently admitted to a locked “memory” unit with advanced stage Alzheimer’s disease, could execute a new Power of Attorney in her favor as long as he could mark an “X” on the paper and have two witnesses sign it before a notary. Seriously. An attorney gave her that “advice.” And got paid for his trouble too.

The Commission found that, in the meantime, (that is, while we wait for better criminal laws)  it is possible to successfully prosecute under the existing theft crime laws: embezzlement, larceny, larceny by trick, and false pretenses. Perhaps there are a couple of more….  fraud, credit card fraud, check kiting. There are even a few FEDERAL crimes one might prosecute if a scheme is perpetrated by postal system, over the “wires” (includes internet) or interstate.

I reckon we oughta’ get on it.  Law Enforcement? Commonwealth’s Attorneys? Are you with me?

 

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Gotta Take Dad’s Keys Away From Him!

If I’ve heard it once, I’ve heard it a thousand times:

“Dad shouldn’t be driving! He’s going to kill someone. We have to get him off the road.”

“Mom’s dangerous on the road! I have to make her stop driving.”

hands on the wheel
Seniors Driving

“I have to take Pop’s car keys.”

Inevitably, a huge war ensues.  Its a pitched battle because the driver, whatever their actual ability to drive may be, feels their final freedom, the independence of going where they want, when they want, is being challenged.

Truth be told, in Virginia anyway, only one authority can revoke a person’s privilege to drive and that’s the folks that gave it to them originally. Yup. The Department of  Motor Vehicles (DMV).

Fortunately, for all the worried adult children (or spouses or other loved ones) out there that want their parents safely off the road, there is a way to alert DMV that attention needs to be paid to a potentially dangerous driver.

You can file a “Medical Review Request” with DMV and they will see that the driver is made to have a medical review and his or her doctor will have to report to DMV on the driver’s fitness to drive.  Best of all, you can submit the request to DMV anonymously!

The form is available in PDF format online and you download it here: www.dmv.state.va.us/webdoc/pdf/med3.pdf

Or if for some reason that link doesn’t bring it up, try googling:  Virginia DMV  MED3

One thing is for sure. The harder you try to take someone’s keys away, the harder they’re going to dig their heels in to retain their driving privileges.  Preserve the peace in your house and let the DMV be the bad guy!

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