News Briefs – OCTOBER 2021

Excessive Drugging of Nursing Home Patients

According to an investigation by The New York Times, nursing homes across the country have engaged in the dubious practice of overdiagnosing patients with schizophrenia in an attempt to circumvent government oversight in their use of antipsychotic medication. Since a 1987 law prohibiting the use of drugs as “chemical restraints” in nursing homes, facilities have been required to report the percentage of patients on antipsychotic drugs, which tend to sedate patients. However, patients diagnosed with schizophrenia have not been included in the count under the assumption that the medication was necessary to treat a mental illness. The apparent intent of overdiagnosing schizophrenia is to conceal the true number of patients taking antipsychotic medication, avoiding a negative impact on their performance rating or the need to take corrective actions.

Nursing homes can save money by using drugs to control dementia patients rather than hiring more staff. Additionally, the Centers for Medicare and Medicaid Services (CMS) give nursing homes a rating of one to five stars, with five being the highest. One of the metrics used in this rating system is “the percentage of long-stay residents who got an antipsychotic medication.” High rates of antipsychotic medication would lower a nursing home’s star rating, affecting their public image and ultimately their bottom line. Caring for dementia patients who are noncooperative or aggressive or who wander requires special training and a higher staff to patient ratio. Yet nursing homes are chronically understaffed and find it difficult to retain staff. Antipsychotic medications, such as Seroquel, Zyprexa, and Abilify, have a sedating effect that makes it easier to control dementia patients, but they also nearly double the chance for heart problems, infections, falls, and ultimately, death.

The Times article also reported that the number of nursing home residents diagnosed with schizophrenia has soared 70% since 2012. That translates into one out of nine residents being “schizophrenic,” compared with one in 150 people in the general population. Schizophrenia is strongly linked to genetics and is usually diagnosed before the age of 40. So, this dramatic increase in schizophrenia diagnoses among elderly nursing home residents is highly questionable.

The article also revealed  that in response to the attempts to limit antipsychotic use, nursing homes have increased the use of Depakote, an anticonvulsant used to treat epilepsy and bipolar disorder. That medication is not scrutinized by CMS as closely, indicating a need for some other government action to truly solve the problem of drugs being used as chemical restraints in nursing homes.

 

Colorado Approves Body Composting

In early September, Colorado became the second state to allow human body composting. Within six months, this process turns bodies into soil that can be used to grow trees or flowers. One family in Colorado has already chosen to use this new green approach to post-death care for their loved one’s body. At the end of the process the family can keep the soil or donate it for conservation efforts.

The process, technically known as natural reduction, has been legal in Washington state since May 2020. In Washington, 85 bodies have already been transformed into soil, and more than 900 people have signed up for the service. Human composting will also be available in Oregon next July and is under consideration in the state of New York.

The one company performing this service in Colorado, The Natural Funeral, patterned its composting container on a design used in Washington, according to an Associated Press article in The Colorado Sun. An insulated wooden box that is 7 feet long, 3 feet wide, and 3 feet deep is Iined with waterproof material and packed with wood chips and straw. The box has two large spool wheels on either end so it can be rolled across the floor, providing the movement and oxygenation needed to allow the composing process to occur. Each body that completes the process produces one cubic yard of soil. The Colorado law does not allow the soil to be sold or used to grow edible crops for human consumption.

This process may not be right for everyone, but provides an alternative to using open space land for burial or releasing carbon dioxide from cremation into the atmosphere.

 

Orchid Extract Could Treat Prostate Cancer

Research led by the Centenary Institute of Cancer Medicine and Cell Biology in Sydney, Australia, has discovered that an extract from a common orchid species native to Southeast Asia could help treat early- and late-stage prostate cancer. Prostate cancer is the second most common form of cancer and the sixth highest cause of cancer-related mortality worldwide.

The compound extracted from the Dendrobium chrysotoxum orchid is erianin, which has the effect of elevating levels of a fatty acid called C16 ceramide inside the androgen-dependent prostate cancer cells. This causes the cancer cells to die, according to an article in Medical Xpress. One of the common treatment protocols for prostate cancer is androgen deprivation therapy, also known as hormone therapy, which can help slow or limit the cancer’s growth. But for up to 20 percent of patients receiving this treatment, the disease progresses to advanced prostate cancer within five years. Erianin in combination with artificially increasing C16 ceramide resulted in successful cancer cell death, thus showing this orchid extract could play an important role in treating prostate cancer.

 

Telehealth Has Mental Health Benefits

We have all been tethered to our electronic devices for over a year and a half since the COVID-19 pandemic began. It was necessary to do our work, shopping, and  physical and mental health appointments virtually to stay safe.  Now, as we gradually move back to more in-person activities, we are discovering that telehealth has a continued place in mental health services. This is especially true for preteens, teens, people who have traditionally been underserved, and those living in rural communities. There are even advantages for people struggling with dementia.

As was pointed out in an article  published by Yale Medicine, “telemental” health services  are effective and satisfying to many people. elemental health services aren’t ideal for every person or in every situation, but work well for kids and adolescents who spend a great deal of time on their phones, computers, and video games. They are extremely comfortable interacting through a screen. The clinicians at the Yale Child Study Center have found ways to take advantage of this screen familiarity by doing such things as having child clients share their screen to show how they navigated a character in a video game or by giving therapists a virtual tour of their room, activities that are revealing and much easier virtually. Some kids feel safer having their interactions with a clinician mediated by a screen—they open up more than they would in person. 

Telemental health isn’t only advantageous for children. It provides easier access to services for adults, particularly in rural communities where clinicians are scarce. It also saves time in getting to a clinician’s office, eases the stigma of being seen entering an office, and can help in monitoring behavior. 

Although none of the recent articles on telehealth focus on the work of doulas, there are obvious parallels. Many of our cases involve families where there are children or grandchildren who might find it easier to talk with a doula virtually because they aren’t in the vicinity of the person who is dying, or because they just feel safer doing it that way. Ease of access is also true for doulas working in rural communities where it might take hours to get to a client’s home.