Norwegian study hints at extent to which drugs are concealed in food and drink in nursing homes
A Norwegian study has suggested that the practice of concealing drugs in patients’ food and drink is common in nursing homes.
The research follows a UK study published in the Journal of the Royal
Society of Medicine in 2000 which revealed that 71 per cent of residential,
nursing and inpatient units in south east England at least sometimes
administered drugs covertly in food and drink. However, this study did
not provide data on how many patients received drugs in this way.
The researchers interviewed health care workers caring for 1,362 patients
in 160 nursing homes and 564 patients in 90 special care units for people
with dementia. They recorded if any drugs had been mixed in food or drink
during the previous seven days without the patient’s knowledge
or consent, along with the reason for hiding the drugs.
The researchers found that drugs were given covertly at least once during
the previous seven days to 11 per cent of the patients in nursing homes
and to 17 per cent of the patients in special care units. In 95 per cent
of cases this practice was routine, they add. The researchers also point
out that documentation of covert administration of drugs was poor, making
the practice difficult to uncover. In most cases the decision to hide
drugs in food or drink was taken by the nurse in charge. The prescribing
physician was involved in just 20 per cent of cases.
The reasons given by carers for covert administration included non-compliance
and problems with swallowing. An analysis by the researchers suggested
patient characteristics such as degree of dementia, aggression and low
function in daily living activities were the strongest explanatory factors
(published on BMJ
Online First).
Commenting on the paper, David Wright, senior lecturer at the school
of chemical sciences and pharmacy at the University of East Anglia, acknowledged
that mixing drugs with food was common practice in the UK. “Sometimes
it is the only way to make a drug palatable,” he said. However,
he pointed out that, along with the ethical considerations raised by
covert administration, there are also pharmaceutical issues. “No
randomised controlled trials have compared the effect of giving a drug
mixed with jam with the effect of giving it without jam,” he said.
He added that pharmacists should advise care home staff to give medicines
without mixing them with food, particularly warm food, wherever possible. |
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