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Concealing Medication in Food and Drink

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Updated: September 17, 2006

Is it ethical to hide medication in the food of someone with a dementia such as Alzheimer's disease? Should all covert drug administrations be medically sanctioned and recorded and just how common is it for nursing homes to conceal medication?

The covert administration of drugs in a person's food or drink has supporters as well as its critics. If you talk to professional caregivers they can often give you very good examples of times when concealed medication seemed sensible and logical. At other times giving medication without the approval of the person taking it seems wrong and recording practices would tend to back up that assertion.

A comprehensive research project of nursing homes in Norway found that the practice of covert drug concealment was common practice, was poorly documented and arbitrary.

Professional caregivers of 1362 patients in 160 regular nursing home units and 564 patients in 90 special care units for people with dementia were questioned.

  • 11% of the patients in regular nursing home units and 17% of the patients in special care units for people with dementia received drugs mixed in their food or beverages at least once during seven days.

  • 95% of the nursing home residents had drugs were routinely put in their food or drinks

  • Only 40% of the people's nursing records recorded the covert administration.

  • When a doctor sanctioned the concealment of a medication in food or drink medical records were more likely to contain written conformation, 57% as opposed to 23%.

  • The types of medication most often concealed were antiepileptics, antipsychotics, and anxiolytics medications. This highlights a major concern. People with dementia such as Alzheimer's are often given powerful sedative and anti-psychotic drugs. It may make life easier for caregivers but may not be in the best interests of the person with Alzheimer's.
  • Covert drug concealment is also common in other countries. In 2000 a study found 71% of residential, nursing, and inpatient units for people with dementia in southeast of England sometimes administered drugs covertly in food and drinks.
    In 71% of the 34 residential, nursing and inpatient units the respondent said that medicines were sometimes given covertly.
    Of the 50 people caring for people with dementia 48 thought the practice of hiding medications in food was sometimes justified. 47 people thought a doctor should ask the opinion of the caregivers before deciding on medications being hidden in food and drink.

    Poor recording, the prevalence of powerful antipsychotic and tranquillizer medications and secrecy surrounding the practice in institutions who 'care' for people with dementia such as Alzheimer's are a major cause for concern.

    Concealment of drugs in food and beverages in nursing homes: cross sectional study
    Øyvind Kirkevold, research scholar, Knut Engedal, Professor in Geriatric Psychiatry, Norwegian Center for Dementia Research, Vestfold Mental Health Care Trust, Tønsberg, Norwegian Center for Dementia Research, Department of Geriatric Medicine, Ullevaal University Hospital, Oslo, Norway.

    A pill in the sandwich: covert medication in food and drink
    A Treloar, B Beats and M Philpot. Oxleas NHS Trust & Guy's, King's Medical School, Memorial Hospital, London, UK.

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