Similarly, withholding meds from people in their 80s because those meds might shorten their life some seems dubious.
You're right that the ethics of the whole thing aren't clear. But a fair discussion of the ethics of cautiously using these drugs for dementia in willing participants - much less rampant, off-label uses in contexts for which there's no empirical evidence of their effectiveness (no FDA indication for any of these drugs for any dementia) - would include an honest conversation about the historical uses of prescribed psychotropics, and of political and economic power in the mental health professions and medicine more generally. Such a historical look would show that stories like this one are far from an abnormality, and that coercion, to greater or lesser degrees, is the norm. Some proportion of people taking these drugs (for any reason) undoubtedly do so of their own volition, and some of these may even derive a benefit from them. I have no objection to this. But vast numbers of people have no such luck, and are forced to take these drugs for some reason or another.
Many of these people are difficult: they're old and agitated and their dementia's getting worse, or perhaps they're yelling to themselves in the street, half-naked, rambling incoherently and looking fairly menacing, etc. What do the rest of us want with difficult people? We want'em out of our way (in a nursing home, say) and we want'em nice and calm. The drugs in this article do exactly that. No one with enough time in the mental health professions, or in geriatrics, is under any illusions about this.
"They want docile" is exactly right. So any discussion about the ethics involved here should also ask: "what are the ethics of coercing people to calm down with drugs?"
No doubt this does happen, and these cases should be investigated. But as with opiates, locking onto one part of the situation without considering the whole picture can lead to monstrous results.
My mother currently has dementia and my father had it before he died.
The confusion and unhappiness these people suffer from due to their illness should not be ignored. If they're in a nursing home, its even worse. In many cases it's quite humane to numb them up. Especially if they don't have loved ones to help them. There is no cure, there is no getting better. There is only getting worse and certain death. And they instinctively know something is wrong.
My mother is currently on two anti-depressant/anti-anxiety meds to help, and its made things much much better for her. No more worrying and confusion over everything, no more phone calls crying. She just goes about doing normal things without being upset.
Nursing care is expensive. Very expensive. No one wants to pay for it, either because people didn't or couldn't save enough for it prior to needing it, or government can't get the will together to properly fund it (Medicaid/Medicare aside) with taxes. People still end up in homes, caregivers continue to be chronically underpaid, and there's some occasional public concern or outrage over it so society can feel better about the situation. "Thoughts and prayers" over meaningful elder care reform.
My estimate would be that you probably need around 1 person for 5 people or less to do the job some justice. Plus doctors and other personnel. This would be freakishly expensive.
Also, it is as expensive as you assume:
"This report, authorized by the Chairman of the Virginia Senate Committee on Education and Health, studies the provisions of Senate Bill 1125 of the 2001 Session of the General Assembly. Senate Bill 1125 requires Virginia nursing homes to implement minimum nursing staff standards of 5.2 hours per resident day (hprd). For Certified Nursing Assistants (CNAs), the Bill requires minimum ratios of 1:5 residents (day), 1:5 (evening), and 1:10 (night) or a total of 4.0 hprd, and minimum licensed nurse-to-resident ratios of 1:15 (day), 1:20 (evening), and 1:30 (night) or a total of 1.2 hprd. These minimum standards exceed those of all other states as well as those recommended by advocacy and research organizations. The fiscal impact on the Medicaid program is estimated to be an additional $91.2 million from the general fund annually."
It would be nice if we could all live to a ripe age, enjoy many years of retirement maintaining mobility and a lucid mind and then suddenly die in sleep. Unfortunately, it doesn't always turn out that way. Hopefully by the time many of us get to be that age, euthanasia will be a mainstream option.
ps - Sorry for misreading. I completely agree with you about nursing home workers in general, and I'm sorry about your father.
Nursing home workers do a job that is important, few want to do or could do. Most do it for pay. Most do not aspire to the job but end up there for practical reasons
Their job is harder than any of the other jobs you mentioned. Some people maybe do it for the money and others probably out of compassion. But in the end it doesn’t matter. It’s a very tough and thankless job.
My wife has been helping care for a dementia patient who is a really nice guy and easy to live with. He just doesn't remember how to get to the cafeteria or do many activities of daily living.
Other dementia patients are nasty and might try to strangle a caregiver that they don't recognize.
Instead of being calming, they were tuned to broadcast channels where the news channels announced the-world-is-going-to-pieces between loud advertisements.
I'm curious if video games being a more common (plus potentially social) activity will be more common in retirement home-like settings.
Maybe by that time we'll have personal VR setups with internet connections that route around health-care-system influence.
I watched my mother in law go through it for many years and I would find it hard to say anyone gave someone "too much" when in reality they had no way of knowing what too much or not enough was without simple trial and error.