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Wife recounts husband's harrowing ordeal at Turku geriatric hospital

Erja Jansson and Karl-Arne Jansson
Erja Ekholm and Karl-Arne Jansson

Erja Ekholm wanted to care for her husband at home for as long as possible when, at the age of 57, he was diagnosed with Alzheimer's disease. After years of them both struggling with the devastating disease - and with health care officials - her husband eventually ended up at a geriatric psychiatric unit in Turku. During his time at the G1 unit, her husband was drugged and restrained until he could no longer move.

After a period of aggressive behaviour at the nursing home where he was being cared for, Karl-Arne Jansson was admitted to the Turku geriatric psychiatric care G1 unit in 2011.

During an interview about her husband's situation with Yle in 2008 his wife Erja Ekholm said she simply did not want to send him to an institution.

"I'm trying to keep my husband at home as long as possible, because I do not want him to be put into a ward and be pumped full of medicine and never come out," Ekholm said in 2008.

Today when she listens back to her comments nearly eight years ago she finds it difficult to hold back the tears.

"Every day I feel so guilty that I gave him away," Ekholm now says.

Jansson's years-long journey to the G1 psychiatric unit was one wracked with arguments and protests from his wife.

In 2010 Jansson was moved to a nursing home in Turku. He also made occasional trips home where he and his wife would try to live as normally as they could manage.

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Karl-Arne Jansson was 'angry and aggressive', according to nursing records. Image: Yle/ Antti Lempiäinen

Nursing home incident records from 2011 state that her husband had been angry and aggressive and was prescribed the antipsychotic drug Risperdal.

Among the most common antipsychotic drugs, Risperdal can be used to reduce aggressive behaviour in dementia patients but only for a maximum of six weeks, according to the drug manufacturer's information leaflet.

According to the records Jansson was given Risperdal for much longer than six weeks. Health care workers began giving the antipsychotic to him in February and stopped several months later that summer because the drug was ineffective.

Further incidents of aggressive behaviour were reported in Jansson's records in the autumn of 2011.

More medication

He was given more drugs, including another antipsychotic called Quetiapine, which is meant for people suffering from schizophrenia or bipolar disorder.

According to Quetiapine's warning guidelines, use of the drug by older people with dementia carries with it an increased risk of stroke or death.

After the Quetiapine prescription was discontinued, Jansson was given another antipsychotic, Levomepromazine, which is not approved for treatment of behavioural issues in people with dementia. 

Side effects of Levomepromazine include body stiffness, tremors and symptoms of akathisia, the inability to sit or keep still.

Right before Christmas of 2011, Ekholm says she tried to take him home. But he never made it, and ended up at the now-infamous G1 unit.

"I said that he should not be taken to G1 because he has Alzheimer's and doesn't know where he will be if he moves," Ekholm says.

Turku Hospital's G1 unit became known to people across the country after an investigative report by newspaper Turun Sanomat earlier this year. The paper documented widespread incidents of overmedication and the humiliation and abuse of patients between the years of 2009 and 2014.

After her husband having spent only three weeks at the unit, Ekholm took a video camera to document his condition; with a stiffened neck and a contorted arm.

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Jansson was unable to move at some points during his treatment. Image: Erja Ekholm

During the first week Jansson was at G1 he was given several different antipsychotic medications and anxiety-reducing benzodiazepine-based drugs.

Patient records show that on his third day at G1 he was given several doses of three different antipsychotics. Records from the following day state that Jansson would not eat breakfast or lunch and would not stay in his bed.

To remedy his anxiety, Jansson was given more antipsychotics. Hospital records state that Jansson slept on a mattress on the floor "for his own safety," and that he did not eat himself and needed to be fed by a staff member.

Ekholm says the hospital medicated him so heavily he was unable to lift his head. She says hospital staff never explained to her why her husband was restrained.

"It was awful to see him. He was tied to a chair and couldn't raise his head at all," she says.

The ordeal at the unit came to an end only after Jansson had developed pneumonia and was moved to another hospital. His wife also points her finger at the G1 unit for his coming down with the respiratory illness because she says old hospital building was inadequately heated in winter.

After a four-month recovery at the hospital, Jansson was moved yet again to a city nursing home facility. Last year he moved to an assisted living facility in Espoo.

"He is in better shape compared to his time at G1," Ekholm says.

"He got better once he left G1 and was taken off the drugs. But the [Alzheimer's] has progressed and he is in his final phase now," his wife says, who soon plans to move to Espoo to be closer to her husband.

The health supervisory authority Valvira inspected the G1 unit after Turun Sanomat's report about the hospital's issues was published earlier this year.

'No endemic problems' at the unit

Valvira's Markus Henriksson says the agency did not find evidence of endemic problems at the unit.

"On the basis of the patients we met during our inspection we cannot draw the conclusion that the medication practices [at the unit] are of poor quality. When medication practices are judged, one needs to carefully look at the care of the patient as a whole," Henriksson says.

Hanna-Mari Alanen, who has researched elder care psychiatry at the University of Tampere, says that medication of patients may be warranted in order to ensure the safety of staff.

"Regarding the small segment of difficult patients, they need to be medicated above recommended levels for the safety of the patient, other patients and staff," Alanen says.

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Jaakko Valvanne of Valvira says that there are no endemic problems at the Turku unit. Image: Yle/ Antti Lempiäinen

Jaakko Valvanne, a professor of geriatrics at the University of Tampere, says that behavioural problems in older people could also be due to physical symptoms like pain, constipation, low blood pressure or low blood sugar.

Valvanne says alternatives to medication are rarely considered by geriatric care staff.

He acknowledges that the use of psychiatric drugs is common in long-term care -- but the first step by geriatric care professionals he says should always be to consider alternatives to medication.

The content of this report was created by producers at Yle Fem's Swedish-language documentary programme Spotlight. The segment "Demented and Drugged" "Dement och Drogad"  was shown on Yle Fem on Tuesday, May 17 and is available on Yle Areena. The article this is based on was written by Christoffer Gröhn.

This story was edited on 19 May to clarify that Levomepromazine is not approved for treatment of behavioural issues in people with dementia.

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