Confusion or delirium in older people
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Summary
This guide explores the covert administration of medicine and what you can do if someone refuses to take their medicine, particularly those without mental capacity, such as someone with dementia.
When Someone with Mental Capacity refuses Medicine
If someone refuses to take a medicine, and they have the mental capacity to make that choice then it is important to respect their beliefs and preferences. You might choose to discuss their decision to ensure that it is fully informed and to explore whether there is an alternative solution which could help them, for example prescribing another version of the drug.
However, you cannot force someone to take a medicine if it is their preference to avoid it. Refusal of medication must be fully respected and prioritised under human rights law. This means that people who are capable of making decisions have the right to accept or refuse medical treatment even if their decisions seem risky and may even lead to their death.
When Someone Without Mental Capacity Refuses Medicine
If someone does not have capacity – perhaps because they are living with dementia or experiencing delirium- to make informed and well judged decisions about their medication you can discuss the issue with their health care team who might consider a covert medication plan.
What is Covert Medication?
Covert medication is when staff administer medicine without the patient’s knowledge or consent; for example, disguising medicine in food or drink without the patient knowing. Covert medication plans are suitable for those patients who lack capacity to make decisions about their medicines. They enable medicines to be hidden in food, drink or given through a feeding tube.
Covert medication arrangements or plans are NOT suitable for anyone who has mental capacity to make the decision about whether to take a medicine – even if staff or family members involved in their care believe the decision is ill-judged.
Supporting Individuals to Take Medication
If there are concerns about a person’s ability to make decisions about taking their medicines, then the prescriber should carry out a mental capacity assessment. If the person does not have capacity then there should be a “best interests meeting” involving the prescriber, any key care staff, a pharmacist and someone (like a Carent) to represent the views and interests of the person. This meeting should ensure that everyone involved can decide whether any medicines should be stopped, given in a different form, or covertly administered i.e hidden and given to the person without their knowledge.
Meetings such as this will take into account any advance decisions, statements or plans which a patient might have made in the past alongside the views of those with Lasting Powers of Attorney for health and care.
Understanding capacity
There are a number of Youtube videos which can help you understand more about what decision making capacity is, and how it is assessed. This 4 minute video is helpful and emphasises the issue of decision making capacity in relation to difficult decisions.
