De facto imprisonment and covert medication use in general nursing homes for older people in South East England.
OBJECTIVE
There is growing interest in ethical issues in nursing home care, including capacity to consent to residence and covert medication use. This study assessed capacity to consent to residence amongst a group of randomly selected residents of non-specialist UK nursing homes and examined the prevalence of de facto imprisonment and covert medication.


METHODS
A cross-sectional prevalence study amongst residents in randomly selected non-specialist nursing homes in South East England. 445 residents (97 men and 348 women) were randomly selected from 157 nursing homes.


RESULTS
14% (64) of the residents interviewed lacked the capacity to consent to residence. 6.1% (27) of residents were prevented from leaving but less than half of these lacked the mental capacity to consent to residence and may be therefore, de facto, unlawfully imprisoned. 4.7% (21) of residents on medication had received it covertly in the nursing home.


CONCLUSIONS
A significant number of residents in the nursing homes studied did not appear to have the mental capacity to consent to being there, possibly in contravention of the Human Rights Act 1998. There appears to be a small but worrying prevalence of de facto imprisonment, and covert medication use in residents without severe cognitive impairment.
MacDonald
Alastair J D
AJ
Section of Old Age Psychiatry, Department of Psychological Medicine, Institute of Psychiatry, King's College, London. alastair.macdonald@kcl.ac.uk
Roberts
Alice
A
Carpenter
Lain
L
D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000453:epidemiology; D003430:Cross-Sectional Studies; D008192:Deception; D004363:Drug Utilization / Q000941:ethics; D004739:England / Q000453:epidemiology; D026690:Ethics, Clinical; D004992:Ethics, Medical; D005260:Female; D006707:Homes for the Aged / Q000941:ethics*; D006806:Human Rights / Q000331:legislation & jurisprudence; D006801:Humans; D007258:Informed Consent; D008297:Male; D016743:Mental Competency / Q000331:legislation & jurisprudence; D009735:Nursing Homes / Q000941:ethics*; D005791:Patient Care / Q000941:ethics*; D015995:Prevalence; D011619:Psychotropic Drugs / Q000008:administration & dosage*; D006113:United Kingdom
D011619:Psychotropic Drugs