Antipsychotic restraint ‘horror stories’ likely

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Dementia Australia has slammed the misuse of antipsychotic drugs and restraints in nursing homes following new reports

In September 2018, the ABC’s Four Corners program reported on failings of the residential aged care system, including the use of medicines; at the time, Prime Minister Scott Morrison announced a Royal Commission into the aged care sector.

This Royal Commission, set to begin on Friday, is likely to unearth “numerous horror stories,” according to Joe O’Brien, presenter of the ABC’s 7.30.

On 16 January, he introduced a piece by reporter Anne Connolly, who told the stories of aged care residents who were allegedly restrained with antipsychotics, as well as with physical means.

One patient, 84-year-old Margaret Barton, was prescribed oxazepam “as needed”.

Three weeks later, the doctor “tripled the drug – a dosage later described as excessive,” Ms Connolly said.

Ms Barton’s husband Harold told the reporter that “because of the drugs, she lost her balance and she got a bruising and a black eye, and a broken pelvis”.

She died soon afterwards.

The family of another man were told that he had not been given medicines, but later received a bill from a pharmacy for three boxes containing 180 doses of an antipsychotic.

Ms Connolly asked dementia expert Professor Henry Brodaty whether he believed GPs were being pressured into prescribing antipsychotics and sedatives.

He replied that this happened “very often”.

“A nurse will ring up and say, ‘Ms Smith is being agitated, she’s going to other people’s rooms, she’s screaming all night. Can you give her something?’

“And of course, that’s the easiest thing to do — to give her something.”

Dementia Australia Maree McCabe said the story highlights flaws in the current aged care system, as well as reinforcing the need for the Royal Commission into Aged Care Quality and Safety to focus on education and building the capacity of residential aged care services to support staff to better understand, manage and support people living with dementia with the sometimes complex and challenging symptoms dementia may present.

“Australians need to have confidence in the system such that when they, their families and loved ones become clients of aged care they will be supported with the best health care system possible, along with staff who have current dementia training, knowledge and qualifications,” Ms McCabe said.

“It is crucial to form a partnership between the person living with dementia, family carers, their treating doctor, pharmacist and other health and aged care professionals to consider providing alternatives to the use of antipsychotic medications.

“Having clear roles and responsibilities of those involved in this partnership is also imperative to ensure that medication management, care practices and individual wellbeing is addressed in a holistic, integrated way.

“When it comes to anti-psychotics and physical restraints, in most cases, staff have an inherent desire to want to keep the person they care for safe.

“However, they may be unaware of the potential side effects of the medications, such as increased agitation, increased risk of falls, the potential masking of other symptoms or they may not understand that physically restraining someone could be a breach of their human rights.”

Watch 7.30’s report here.

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1 Comment

  1. It’s not just antipsychotics. Benzodiazepines are now being used instead of antipsychotics- prevalence in aged care is rising. If you restrict one class the use of substitutes will occur. Pick your poison.

    It’s not just in people with dementia either. Both antipsychotics and benzodiazepines are being given to people who are agitated, calling out for attention and anxious. Older people without dementia have these symptoms too.

    Pharmacists should provide education as QUM about these drugs, do audits and recommend monitoring for effect and adverse effects. Deprescribing is the key.

    For the first national audit of psychotropic use please web search: Westbury: time for action. ANZJP.

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