Seniors in pain being inappropriately restrained

As many as half of residents in aged care facilities may be living in pain, according to Painaustralia

In too many cases, residents are subject to inappropriate use of chemical and physical restraint in aged care facilities when they should be having their pain investigated, says Carol Bennett, Painaustralia CEO.

Pharmacists could and should be a key part of this investigation process, whether in aged care facilities or in the community, she told the AJP.

The organisation highlighted figures during National Pain Week (24-30 July) which showed up to 80% of aged care residents are estimated to have chronic pain.

52% of people in residential aged care have a diagnosis of dementia, and 67% require high-level care to manage behaviour.

Painaustralia says this suggests a great deal of pain goes unacknowledged or untreated in such facilities, due to dementia and cognitive impairment reducing the capacity for appropriate detection.

In people with cognitive impairment who are non-verbal, untreated chronic pain can result in behavioural and psychological disturbances (BPSD) and lead to inappropriate use of chemical and physical restraints.

“Pharmacists are critical as frontline professionals who do recognise that people experience pain but may not necessarily communicate it all that well,” Ms Bennett told the AJP.

“They’re in a key position to be able to assess that, and be part of the team that works residential aged care.

“When it works well, it works really well, and people get good access to medicines that are appropriate for their treatment, and help get them out of pain and safe and well.”

But in some cases, pharmacists may intervene, but their recommendations may not be acted upon, or they may be acted upon for a short time only, leaving residents suffering pain again being restrained instead of having their pain managed.

AJP readers have expressed frustration in comments on articles examining residential aged care support, with facilities being unwilling or unable to take pharmacist recommendations on board.

Former Pharmacist of the Year Karalyn Huxhagen penned a piece in AJP on the subject, detailing a case where a dementia patient had done well after deprescribing efforts, but was again placed on antipsychotics following hospitalisation.

Ms Bennett says that this sort of problem is “really systemic”.

“Our system is very focused on safety, and very often if you focus too much on safety, it can impact quality,” she says. “We need to measure quality of care and incentivise positive outcomes.

“If we had really effective multidisciplinary teams, including working in residential aged care, that would be the most effective way of managing people’s treatment.

“We have a lot of work to do, because this is going to be an unrolling issue.

“We are way too over-reliant on chemical and physical restraint, and the recent Law Reform Commission report on elder abuse really did highlight the extent to which we are still reyling on those things.

“And it’s simply unacceptable. We shouldn’t be leaving people in a situation where they’re going untreated, or being inappropriately treated.”

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