Aged-care homes’ drug use slammed as ‘elder abuse’

The Australian August 14, 2018:

Nearly two-thirds of Australian aged-care residents are every day given psychiatric drugs — many inappropriately prescribed — that cause deaths and strokes or are linked to falls and seizures.

The “horrifying” findings of a University of Tasmania study have prompted the Royal College of GPs to warn that aged-care homes can no longer be ­assumed to be safe places, and an expert to condemn ­resident-medicating practices as “elder abuse”.

Reporting on the first national audit of psychiatric medication prevalence in aged-care facilities, the study finds homes are beset by “high rates and inappropriate use”, that use of highly sedating antipsychotics and benzo­diazepines is “of major concern” and interventions are “urgently ­required”. The findings are likely to deepen turmoil over dysfunction and abuses exposed within Australia’s residential aged-care system, with experts saying the study numbers show “chemical restraint” — where sedation is used to control the behaviour of residents, particularly those with dementia — is “widespread”.

The federal government remains under pressure over a reform process to improve quality and safety in the sector sparked by the Oakden elderly abuse scandal in 2017.

The drug-use survey reveals more than 61 per cent of the 11,300 residents in 150 audited homes were found to be on daily doses of benzodiazepines, such as temaz­epam, so-called “tranquillising” antipsychotics, such as Risperdal, or antidepressants, many of which were also a sedative, such as Mirtazapine.

It said high drug use was ­occurring in spite of existing research evidence of only modest or no benefit for aged-care residents as well as the drugs’ “substantial adverse effects”, including deaths, stroke and heart problems, and links to increased rates of pneumonia, falls and seizures.

“Despite repeated warnings of limited effectiveness and significant risk associated with psychotropic medication … the residents of Australian aged-care homes continue to be prescribed (it in) excessive amounts,” lead author Juanita Westbury said. “As concerning … was high ‘as-needed’ prescribing where nursing staff decide when to medicate and which … is often used to sedate and control behaviour — in other words, as chemical restraint.”

Branding the survey findings “horrifying”, RACGP’s president, Bastian Seidel, said: “Medical sedation is a foul compromise for ­inadequate nursing care. People think they’re in a safe place in residential care and everything (will) be fine, but the reality is what’s being reflected in this research.”

Asked if he was saying aged-care homes could no longer be assumed to be safe places, Professor Seidel said: “That’s correct.”

Experts and peak clinical guidelines say antipsychotics should be used with people with dementia only exceptionally after psychological or person-centred approaches have failed.

Dr Westbury’s study concludes antipsychotics and benzodiazepines are being used to manage “common” behaviours such as wandering, agitation and calling out.

University of NSW conjoint professor of psychiatry Carmelle Peisah said the community should be “deeply disturbed to hear older people’s needs are not being met and they are instead being given psychotropic drugs … giving psychotropics without consent is elder abuse”.