Home' Australian Ageing Agenda : AAA May-Jun 2013 Contents Alittle under a year ago, a national audience of ABC
network viewers watched on intently as one of
Australia's best investigative journalism programs
alleged that aged care staff are unnecessarily drugging
dementia care residents with antipsychotic medication.
The Lateline episode that went to air in late August 2012
highlighted serious concerns about the state of dementia care
in Australia's aged care facilities, with reports that some older
people with Alzheimer's disease were being sedated by doctors
and staff because that made them easier to manage.
"Up to 6,000 elderly people could be dying prematurely each year
because of widespread over-
prescription of anti-psychotic
drugs to dementia patients in
nursing homes," the show's
transcript reads. "...But the
drugs can increase the risk of
death by 50 per cent and family
members are often left in the
dark about their use."
It is not the first time such
claims have been made. The
Lateline report came as no
surprise to advocacy group,
Alzheimer's Australia, which applauded the media investigation.
A prominent elder advocacy lawyer, Rodney Lewis, featured in a
follow-up Lateline report with supporting commentary and facts
about the sector's overreliance on antipsychotics.
Ten months have passed since alarm bells were rung and the
sector was reminded that both the country's media and broader
community are watching how it treats the vulnerable in its care.
But has anything changed since the Lateline report aired in
mid-2012? What movements, if any, has the government made to
either investigate or solve the issue? And, most importantly, what
is the state of dementia care in Australia's aged care facilities?
AUDIT URGENTLY NEEDED
Accompanying the Lateline investigation into antipsychotic use in
dementia care was an interview between Lateline presenter, Tony
Jones, and the Minister for Mental Health and Ageing, Mark Butler.
In the interview, Minister Butler made an on-air promise to
discuss the option of a federally-mandated pharmacy audit of all
nursing homes, "as a matter of urgency".
Alzheimer's Australia praised the minister's announcement,
saying an aged care medication audit is crucial to determine how
big and severe the chemical restraint issue in Australia really is in
the absence of contemporary national evidence.
The good news is that since that statement was aired, Minister
Butler has held two meetings with leading health professionals
and researchers to discuss options to improve care for people
with dementia who exhibit 'concerning behaviors'. The not so
good news is that little has happened beyond those meetings.
National research manager for Alzheimer's Australia, Chris
Hatherly, who was party to the roundtable discussions believes
that, at the time of writing, "the audit isn't happening". "Nothing
else has happened [since] and we are waiting impatiently,"
This, he concedes, is partly because the issues at hand are
complicated and "are very, very difficult to deal with. There aren't
any good regulatory leaders [in this field] that the government
has access to."
But Hatherly says that anecdotal reports tell a similar story
to the one told via Lateline. And although some facilities boast
shining examples of dementia
care practices, he explains,
not all engage in best practice
and truly 'person-centred'
suggests that people still using
them as a first resort is quite
prevalent." Hatherly says the
experts currently estimate
that "anywhere from 1,000
to 6,000/7,000 plus people
die [from their use] each year
because antipsychotics increase the risk of stroke and so on".
"That's a lot of people dying. And we wouldn't stand for that at
all if that many kids were being killed by Ritalin.
"...The risks of using antipsychotics [unnecessarily as a first
resort for behaviour management] are known. That is why their
use is limited and restricted as a last resort."
Although there has been limited movement to enact the desired
medications audit, the federal government says it has recently
taken other steps to support the sector to improve its medication
management and dementia care practices.
In late 2012, the Commonwealth released a revised version
of the Guiding Principles for medication management in
residential aged care facilities. It aims to help managers and
staff develop, put into practice and continuously assess their
policies and procedures in the quality use and safe management
"Two projects have been shortlisted for the department to
enter into contract negotiations with, which seek to reduce the
use of sedatives and antipsychotic medicines for people with
dementia in aged care homes," the Minister for Mental Health and
Ageing, Mark Butler, says.
And marking a significant step forward on the issue of
chemical restraint in dementia care, on 28 February this year
the Senate referred the care and management of younger and
older Australians living with dementia to the Senate Community
Affairs Committees for inquiry and report. The inquiry's terms of
The legal implications of misuse
Unnecessarily sedating an older person with antipsychotics, non-intentionally or otherwise, has ramifications for both the dementia care
resident and medical practitioner.
Hatherly explains that only one of 16 antipsychotics commonly used to manage the behaviours of people with dementia is actually
approved by the Therapeutic Goods Administration for use as a last resort.
"But they are all often used anyway, off-label," he says. "That means antipsychotics are not available to patients on the PBS. And,
doctors have to be quite certain in terms of clinical indication as things could go wrong. If prescribed off-label and something goes wrong
[like an overdose or medical complication], doctors could be liable and face medical indemnity consequences.
Hatherly adds that consent is another major complication associated with the use of antipsychotics off-label and as a first resort for
behaviour management in the dementia population.
A recent survey of a NSW nursing home showed that consent -- via the resident or a substitute decision maker -- had not been provided for
antipsychotic use in 85 per cent of cases. "People giving out these antipsychotic medications could probably be up for assault and battery."
A medication audit of all aged care facilities throughout the country is therefore vital, he says, as is further pharmaceutical regulation,
mandatory reporting requirements and tighter standards around the use of antipsychotic medication.
The benefits will not only reach older people but impact on the work practices of those who prescribe and administer the drugs.
"We wouldn't stand for that
at all if that many kids were
being killed by Ritalin."
-- Chris Hatherly
www.australianageingagenda.com.au | 49
Links Archive AAA Jul-Aug 2013 AAA Mar-Apl 2013 Navigation Previous Page Next Page