Home' Australian Ageing Agenda : AAA May-Jun 2013 Contents reference require the Senate committee to look at reducing the
use of physical and chemical restraints.
"I look forward to the results of that inquiry," Butler said.
EDUCATION BRINGS CHANGE
GP specialising in aged care and immediate past president of
Palliative Care Australia, Dr Scott Blackwell, says examples of
antipsychotic overuse in the sector do exist.
But he says progress is being made in the war against their
misuse at the facility level. Overall, the unnecessary use of
antipsychotics in dementia care, in Dr Blackwell's experience, has
been "on the downward trend" over the last three to four years.
The reason, he says, is that education in antipsychotic medication
management and person-centered dementia care has increased.
"Using antipsychotics and benzodiazepines like that is like
throwing oil on troubled waters," Dr Blackwell says. "But we have
been able to educate people that an antipsychotic is not a drug
designed to manage bad behaviour in a person with dementia."
President of Alzheimer's Australia NSW, John Watkins, agrees
that person-centred dementia care education and training could
help change medication management cultures and thereby influence
the number of people being unnecessarily given antipsychotics.
Watkins says that just recently, the state-based organisation has
adopted an educational consultancy role, offering aged care facilities
assistance in lifting the quality of their dementia care practices.
"More organisations, for-profit and not-for-profit are coming to
us for services," Watkins says. "Sometimes we do audit training
and other times we look at organisational charts and see what we
can do to assist the facility to bring about change."
"There is a generational change happening in the delivery of aged
care. We are moving away from the 1980s model of just providing
physical care to being more person-centred and more aware of the
psychological, social and individual needs of residents."
In theory, the practice of true person-centred care brings with it
an emphasis on the human being behind the dementia, a deeper
respect for the individual and an understanding of why the
resident is behaving the way they are.
An organisational culture of person-centred care is meant
to influence all care practices, including the prescription
and administration of antipsychotics. That means alternative
behaviour management tools and psychosocial approaches will be
tried first before antipsychotics are even considered.
"That's all happening now. It's happening more in some
facilities than others but it's good that it is happening."
Hatherly agrees that an increasing number of organisations are
making the effort to change their culture of dementia care. "The
huge differences you see between patients that are well cared for and
those who aren't, stems from the management down," Hatherly says.
"Yes, not all practice person-centred care...[But] there are
some really good examples out there. For example, there was one
AAA: WHAT DO YOU THINK OF THE
CURRENT STATE OF DEMENTIA CARE
CEO of Alzheimer's Australia NSW, John Watkins: We are
really conscious that most people with dementia are not in a
residential care facility but they are cared for informally or cared
for via the organised community care models in place. Yet there
is simply not enough care packages out there to enable people
to be providing the best care to their loved ones outside a
We need a huge level of commitment of funds in community
care from the federal government. I'd hate to say it is just about
money. But EACHD packages are great if people get them. I
hear extremely positive things about them.
National research manager for Alzheimer's Australia,
Chris Hatherly: One of the biggest dementia care challenges
facing the sector is providing flexibility and choice for people,
allowing older people to receive the care they want when they
want it. That applies to everyone but particularly to people with
dementia -- the situation is more complicated as there's not a huge
oversupply of dementia care packages available. There is also not
a big enough skilled workforce to deliver person-centered care.
General practitioner and immediate past president of
Palliative Care Australia, Dr Scott Blackwell: Here in WA,
most dementia units are providing quite good care but not
many of them are taking on good palliative care standards.
That is because they are not seeing dementia as a palliative
illness deserving a palliative approach.
So firstly, we need to recognise what Alzheimer's Australia
has been saying for ages: dementia is a degenerative disease.
And then I think we just need to keep saying it really.
...I'm hopeful that this is an area that is gaining a lot more
exposure and therefore, it will improve over time just because
we will know and understand what is better.
Dr Scott Blackwell
facility that tried turning off
the television for an hour and
saw a dramatic reduction of
[difficult behaviour exhibited]
in the evenings. The staff were
focused on residents as the
people they are, with names and
stories and particular needs,
backgrounds, likes and dislikes."
Effective education, Dr
Blackwell believes, is the
foundation upon which
positive culture change in
dementia care is built. And,
he explains, it should teach
aged care staff and medical
professionals the following:
"Sometimes we do need to use
antipsychotic drugs and use
them heavily, and then draw
their use back until we find the
more settled person within. That takes some time.
"But we have to understand that antipsychotics are for
people with a psychosis and dementia is not a psychosis -- it is a
"Sometimes we use antipsychotics as a last resort because a person's
behavior might get in the way of them living what life is available to
them. If you use it to settle a person down, you then withdraw them
slowly. But if you use antipsychotics to blanket out a person with
dementia and then leave them in that state, then that's misuse.
"We've got to personalise the treatment of aged and palliative
care for people with dementia." n
50 | MAY--JUNE2013 | AAA
Links Archive AAA Jul-Aug 2013 AAA Mar-Apl 2013 Navigation Previous Page Next Page