Updated
Up to 6,000 elderly people could be dying prematurely each year because of widespread over-prescription of powerful drugs to dementia patients in nursing homes.
Experts say anti-psychotic drugs can leave patients immobilised and unable to speak and are often used unnecessarily to keep dementia sufferers quiet for overworked staff.
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.
John Burns? family thought they were doing the best thing for their father when they booked him in to a nearby nursing home in Adelaide offering specialist dementia care.
Just 63 years old, he had severe symptoms such as disinhibited sexual behaviour. He never hurt anyone but his lewd remarks and wandering put him at risk of harm.
What then happened to Mr Burns, while extreme, is not uncommon, according to experts.
He walked into the nursing home able to feed and clean himself and able to converse with his family.
Within 24 hours he was so doped up they could barely wake him, within a week he was unable to sit upright or converse at all, and within 12 days, he was dead.
Jody Playford knows now that her father had a stroke.
She also knows that during his short time in the nursing home, he was massively dosed with dangerous anti-psychotic drugs that can heighten the risk of stroke and death.
?I don?t think in your worst nightmares you could have every imagined it could have gone so wrong,? she said.
?I went down to the lounge room only to find Dad sitting in the lounge room in his own urine and he had jelly in his eyes, his eyes had turned to jelly and the jelly was coming out of his eyes.
?And he was away with the fairies. He didn?t know me and we hadn?t had that problem with dementia, so I was rubbing his hand, saying, ?Dad, it?s Jody, it?s Jody!??
Soon after arriving at the nursing home, Mr Burns had tried to leave.
He guessed the security code and wandered outside the locked dementia wing. He also made sexual remarks to staff, raised his fist and touched a female staff member?s breast.
None of this is unusual behaviour for dementia patients who often become agitated when adjusting to new environments.
No one was hurt. And each time he had become compliant again.
But some staff were worried enough to call a doctor who prescribed the powerful anti-psychotic haloperidol, which he was given repeatedly in large doses.
?This was a level four chemical restraint, which means your life?s in danger, the client?s life is in danger. It drops them to the floor instantly,? Ms Playford said.
High doses of potent drugs
One of South Australia?s leading geriatric experts, Dr Craig Whitehead, testified at a coronial hearing into Mr Burns? death that he believed the overall dose over the next five days was excessive.
?He did have a very high dose of halperidol, which is a very potent anti-psychotic? I think he had about 35 milligrams,? he told the hearing.
?I would ordinarily give, in that circumstance, at best, 5 [milligrams] orally.?
In fact, Mr Burns was given 45 milligrams in five days, as well as other anti-psychotics and sedatives.
The coroner heard that sometimes he was drugged because he was restless or wanting to go for a quiet walk in the corridor at night.
?And even the coroner said, ?Well, what else is the man meant to do in the facility? What?s wrong with going for a walk??? Ms Playford said.
The coronial inquest heard the doctor believed he had given an appropriate dose and that he was concerned for the safety of nursing home staff because Mr Burns had become aggressive and abusive.
South Australian Coroner Mark Johns found last year that Mr Burns died of a stroke in 2006.
He did not link it to anti-psychotic drugs, but he noted that Dr Whitehead?s expert concerns that haloperidol played a role??may well be correct?.
?Essentially the man died of a stroke and that had been acquired after what seemed in my mind significant prescription or over-prescription of anti-psychotics to treat his behaviour,? Dr Whitehead told Lateline.
?I thought it was a really important example of how these medications we give to people with dementia, a very common problem, and behavioural disturbance in dementia is a very common problem, have serious and high risk effects. And it was clear to me that the family had never been engaged in a discussion about that.?
Dr Whitehead says while there are many excellent nursing homes, he is concerned about a lack of properly trained staff to care for the 140,000 dementia patients who now dominate residential care ? and whose numbers are set to explode.
?I think there is a sense that the aged care industry is less tolerant to patients with behavioural disturbance,? he said.
?There is a tendency to gravitate towards blaming the person for their behaviour.?
Ms Playford was at her father?s bedside when the doctor who had prescribed the anti-psychotics arrived.
?Mum and I couldn?t quite believe it. Because he looked at Dad and said, ?You know what you did, Mr Burns. We?re not going to tolerate that sort of behaviour here and you know what?s going to happen if you continue to do this,?? she said.
?Massive amounts of drugs?
Many of the same issues were faced by Beverley Harvey and her family when their mother went into a Gold Coast nursing home late last year suffering dementia.
Even though?she was 93 years old, Annetta Mackay was mobile and could converse with her family. But within two months she had lost 16 kilograms and was hard to wake.
?We walked in and our mother looked dead,? Ms Harvey told Lateline.
?I suspected she was heavily drugged. So that?s why I spoke to the doctor. He said, ?Your mother is on massive amounts of drugs.??
Ms Harvey and her family were told their mother was calling out at night and using vulgar language that upset other residents.
Once the sedation began, it did not seem to stop.
?They were still drugging her even though she was well and truly comatose, not eating, not drinking, just sleeping,? Ms Harvey said.
Experts interviewed by Lateline say the science is clear: anti-psychotics are not beneficial for the vast majority of dementia patients whose behaviour can often be managed by better trained staff.
?We also have some limited evidence that stopping those medications improves those outcomes, improves their behaviour and improves their cognition,? Professor David Le Couteur from the Australasian Society of Clinical and Experimental Pharmacologists and Toxicologists said.
?From my perspective, the correct management of behavioural problems in dementia is nearly always reducing medications, not starting them.?
The anti-psychotic drugs were stopped when Ms Harvey?s mother went to hospital and suddenly Ms Mackay was able to chat to her family again.
But she then returned to the nursing home.
?She was like a zombie,? Ms Harvey recalls.
?The last day, I put my arm around her and said, ?We?re going now,? and she didn?t open her eyes, she just made sure I kept there.
?She was sort of holding me in, and said, ?Beverley, don?t leave me here.??
Her family managed to have the anti-psychotics and sedatives stopped in January, after four months. Ms Mackay died in April.
Thousands affected
Up to 60 per cent of nursing home residents are on psychiatric drugs, and up to 30 per cent are on powerful anti-psychotics.
Professor Le Couteur says in many cases doctors are treating people with dementia in order to make life easier for the carers and the health workers.
He calculated how many patients are dying six to 12 months prematurely each year because of the over-use of anti-psychotics, and got figures ranging from 500 to 6000.
?I think the answer is thousands,? he told Lateline.
?I think there are probably thousands of deaths where can attribute to these medications.
He said he was not aware the figure would be so high.
?I was shocked, very sad for the elderly people,? he said.
?People with dementia are human beings and they need to be treated with respect and sedating them because of their behaviour just feels wrong as a human being.?
While not commenting on specific cases, Queensland specialist geriatric psychiatrist Professor Gerard Byrne says there are likely to be hundreds of premature deaths each year with thousands more adversely affected.
?I think it?s likely to be hundreds, if not, thousands severely adversely affected each year in this country,? he said.
?I have certainly seen on a fairly regular basis, older people with dementia that have been prescribed antipsychotic medication either inappropriately, or in excessive dose or for too long a period.
?The problem is that they seem to be used indiscriminately and significantly overused, really.?
Minister concerned
Federal Minister for Mental Health and Ageing Mark Butler says he has asked for detailed information about the issue from health groups and the National Prescribing Service.
He says he has heard the claims before and will investigate them.
?When you go to issues like consent, when you go to issues like the proper prescription of medications before non-pharmalogical methods have been proven to fail, I think this is arguably seen as a human rights issue,? he said.
Topics:
aged-care,
community-and-society,
diseases-and-disorders,
alzheimers-and-dementia,
pharmaceuticals,
health,
older-people,
australia
First posted
Source: http://www.kevinrudd.org/?p=3839
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