Helping aged care to ditch drug habit

HammondCare has supported calls for time-limited reviews of the use of antipsychotic drugs for older people, saying the sector needs to ditch its drug habit.

Recent media reports have highlighted that regulatory authorities have serious concerns about GP over-prescription of antipsychotics to older people and people living with dementia.

Experts have described the issue as “an outrage” and the over use of antipsychotics as “shotgun therapy”, calling for the removal of PBS benefits for the drugs after three months, without specialist approval to continue. 

Independent review would cause drug use collapse

HammondCare Chief Executive Dr Stephen Judd said one study had shown as many as 80 per cent of people with dementia in aged care were on psychotropic drugs but a key finding was that this “varied from facility to facility”.

“This shows that powerful drugs are not the only way to care for people with dementia. While they may be an appropriate treatment in some cases, they are not an inevitable form of treatment for everyone."

Dr Judd said in most cases, antipsychotics should be used as treatments for a particular intervention and not as a long-term solution. They should have a start time, a review period and a finishing date.

“I would even go further and say that if we had independent review after a defined period we would see the use of these medications collapse.”

Quality care and good design reduces drug prescription

Providing residential care grounded in a deep understanding of the individual located in environments that minimised confusion and agitation vastly reduced the need for antipsychotics, Dr Judd said.

“Before calling for a prescription, why not find out who the person is, what matters to them, what they enjoy, what they dislike.

“We can do this by spending time with them and their families, listening, asking questions and observing. We can use psychosocial interventions that give people with dementia the opportunity to enjoy themselves or contribute meaningfully to other people.

“It’s about creating an accessible environment where every person’s inherent dignity and worth is acknowledged, respected and upheld.

“It’s also about the physical environment - noise to a person with dementia is like steps to a person in a wheelchair. So let’s find ways to remove the noisy disruptions and distractions from our aged care homes.

“It’s about minimising confusion for someone who has poor eyesight and difficulty processing information by creating environments that are instantly recognisable and familiar.”

Pain and other undiagnosed triggers

Dr Judd cited recent evidence from the Dementia Behaviour Management Advisory Services in NSW (managed by HammondCare) that showed up to 70 per cent of referrals for behavioural and psychological symptoms of dementia (BPSD) had undiagnosed pain needs.

“Alongside other measures, we recommend opportunities for better education for nurses and staff in identifying untreated pain.

“As well, more Special Care Units would see many people who have until now often bounced around the system, find a home where they are safe and respected and often taken off antipsychotics altogether.”

In a related development, the Therapeutic Goods Administration has updated product information for risperidone, a commonly used antipsychotic, removing it from use for people with dementia except for Alzheimer's and limiting it to short term management.