Older Australians in aged care facilities are routinely being given dangerous medicines to control their behaviour, a new report reveals.

A Human Rights Watch report released today found many facilities in Australia were using drugs as “chemical restraints” to control people with dementia and “knock them out”.

Many of the drugs used were antipsychotics not approved for older people with the degenerative brain disease.

The use of drugs can have disturbing consequences with family members reporting a dramatic deterioration in the condition of their loved ones.

One woman said that her grandmother was placed on antipsychotic drugs after wandering away from an aged care facility in 2017.

“Everything about her, her health, her spirit, declined after that drug,” the granddaughter said. “We went to see her after the meds, and she couldn’t hold a conversation, she was dropping off to sleep, (just) like that. … Her eyes would roll back in her head.”

The use of drugs is considered “chemical restraint” when they are being used to restrict a person’s freedom of movement or control their behaviour, rather than to treat a diagnosed mental health condition or a physical illness or condition.

In facilities that are understaffed, chemical restraint can make it easier to manage people with dementia, who can become aggressive or suffer from delusions or hallucinations.

However, the use of drugs can have inhumane consequences.

Many family members interviewed by Human Rights Watch said their previously energetic relatives had become so lethargic they were unable to speak.

Some had lost large amounts of weight and become dehydrated as they could not stay awake long enough to eat food or drink water.

Others became so weak from not using their muscles that they lost mobility and the ability to perform self-care tasks such as using the bathroom or showering.

Facilities were also using these drugs without permission from residents or their family members.

Some family members said that staff threatened and intimidated them when they asked questions about the drugs or challenged their relatives’ treatment. Complaints to government agencies with responsibility for monitoring aged care were unsuccessful.

media_camera Older Australians with dementia are being given drugs to control their behaviour.

The report included accounts from 37 family members who had relatives living in facilities in Queensland, NSW and Victoria, as well as aged care facility staff, doctors, nurses, advocacy organisations, government officials, aged care experts and disability rights experts.

It found many aged care facilities had staffing levels well below what experts considered the minimum needed to provide appropriate care. There was also a lack of training for staff to take an individualised or comprehensive approach to supporting people with dementia.

“They don’t have enough staff or supervision so they knock them out,” one woman told Human Rights Watch.

INCREASED RISK OF DEATH

Human Rights Watch documented the use of various drugs including antipsychotic drugs, benzodiazepines, and sedative-hypnotic drugs, sometimes known as “tranquillisers,” “sleeping pills,” or “sedatives”; and opioid analgesics, also known as narcotic painkillers.

It noted that clinical studies in the United States found antipsychotic drugs increased the risk of death in older people with dementia. This includes benzodiazepine, which is associated with increased risks of falls, pneumonia, and death in older people.

Australia has not approved the use of many of these drugs in older people, citing the studies.

“When older people are silenced by drugs rather than given person-centred support, it risks their health and insults their humanity,” report author Bethany Brown said.

Human Rights Watch said chemical restraint violated human dignity, bodily integrity, and equality.

“The use of drugs as a chemical restraint could constitute cruel, inhuman, and degrading treatment under international law,” the report said.

In many cases once the person stopped taking the drugs, they regained their vitality, and were able to talk, interact and remain awake during the day.

However, some of the negative physical impacts continued, including the loss of muscle strength and the inability to swallow.

media_camera Benzodiazepine is associated with an increased risk of falls, pneumonia and death in older people.

CHEMICAL RESTRAINT SHOULD BE PROHIBITED

Human Rights Watch said Australia’s existing legal and regulatory framework was inadequate to protect older people in aged care facilities from chemical restraint.

“It explicitly allows it,” the report said.

On July 1 this year, a new regulation was introduced to minimise the use of chemical restraint but this does not prohibit its use, guarantee the right to informed consent or provide a way for people to complain about its use.

It also does not set out any penalties for aged care facilities that engage in the practice.

Human Rights Watch believes the Australian Government should end the use of chemical restraint to control the behaviour of older people in aged care, or for the convenience of staff.

“The government should develop support and interventions, including person-centred care, for persons experiencing agitation, emotional distress, or challenging behaviours in aged care facilities,” the report said.

The report said clinical studies found non-medical interventions including exercise and music that focused on a person’s unique qualities, as well as building and nurturing relationships, were effective at addressing symptoms including agitation and aggression.

It said authorities should make sure any medical intervention only takes place with free and informed consent, and that medications are administered only for therapeutic purposes.

Human Rights Watch believes the Aged Care Quality and Safety Commission should monitor for chemical restraint.

It noted chemical restraint infringed international human rights law and that the United Nations Committee on the Rights of Persons with Disabilities criticised Australia in 2013 for allowing practices that would subject people with disabilities — including older people with dementia — to “unregulated behaviour modification or restrictive practices such as chemical, mechanical and physical restraints and seclusion”.

“The Australian government should prohibit chemical restraint and penalise aged care facilities it finds violating that prohibition” Ms Brown said. “We all have the same right to be treated with dignity, which doesn’t change with age or dementia.”

@charischang2 | charis.chang@news.com.au

Originally published as Shock practice uncovered at businesses