Staff urged to reduce dependency on sedative medication amid reports more than 60% of elderly residents taking psychotropic drugs

This article is more than 1 year old

This article is more than 1 year old

The royal commission into the aged care sector will examine whether nursing homes are unnecessarily turning elderly residents into “zombies” amid high rates of sedative medication use.

The first hearing is scheduled for Adelaide on Friday and commissioners Richard Tracey and Lynelle Briggs will outline their vision for how the inquiry will operate.

Their main task is to examine evidence of substandard aged care, abuse, systematic failures and draw up recommendations for improvement. The controversial practice of “chemical restraint” in aged care homes will also be examined.

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Ian Yates from the Council on the Ageing said the practice is widespread and unregulated.

“A lot of families will complain that their mum or dad, although frail, went into residential care still alert and within a month are like a zombie,” Yates said.

A University of Tasmania study of 11,500 nursing homes residents found that more than 60% are taking one or more psychotropics drugs.

Senior lecturer in dementia care, Dr Juanita Westbury, has been trialling strategies such as staff training to encourage homes to reduce dependency on medication.

“We found that de-prescribing or lowering doses did not increase behavioural symptoms of the residents, in fact some aspects of behaviour improved upon dose reduction, for example sleep and calling out, when antipsychotics were ceased,” she said.

“If someone can’t communicate because they are dozing in a chair most of the day, is that a good thing? If someone can’t eat their lunch because they are really a bit too disengaged because of the medication, is that a good thing?”

Some residents are on the medication for up to 12 months when they should only be on it for a few months, she said.

Aged care staff were often not aware of side effects associated with use such as a higher risk of falls, pneumonia and stroke, she said.

“Many of the staff believe that these medications are a lot more beneficial than the evidence suggests,” Westbury said.

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Anxious or agitated behaviour sometimes masked underlying pain, discomfort from environmental factors such as heat or cold, or fear about certain activities, she said.

“It’s about proper assessment before you start on the drugs,” Westbury told Guardian Australia.

Labor’s aged care spokeswoman, Julie Collins, hopes drugs aren’t being used to make up for a shortfall of staff, programs and rehabilitation or activity sessions.

“I hope there are sufficient checks and balances and they are being used appropriately,” she said.

Yates expects resourcing will also be a big focus of the commission and hopes the interim report due by the end of October makes solid recommendations around funding in order to feed into the budget cycle.

He believes cultural change in the sector is needed, in particular the acknowledgement and willingness of facilities to learn from mistakes.

“Aged care has been a bit of a forgotten ghetto in this area,” he said.

Negative publicity around substandard care in the past year was already causing some people to delay entering facilities, Yates said.

He said the commission was likely to uncover “a few” more scandal-plagued nursing homes like the notorious Oakden facility which was shut down in South Australia.

Sean Rooney, the chief executive of the aged care industry peak body Leading Age Services Australia, insists the vast majority of services and their dedicated staff deliver outstanding care.

“The whole industry is judged by the behaviours of the participants in the industry. So where there is an issue of abuse and neglect … when they do happen it reflects poorly on everybody in the system,” he said.

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The prime minister, Scott Morrison, announced the royal commission last year and warned the country is going to have to “brace itself for some difficult stories”.

Collins has spoken to a few families who will come forward with stories of abuse following the death of loved ones at nursing homes.

“One of the problems in the system is that people don’t have the confidence to make a complaint at the time; they wait until their loved one is deceased because they fear retribution,” Collins said.

The commission will hold hearings in February and March in Adelaide before travelling across Australian cities and regional hubs.

The commission’s final report deadline is 30 April 2020.