Aged-care royal commission: ‘side-effect for dementia patients is death’

A significant overuse of psychotropic medication on dementia sufferers has resulted in ‘increased rates of death’.

Edward Strivens gives evidence to the royal commission. Picture: Stewart McLean

A significant overuse of psychotropic medication on dementia sufferers within Australia’s residential care facilities has resulted in a range of negative outcomes, including increased rates of death, the aged-care royal commission has heard.

The president of the Australian and New Zealand Society for Geriatric Medicine, Edward Strivens, told the commission in Adelaide yesterday about 80 per cent of people in residential care with dement­ia were being prescribed at least one psychotropic drug.

These include antipsychotics, antidepressants, and sedatives.

Yet Professor Strivens said as few as 10 per cent of people bene­fited and the use of such drugs was too often viewed as a first option, rather than a last resort.

“The side-effects will often ­outweigh the benefits,” he said.

“Non-drug treatments should always be tried first and this is often more time-consuming and labour-intensive, but it’s what we need to do. We shouldn’t be using strong medications as a substitute for care.”

Asked by counsel assisting Eliza Bergin what proportion of dementia sufferers should be prescribed psychotropics, Professor Strivens said: “It would be on the lower rather than the high side.”

He said inappropriate use of the medication increased the risk of death, disability caused by stroke, pneumonia, and falls.

“If we were to take 1000 people and treat them for 12 weeks with these (psychotropic) agents, we would probably see about 10 per cent get some benefit,” he said.

“But along with that we’d see 10 excess deaths, 16 people having strokes, and around 10 to 12 per cent being impacted by reduced mobility and risk of falls.”

About half the people in residential care have dementia. By 2050, one million Australians are expected to suffer from the condition, up from the current 400,000.

Professor Strivens also raised concern about the overuse of incontinence pads within residential care facilities. He said infections around pressure areas could occur “frighteningly quickly”.

“Pads should be an augment­ation to clinical care, rather than the sole way of managing contin­ence,” Professor Strivens said.

“Things like regular toileting, looking at the medications people are on, their built environment, looking at ways to facilitate independence rather than simply a bandaid solution.”

The commission also heard harrowing stories told by nurses to their union — situations that regularly stemmed from tight time constraints and a lack of staff. One involved a man whose catheter was “tunnelling into his penis”.

“I am blown away the staff did not report the erosion as it was happening … more educated staff had not looked at the source of his pain,” the nurse said.

The federal secretary of the Australian Nursing and Midwif­ery Federation, Annie Butler, lam­ented a lack of specialised carers. She said one registered nurse for every 60 aged-care residents was “not the most extreme example”.

Ms Butler said “unsafe” workloads for many nurses were untenable and had resulted in significant employee churn, while poor remuneration made it hard to attract staff: “They (facilities) will ration care and so they will pay attention to the absolute must-dos. So many other things … get missed.”

The Australian College of Nursing’s Deborah Parker said the number of nurses within the system was falling while the complexity of patient needs was on the rise.

Hearings before commissioners Richard Tracey and Lynelle Briggs resume on Monday.