Providers face crackdown on chemical restraint of elderly

Aged-care providers face a crackdown over the chemcial restraint of nursing home residents after new standards were amended.

The Royal Commission into Aged Care Quality and Safety has announced antipsychotic drugs and other psycho­tropics will be a key focus of the inquiry.

Aged-care providers face a crackdown over the misuse of anti­psychotic drugs to dope nursing home residents after new standards were amended almost two years after the Department of Health was warned that the issue was a priority.

The development of new standards, released late last November and which are already in force, contained no reference to the significant problem of “chemical restraint” through inappropriate drug prescriptions and neither did more detailed guidance notes for providers.

The Royal Commission into Aged Care Quality and Safety has announced antipsychotic drugs — developed to treat severe schizophrenia — and other psycho­tropics will be a key focus of the inquiry, particularly as they are associated with an increased risk of falls, stroke and death.

After a series of revelations in The Australian earlier this month, Aged Care Minister Ken Wyatt announced he had told his department to speed up work on new “regulations” to crack down on the misuse of such drugs.

On Friday at 4.07pm, the Department of Health changed the guidance notes for providers in ­relation to clinical care to insert a reference to the issue.

“Although antipsychotic medicines may be appropriate for adults with severe mental health issues or long-term mental illness, there is concern that these medicines are being prescribed inappropriately in people aged 65 years and over for their sedative effects — that is, as a form of chemical restraint for people with psychological and behavioural symptoms of dementia or delirium,” the update says.

Former pharmacist and University of Tasmania researcher Juan­ita Westbury said the timing of the changes was “interesting”.

“The guidance for providers has more detail but is still woolly. There is no mention of chemical restraint in the basic standards,” Dr Westbury said.

“They are vague and so unspecific that they don’t really clearly state what is and what is not required in terms of care. Pharmacists and reviewing medication, especially psychotropic medication, are not mentioned at all. And it’s not just antipsychotics that are overused. Other agents, especially benzodiazepines, are not referred to at all. It’s also not just residents with dementia.”

The Department of Health consulted the sector during the development of the standards, hearing the advice of experts on psychotropic drug prescriptions.

Some stakeholders urged that the standards should require providers to use the “most minimally restrictive option” to discourage the inappropriate use of psychotropics, but these views did not make it into the final standards.

A spokeswoman for the Department of Health said: “The Aged Care Quality and Safety Commission has moved quickly to strengthen the administration of the standards.”