By Linda Belardi.
Aged care providers have called for more robust guidelines on the long-term use of antipsychotic medication and increased education for GPs and nursing staff to address the widespread and controversial use of chemical restraint in care.
In public hearings to a parliamentary inquiry investigating the care and management of people living with dementia and the behavioural and psychiatric symptoms of dementia, Denise Edwards, Service Development and Improvement adviser at Blue Care said unnecessary prescribing of psychotropic medication increased the risk of falls, which could lead to premature death.
To improve practice, Ms Edwards recommended a national program to measure and benchmark patient outcomes in dementia care, similar to the current Palliative Care Outcomes Collaboration or PCOC program.
In her evidence to the committee, Ms Edwards stressed the importance of a person-centred approach to care for people with dementia and also drew attention to the importance of language and addressing the stigma attached to dementia.
She said the widely used term ‘Behavioural and Psychological Symptoms of Dementia’ or BPSD – which is contained in the inquiry’s terms of reference – should be avoided.
“This terminology can detract from the individuality of the person living with dementia and subconsciously begins the process of labelling, which can result in negative attitudes towards the disease and the person living with the disease,” Ms Edwards told the recent senate committee hearing in Canberra.
She said the term encouraged the assumption that everyone who has dementia will exhibit certain behaviours. Ms Edwards said many behaviours perceived as concerning or challenging occur because individual needs are not being met by staff.
“This is commonly overlooked in the aged care industry and behaviour is often seen purely as a symptom of dementia and so no action is taken to improve the situation and improve the quality of life for both the person and their carers,” she said.
Understanding what has triggered the behaviour is key to preventing behaviours and supporting the person living with dementia, she said.
Sue Pieters-Hawke, Co-Chair of the Minister’s Dementia Advisory Group said societal attitudes of dementia had not “crept out from the shadows of the medieval demonisation of people with mental and behavioural differences.”
She told the committee that language used both in the community and in aged care often described people living with dementia as ‘a problem’, as ‘aggressive’ or lacking any capacity.
“The language and the perception of people rob them of humanity, dignity and respect and accord a sort of capriciousness to their behaviour,” she told the committee hearing.
Ms Pieters-Hawke said the level of social stigma underscored the need for a widespread public education campaign on dementia to overturn negative biases and misconceptions.
Glenn Rees, CEO of Alzheimer’s Australia said while additional funding in residential aged care was important, cultural change was the bigger challenge.
He said through Montessori training techniques and psychosocial approaches, improved standards of care could be achieved.
Mr Rees said funding for the Dementia Behaviour Management Advisory Service (DBMAS) needed to be doubled.
Angela Raguz, General Manager of Residential Care at HammondCare told the inquiry that specialised units with dementia-specific environmental design, as opposed to ad hoc, generic services in mainstream aged care represented best practice care for people with severe behavioural and psychiatric symptoms of dementia.
“A program approach means that specialised aged care psychiatry services are in support, that there is specialised training and that there are specialised environments that are small with individualised care,” said Ms Raguz.
She said focused programs could draw on specialist expertise involving a psychogeriatrician, clinical nurse specialists and highly trained care staff that provide continuous review and care to people with dementia.
Blue Care and HammondCare also discussed the difficult situation faced by providers when families rejected the risks of chemical and physical restraint and asked for this approach for their loved one in care.
The Senate Community Affairs Committee inquiry is ongoing and is due to hand down its final report on 12 August.