Chemical restraint is a human rights issue

The over-use of antipsychotic medication in people with dementia is not just a medical issue but a human rights concern, says Britain’s top dementia policy expert.

Above: Prof Sube Banerjee speaks in Sydney on behalf of Alzheimer’s Australia

By Yasmin Noone

Medical professionals in Australia, the UK and US are unnecessarily treating people with dementia using antipsychotic drugs instead of effectively managing the behavioural and physical symptoms of the disease, according to Britain’s top dementia policy expert.

Professor Sube Banerjee, who is currently on a nationwide seminar tour for Alzheimer’s Australia, has warned that the over-use of antipsychotic medication in people with dementia is not just a medical concern but a human rights issue.

He claims that medical professionals are chemically restraining people with dementia, using antipsychotics, instead of managing their behavioural and physical issues using non-chemical means.

Governments must therefore tighten up practise in the use of antipsychotic medications in people with dementia, as overuse can cause long-term negative side effects and even premature death.

“The inappropriate use of antipsychotics to manage behavioural and psychological symptoms of dementia (BPSD) is widespread and should be a major concern for health services and policy makers,” Prof Banerjee said.

“This overuse stems from a disregard of the value and the human rights of people with dementia who are stigmatised and are often not given access to the same level of care as people with other chronic conditions.”

Prof Banerjee believes that cases of unnecessary chemical restraint are common in Australia and around the world.

“There are reasons to believe that there are similar issues certainly in Canada and the US, and from what I am hearing from Alzheimer’s Australia and people in Sydney (where I was yesterday), it seems there are similar issues here in Australia.

“…I see the use of antipsychotics as a symptom of a wider system failure in adequately providing for people with dementia and their carers.”

Prof Banerjee estimated that around one in four people with dementia use an antipsychotic, although there is insufficient evidence available to accurately represent the high number of people with dementia (diagnosed or undiagnosed) using the drugs.

Although the behavioral and physical symptoms of dementia are complicated, the high use of antipsychotic medication in this population is “unlikely to be warranted’.

In 2011, the National Prescribing Service in Australia issued an official warning about the serious and potentially life threatening side effects of the medications.

“There are people who require these medications and there is a place for antipsychotics in the proper treatment of dementia,” he said. “So this is not about banning them. But too often, [medical professionals] reach for the prescription pad and for antipsychotics to treat people with dementia.

“[Antipsychotics] should be the last resort to treat dementia, not the first.

“…There are often far better and more effective ways to deal with the difficult behaviours sometimes associated with dementia that do not involve these medications which can have severe adverse effects, including stroke and death.

“If there are changes in behaviour, such as wandering, aggression and depression, doctors need to talk with the patient and their family carers to gain an understanding of what is troubling them and what they need, not reflexively prescribe potentially harmful antipsychotics.”

But, he stressed, the over-prescription of antipsychotic medication must not be addressed in isolation: “You need to get the system, as a whole, right.”

That includes providing medical professionals with adequate education and training; improving and possibly increasing the number of specialist services available; encouraging early and accurate dementia diagnoses; strengthening the hospital system, and more.

Prof Banerjee – who wrote the report The use of antipsychotic medication for people with dementia: Time for action commissioned by the UK Government is currently working with the UK government to reduce the current level of prescribing by a third.

“The report suggests that 180,000 people with dementia in the UK were receiving antipsychotics, but only about 20 per cent of these people derived some benefit from the treatment; many suffered adverse effects including death, Parkinsonism, chest infections, confusion and accelerated cognitive decline,” he said.

“Since the report, the UK has put in place strategies to reduce the use of antipsychotics to a level where the benefits outweigh the risks.

“Evidence suggests that these strategies are starting to work.” 

Prof Banerjee is visiting every capital city over the next two weeks for Alzheimer’s Australia. For more information about his tour, click here.


Tags: alzheimer, alzheimers-australia, antipsychotic, chemical-restraint, dementia, drugs, human-rights, nhs, nps, professor-sube-banerjee,

4 thoughts on “Chemical restraint is a human rights issue

  1. I can only agree with prof banerjee and the evidence of literiture in the public domain that clearly provides the support for non pharmocological management for challenging behaviours especialy in the demented clients we work with. The problem with this is it is multi facited with numerous bariers. 1. is the level of learning and development needed for a direct care worker to have underpinning knowlege on this difficult area of care management, and carry out the directives given by the clinical leaders. 2. clinical leaders and in particular the RN in aged care needs specialised training and skills in this field of geriatric care and dementia work. 3. The conditions of regulation in the standards of accreditation do not reflect this need, nor does the aged care act of 97, and 4. that there is not enough funding in the ACFI system to support the service providers to run and maintain programs that use considerable human and logistical resources. the other side of the coin is the lack of understanding from the family and the GP in supporting a managed case conference and care plan that specifically addresses these issues.
    There is much more needed from the ground up to truely develope a person centered approach that everyone keeps taking about but no one actions.

  2. I am so pleased that there are other people who aware that antipsychotic agents has been over used and wrongly used, used unscrupulously, some times to shut up people with challenging behaviour. i hope they get rid of those practicioners.

  3. I agree that there is overuse of antipsychotic medication in all areas of Aged care. Unfortunately there is a dirth of education programs for Doctors , Nurses and Personal carers as to why these behaviours occur in the first place and how they can be managed non-pharmacologically.
    We have an ACFI funding system that is far from person-centered, our RN role models have no training in BPSD management and our poor personal carers, many who speak english as a second language are thrust into the workforce with a bare minimum of experience in general Aged care management let alone behavioural management. I agree with Drew Dyer I am sick of hearing the term person-centered care when there are few organisations truly supporting their staff to practice this way. I have had significant experience in providing education and modelling for Aged care staff in the management of BPSD non-pharmacologically . I know that it can easily be done but only where there is comitment from the top down and where everyone in an organisation is trained to rethink their management.

  4. I am so releaved to hear that Dr Banerjee finally understands the effect antipsychotics have on patients with dementia. Recently we experienced this with my elderly father who was given antipschotic drug and all it did was make him more confused and aggressive, and then resorted to restraining him to his bed. I was disgusted at the treatment. This drug has to be stoped, and medical professionals should be rethinking their management in old age dementia.

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