By Yasmin Noone
Age discrimination and a lack of community awareness about Alzheimer’s disease could be to blame for a nationwide failure to recognise the vast number of older people with dementia who are being unnecessarily overprescribed and administered antipsychotics, it was inferred during an episode of the ABC show, Lateline, last week.
This inference followed on from a line of questioning made by the show’s host and established journalist, Tony Jones, as he asked the Minister for Mental Health and Ageing, Mark Butler, about a recent Lateline investigation into the use of dementia drugs and a previous coronial inquiry into the death of an older person, as a result of an antipsychotic overdose.
The ABC story, which was played on air before the minister’s interview screened, claimed that “up to 6,000 elderly people could be dying prematurely each year because of widespread over-prescription of anti-psychotic drugs to dementia patients in nursing homes”.
“Experts say anti-psychotic drugs can leave patients immobilised and unable to speak and are often used unnecessarily to keep dementia sufferers quiet for over-worked staff. But the drugs can increase the risk of death by 50 per cent and family members are often left in the dark about their use,” reads the transcript of the story.
During the minister’s pre-recorded interview, Mr Jones put it to Mr Butler that if younger people were being unnecessarily drugged and overprescribed antipsychotics when there were alternative behavioural treatments available, there would already be an inquiry into the matter.
Yet, the numbers of older people affected by this practice – and experts agree that it does happen and on a disturbingly broad scale – is still up for debate.
“If these numbers, even if they were remotely correct – and these are numbers produced by experts looking at peer-reviewed studies – even if they were remotely correct, if we were dealing with younger people dying prematurely because of the inappropriate use of dangerous drugs there’d be a Royal Commission, wouldn’t there?,” Mr Jones, asked the minister.
Mr Butler replied: “Well I think that’s right and I think that is a symptom of the lack of profile that dementia has historically had as a very, very serious condition and the treatment of people living with dementia has had as a community responsibility.
“I think we’ve come a long way over the last several months particularly through a campaign run by Alzheimer’s Australia, and last Friday the health ministers of all jurisdictions agreed to a proposition that Tanya Plibersek and I took that dementia be added as the ninth national health priority.
“Now, that won’t be of much solace to the families identified in your story, but I think these issues are a broader symptom of the problem we have in the health system and in aged care system in terms of the profile given to what is now such a major health challenge for us.”
The minister did not agree to the need for a Royal Commission into the matter but, during the interview, he did promise to discuss the option of a federally mandated pharmacy audit of all nursing homes “as a matter of urgency” with Alzheimer’s Australia and other consumer representative groups.
Minister Butler: “…No, I don’t rule it out because I am committed to getting a better understanding at government level and for consumer organisations and most importantly for families about what exactly is happening in aged care facilities with the prescription of anti-psychotic medication to people largely with behavioural symptoms of dementia rather than psychotic symptoms.”
A welcome committment
Alzheimer’s Australia CEO, Glenn Rees, said his organisation welcomes the minister’s commitment to discuss the matter.
“Alzheimer’s Australia supports the concept of an audit into the use of anti-psychotics in dementia patients in aged care,” Mr Rees said.
“We look forward to working with the government to address this important issue.”
Alzheimer’s Australia have long purported that antipsychotic medications are being used inappropriately in Australian nursing homes to control behavioral disturbances or anxiety among people with dementia.
“Antipsychotic medications are overused in Australia as a first-line response to managing behavioral and psychological symptoms experienced by people with dementia, particularly in residential aged care.
“We know that antipsychotics can have very serious side effects, including risks of death and stroke.
“Experts also estimate that of the 50-100,000 people with dementia in Australia who receive antipsychotic medications, treatment is only clinically warranted in approximately 20 per cent of cases.”
According to the expert figures, quoted by Alzheimer’s Australia above, around 40,000 to 80,000 (80 per cent) Australians with dementia are being unnecessarily treated with antipsychotic medications for the disease.
And while Alzheimer’s Australia does concede that antipsychotics have an important role in the treatment of severe behavioral and psychological symptoms for some people with dementia, it also says that the medications should only be used after alternative approaches have been tried.
“Non-drug approaches come down to basic principles of good care,” said Mr Rees.
“Often you can address behavioural symptoms by doing simple things. For example, determining whether a person with dementia is crying out because they are in pain, and if so treating the pain; or identifying if a person is resisting care because they are uncomfortable being showered by strangers, and finding ways to work around that.
“These are much better approaches to responding to behavioural symptoms in most cases than sedating people with powerful antipsychotic medications.
“We also know that some residential care facilities have been able to reduce rates of antipsychotics amongst their residents, however we still have a long way to go.
“Last year the National Prescribing Service issued a warning about the use of antipsychotics for people with dementia. This was excellent good first step in raising awareness about this issue, but clearly it is not enough.”
Evidence suggests that rates of antipsychotics in nursing homes in Australia have remained relatively stable at around 25 per cent over the past 20 years.
According to the consumer advocacy group, the Lateline reporter who broke the story about dementia drugs is now looking at a follow-up story focussing on cases of systems failure.
Alzheimer’s Australia said the story will attempt to question where medications have been used and why; how their misuse resulted in terrible outcomes despite the wishes of carers; and how complaints about use of antipsychotics and the consequences have often fallen on deaf ears.