Psychotropic drugs are being inappropriately used to manage symptoms of dementia, the aged care royal commission has been told.
President of the Australian and New Zealand Society for Geriatric Medicine Edward Strivens said powerful psychotropics, including antipsychotics, antidepressants and sedatives, are sometimes used to treat symptoms of unmet need and cognitive disability.
Eighty per cent of people in residential care with dementia were on one form of psychotropic drug, he said in evidence to the Royal Commission into Aged Care Quality and Safety in Adelaide on Wednesday.
Dr Strivens said while these drugs could play a role in some cases, they only achieved improvements for about ten per cent of those who took them.
Research also suggested that only 6.5 per cent of older people on antipsychotic medication given adequate consent.
Side effects outweigh benefits
“If we treated 1000 for a few months with antipsychotic medications we would get some improvements … in about 10 per cent. However we would see in excess of 10 extra deaths and 16 strokes as well as 10 to 12 per cent more people likely to fall over,” he said.
There was also evidence at sedatives could increase the risk of pneumonia , Dr Strivens said.
“Side effects will often outweigh possible benefits,” he told the commission.
“They are a last resort but too often we see them used as a first resort and the use of medication should never be a substitute for good quality care.
“When you have a hammer every problem looks like a nail, and that is one of the issues with antipsychotics.
“It’s far too often the first step to look at managing someone with agitation, sometimes physical outbursts, rather than actually looking at the reasons behind this.”
Start low, go slow, review regularly
Dr Strivens said the guiding principles for the use of psychotropic medication in the elderly should be “start low, go slow and review regularly”.
He said frail older people responded differently to drugs than young people, yet most drug trials were conducted on the young.
He said a new term, “hyperpolypharmacy”, had been invented to cover people who were on ten or more drugs.
“Polypharmacy, or five or more drugs, wasn’t really cutting the mustard in terms of differentiation because so many people are on so many medications,” he said.
One the other hand, underdosing was also a problem, particularly in relation to pain, he said.
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