The Troubling Over Reliance of Anti-Psychotic Drugs for Dementia Residents

With the controversial withdrawal of dementia supplement funding by the Australian government, are dementia patients living in residential care facilities being over prescribed antipsychotic drugs as a form of chemical restraint? An aged care residential facility ‘insider’ recently brought this concern to our attention, and we at Aged Care Reviews could not ignore it.

According to our insider, both public research and internal operator audits show that there has been an increase in the documented use of antipsychotic drugs in aged care. The common response has been for facilities and their physicians decrease the use of these drugs across the board.

“Fair enough”, says our insider. “However, most residents in aged care have at least 1 to 2 mental health issues. To add to those concerns, they are surrounded by other “strange people” (other residents) and staff in a totally new environment. This results in agitation, anxiety, withdrawal and more.”

So, should a residential care facility unilaterally attempt to reduce the use of these medications? It is clearly not that simple.

“Decreasing or eliminating antipsychotic drugs for individuals with dementia is not a bad idea”, the insider claims. “It is ideal for people to have a quality of life, and enjoy their new home. However, this decrease can only happen if there is enough staff support. There must be programs specifically designed for residents with dementia”.

So how specifically can antipsychotic medication use be reduced? The insider suggests:
1) Increase staff to resident ratio.
2) Train lifestyle staff to manage these behaviours.
3) Have a strict funding line for lifestyle improvement.
4) Be able to access a dementia program funded by government including actual physical support and a program on a regular basis. This does not mean guidelines – staff know what to do – it means resources.

Clearly, doctors are aware of what they are prescribing. Their reasons are well and truly valid given the conditions that exist in residential care facilities for individuals with dementia.

If you have a loved one with dementia in a residential aged care facility, here are some ways to find out if dependence on antipsychotic drugs, in place of other lifestyle strategies, is an issue:

• What is the resident-nurse ratio in that facility? Has it increased or decreased in the last few months and years?

• How many hours a week does the facility devote to lifestyle programs for your loved one?

• Ask about dementia specific programs that exist. How often are they run? How many hours a week are devoted to them?

If the staff to resident ratio is high and there is little programming, over-medication may be a concern. Consider discussing with the staff of the residence and your loved one’s health care team.