Around 80% of people in residential care are on at least one form of psychotropic, but the majority would benefit from non-pharmacological treatments, according to Edward Strivens, President, Australian and New Zealand Society for Geriatric Medicine.
In a 90-minute session, he answered queries from Senior Assisting Counsel Eliza Bergin on a range of health conditions including dementia, depression, anxiety, skin issues, pressures areas, incontinence, dysphagia, and advance care planning, but psychotropic drugs were clearly the hot-button issue.
He told them that more often, these drugs won’t help – and will actually increase the risk of death.
“If we were to treat 1,000 people for a few months with antipsychotics we could get some improvement in maybe 10 to 12 % of those people but we would see in excess of 10 extra deaths and 16 strokes and 10-12 % likely to fall over,” he said.
Mr Scrivens told the Commissioners he wouldn’t say they are never appropriate, but they should be a last resort.
“Far too often they become the first step to manage people who present with agitation rather than look at reasons behind this,” he said,
He cited the example of a baker who kept getting up at 2am in the aged care facility where he was living because that was the time he had always woken up. This was a problem for the facility – “it wasn’t necessarily a problem to him”.
His advice? “Start low, go slow and review regularly.”
“And if it doesn’t work, don’t just keep on increasing or adding different agents. You look at withdrawing and trying other things.”
“This is often more time consuming and labour intensive but it’s what we need to do.”
The issue of consent was also noted with Mr Scrivens drawing on research that showed just 6.5% of residents on antipsychotics had actually consented to them.
“That’s one of the concerns that agents are being used without full discussion of benefits and side effect. Ideally this should be with the person themselves or if they’re unable to consent due to reduced capacity I would still be discussing with the individual and with their substitute decision maker.”
He advocates a multi-disciplinary approach of coordinating care around the person, pointing to the fact that ACAT assessments initially included more of a medical component. He also promotes more use of the Comprehensive Geriatric Assessments (CGAs) given to residents when they enter aged care and when they need reassessment.
He says the existing funding levers exist to make it happen – including a Medicare item number for Comprehensive Geriatric Assessments (CGAs) which mean any elderly person could potentially set up their own ‘team’.
An interesting point.
Another item worth noting – Mr Scrivens says dementia is currently listed ninth on our national health priority list. With dementia the leading cause of death for women – and set to be our main leading cause of death within a few years – surely it should be higher?
