SocietyGuardian.co.uk Society Going quietly

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JoAnn Guest wrote:

 

> http://society.guardian.co.uk/longtermcare/story/0,8150,611990,00.html

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Jo, where do you live again? New Zealand, right? Are there lots of old

folks homes where you are? There are lots here (USA) and it's a damn shame,

too... but I understand that many people feel they have no choice, on

account of more families with both parents working, etc. :/

 

Anyway, here's the story cut and paste in this e-mail, in case you don't have

a browser.

 

Going quietly

 

The scandal of how older people in

care are being

prescribed drugs they may not need is

one that has

gone unheeded for far too long, says

a new report.

James Meikle on the problems of

monitoring

medication policy inside care homes

 

Wednesday December 5, 2001

The Guardian

 

People do not always grow old

gracefully. They can be fiercely

independent, curmudgeonly, confused,

even aggressive. Some

with dementia will wander, have

impaired memory and

demonstrate restlessness or agitation

that can irritate others.

There may be an understandable

temptation to sedate them - for

their own safety and good, of course,

even if it does make life

easier for carers too.

 

A report out today should help shake

such complacency, both

among individuals working with older

people and in the care

system responsible for them. Its

authors, Liberal Democrat MP

Paul Burstow and his researcher,

Richard Stokoe, have drawn

together compelling evidence to

suggest that the use of the

" chemical cosh " - medication as

management tool, rather than

effective therapy - is still

distressingly prevalent, despite

mounting concern about it over the

past decade.

 

Their main sally is against the

inappropriate use of

anti-psychotic drugs in nursing and

residential homes. These

drugs are vital in the battle against

schizophrenia and other

forms of severe mental illness,

symptoms of which may be

shown by as many as one in 10

residents in care homes. But

research both in Britain and overseas

suggests another two in

10 residents are being kept under

sedation for no medical

reason.

 

Burstow calculates that this may mean

that as many as 35,000

people in nursing homes and 53,500 in

residential homes are

being inappropriately treated. Worse,

the side-effects -

constipation, dizziness, drowsiness,

fainting - may help lead to

misdiagnosis of real health problems

and even to death. This,

the MP says, is a scandal. And while

the government is taking

some steps in the right direction to

stop it, including the new

national framework for older people

and its accompanying advice

on medication, ministers are

notoriously reluctant to be seen to

be interfering in the judgments of

doctors. Even with a new

inspection regime for care standards

on the way, there may be

insufficient resources to monitor and

police what is going on.

 

Some guidance from the national

institute for clinical excellence

is now expected next March, having

been delayed. But this will

concentrate on the use of

anti-psychotics for patients with

schizophrenia, instead of offering

wider guidance on the use of

such medication for older people and

on non-drug alternatives.

When an elderly person in a care home

is likely to receive as

many as four times as many

prescription items (for all drugs) as

a person living in their own home,

Burstow reckons this is

unacceptable.

 

He and Stokoe have, through

parliamentary questions to health

ministers, established that

prescriptions issued outside

hospitals of new, so-called

" atypical " anti-psychotic drugs for

the over-60s rose 70% in the 12

months between 1999 and

2000, an increase of 149,700 items,

while the prescription of

more traditional ones fell only 2.9%

(53,900 items). Overall,

there was a 6% rise on the use of

anti-psychotics in the age

group.

 

Burstow, MP for Sutton and Cheam, and

his party's spokesman

for older people, found his interest

in this issue first aroused in

1997 by a Royal College of Physicians

report which found that

" the use of sedation is all too

common " . His compilation of

existing evidence, and collation of

prescription figures, suggests

that there may have been a doubling

in the use of

anti-psychotics in a decade. " This

increase cannot be explained

just in terms of increased psychosis,

schizophrenia among the

elderly or an increase in the elderly

population, " he says.

 

The new national service framework

might insist that, by next

year, all people over 75 should

normally have their medicines

reviewed at least annually and those

taking four or more

medicines should have a review every

six months. But in the US

there are reviews at least monthly

for those on four or more

drugs and quarterly reviews for those

on fewer medications. The

new care standards inspectorate will

only succeed, Burstow

says, if the frequency of medication

reviews in Britain is along

such lines. He says: " It is also

vital that the inspection teams

are challenging of assumptions about

the use of drugs and alert

for over-dependency by home

management, staff and the

medical professionals with clinical

responsibility. "

 

Better understanding among, and

training of, care home workers

could help reduce residents'

confusion and aggression, Burstow

believes. Stability is also vital:

distress among dementia

sufferers can be severely exacerbated

by moving them from one

home to another. Pressures on

providers are undisputed, he

says, but can be no excuse for

overuse of drugs. The use of

chemical management " denies older

people dignity and robs

them of a better quality of life " .

 

His concern is shared by charities

working with older people.

Les Bright, deputy chief executive of

Counsel and Care, says

relatives have expressed anxiety

about the levels of medication

administered to their loved ones. In

the past, restraint was often

more visible - the use, for instance,

of the Buxton chair, which

has a table flap that can be lowered

in front of the occupant and

make moving around extremely

difficult.

 

Bright, too, wants far more reviewing

of medication in homes,

and some recognition that residents

should have more rights in

determining how they are treated.

" There is no place in law for

that, yet someone with the power of

attorney can act in matters

financial, " he says. " There is a need

for government to help

ensure action which complies with

people's wishes, as well as

ensuring staff have the capacity to

carry out those wishes. We

can then offer people some degree of

certainty that their wishes

will be followed and respected. "

 

This would make matters easier for

staff, says Bright, even

though he recognises that older

people can both change their

mind, after determining a course of

action they want others to

take, and deteriorate extremely

rapidly, thus making it almost

impossible either to make their

wishes known in the first place

or to change them. That must mean

proper support and

guidance for people to make the

decision they think is right.

 

Harry Caton, chief executive of the

Alzheimer's Society, puts in

bluntly. " Drugs have a role, but

people are put on them, stay on

them and are kept on them when they

no longer need them, " he

says. " What concerns me is that a lot

of people have been

talking about this for a number of

years, and yet the evidence

from this report is that it is not

getting any better. The

Department of Health has really not

taken any coherent action. "

 

Sheila Scott, chief executive of the

National Care Homes

Association, says many homes work

with doctors to keep

medication as low as possible. But

sometimes use of drugs is

inevitable. " Care homes do not

prescribe medication; doctors

do, " she says. " That is where the

question mark lies. Any

overprescribing that does happen

doesn't happen because of

care homes: they are following the

instruction of doctors. "

 

Jim Kennedy, spokesman on prescribing

for the Royal College

of General Practitioners, insists

that inappropriate use of drugs

has " declined very significantly " . He

says: " Large dosage

treatment is far, far less frequent

now. It is a lot better than it

used to be. It is still not as good

as we would like it to be. "

 

Kennedy, a GP in Hayes, Middlesex,

recognises the need for

regular reviews of medication - even

daily among very disturbed

people - and points to improvements

that can help older people

be less confused by their

environment: some lighting left on at

night; simpler layout of rooms; use

of the bathroom later in the

evening. But he thinks Burstow and

others should continue

asking the questions. " It is through

interest like this that you

can do something about it, " Kennedy

says. " If nobody cares a

damn about what Auntie Jane is on,

nobody will do anything

about it.

 

· The report, Keep Taking the

Medicine?, is available free by

emailing stokoer or by

writing to Paul Burstow's

office at the House of Commons,

London SW1.

 

· Full report and prescription

figures at

SocietyGuardian.co.uk/longtermcare

 

 

 

 

 

 

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