Leaders: Study on sedatives in care homes is a worrying read

Published on 14/09/2012 02:10

READING the disturbing report by Dundee University and NHS Fife on the incidence of elderly patients in care homes kept on sedatives, it is hard to avoid the conclusion that such medication can be more for the benefit of the staff than for the health of the patients.

This troubling and disturbing study found that two in five elderly people in homes were taking sedatives, compared with just one in six still living in the community. It also found that seven in ten people who were taking the drugs when they went into care homes were not reassessed to see if they still needed them.

The report has called for a ­review to assess why this is the case and whether it is indeed because staff find the patients “easier and more convenient to manage”. Such a study cannot come too soon, together with national guidelines to ensure patients over 65 who are in care are not being kept on sedatives or anti-depressants for the wrong reasons. The Mental Welfare Commission for Scotland has also called for new guidelines to ensure older people are not being prescribed the drugs unnecessarily.

There is little doubt that sedatives and anti-depressants can lead to a perceived improvement in the quality of life for the elderly. It is frequently the case that their entry into a care home has been caused by a variety of distressing factors – the loss of a partner, for example, or an inability to cope with living at home and looking after themselves when many would prefer to stay in the reassuring comfort of their own homes for as long as possible. Indeed, a common factor in admissions can be an inability or reluctance to take medicine on a regular basis.

It can be a very difficult ­period for many and in such situations resort to sedatives and anti-­depressants for a temporary ­period is justified while patients adjust to their new circumstances.

However, such prescription is not without risk. Regular resort to tranquillisers or anti-depressants can increase the risk of a stroke in some patients, while it can also lead to addiction.

Such drugs by their nature do imbue patients with a sense of well-being or at least subdued anxiety. It is natural that those taking them begin to feel that they cannot cope without them. Rather than allow the mind and body to undertake their own necessary adjustment to a ­significant change in life, mind-altering drugs can work to inhibit the progression to more lasting ­settlement.

And certainly for the staff, residents who are sedated tend not to make demands or to ­complain in a way that they otherwise might.

For these reasons, prolonged use of psychotropic medication can expose patients to harm. Regular review after, say, six months to ensure that there is still a genuine medical need for sedation should surely now become standard practice across all care homes.

Banker’s protests don’t quite add up

On two issues Peter Cummings, the disgraced former head of corporate lending at HBOS, may have a point in his protest over the £500,000 fine levied on him by the Financial Services Authority.

His complaint that he has been “singled out” in an ­“Orwellian process” and that he was the only individual from HBOS to face investigation does defy comprehension. What was the chief executive doing at this time, or indeed the FSA itself as bank regulator?

Second, the FSA accused Cummings of leading a “culture of optimism”. If that is a punishable offence, most executives in business would merit sanction. It was his reckless conduct that was deeply injurious to the bank, its shareholders and the wider economy.

It is here that his complaint against being “singled out” falls down. The clue is surely in the title: head of corporate banking. He was paid highly in this role. But with it is an obligation to carry the can should things go wrong. And this was no single failure. Under his watch, HBOS’s lending to commercial property between 2006 and 2007 rocketed from £44.4 billion to £68.1bn, representing 56 per cent of the bank’s total loan portfolio.

These figures alone should surely have alerted him to the huge risk he was taking. That ­others should also have been aware, does not mitigate Cummings’ own failure. That is what earned him the largest fine levied to date against a UK banker for management failings.

As for the FSA, the least it should now do to help guard against any early repeat of this misjudgment is to publish its wider report into the bank’s near collapse. It is this that taxpayers are surely owed.