‘No excuse’ for using drugs to keep the elderly manageable in care homes
EXPERTS have called for a review into drug prescribing in care homes after a study found almost half of elderly people may be kept on sedatives that make them “easier and more convenient to manage” for much longer than necessary.
Health experts want to see national guidelines drawn up to ensure over-65s in care are not being kept on anti-psychotic drugs for non-medical reasons.
The study found two in five elderly people in care homes were taking the drugs – compared to just one in six who still lived in their homes in the community.
The report by Dundee University and NHS Fife, carried out over a two-year period in Tayside, also found that seven in ten people who were taking the drugs when they went into the care homes were then never reassessed to see if they still needed them.
The authors of the study have now called for systematic reviews to be carried out at least every six months on all elderly people in Scotland’s 911 care homes who are taking the drugs, to ensure there are medical grounds for using them.
Dr Colin McCowan, deputy director of the Health Informatics Centre at Dundee University, and one of the authors of the report, said: “These drugs are widely used among people aged 65 and over but we found there were many more taking them in care homes than in the community.
“Some elderly people are taking these drugs to make it easier and more convenient for people to manage them and for them to cope. Often this could start when they are living at home, on their own, and when they are waiting to go into residential care.
“But then, when they go into care many are kept on them and remain on them. No-one checks to see if they still need them. Some of these individuals and their families will know about them taking them, but there is evidence some won’t.
“This is why we are saying every care home, private and local authority ones, should ensure people taking these drugs are assessed at least every six months to make sure they still actually need them.”
He said the use of the drugs, known as psychotropic medication, which includes anti-psychotics, was a growing concern to health officials.
Dr McCowan said guidelines for the use of the medication stated they should not be used, in most cases, for more than six months.
He also said previous research had shown many of the anti-psychotics being prescribed to patients were likely to be having “very little beneficial effect” and could usually be gradually stopped without side effects.
He said: “There may be valid reasons for the initiation of these drugs but prolonged use of psychotropic medication in older people is not recommended and may cause harm. So you have to ask why they are being kept on them.
“The key issue our study suggests is there should be systematic medication reviews for patients on these drugs, to highlight drugs that may be discontinued if the reasons for their initial prescription are no longer valid.”
The Mental Welfare Commission for Scotland – an independent body set up to safeguard the interests of people considered to be mentally disordered – has also called for new guidelines to ensure older people are not being prescribed the drugs unnecessarily.
Dr Donald Lyons, the commission’s chief executive officer, said: “It is no surprise to hear some people are being kept on these drugs for completely the wrong reasons. There is no excuse for this.
“Anti-psychotic drugs are unquestionably being overused, more so in care homes but also, to a lesser extent in hospitals. The bottom line is more needs to be done to reduce the number of these drugs being prescribed. The rates are too high.
“We have long been asking for a review of the way the drugs are issued to find out why so many are being given out and what could be done instead.
“At the end of the day, patients should only ever get any drug if it is for the benefit of their health, not for any other reason, not least to keep them more manageable.”
Dr Lyons said previous studies had questioned the effectiveness of the drugs and concluded in some cases individuals would be better off not taking them.
He said: “Drugs may well be needed by some people, but not by the numbers which are currently taking them. The harm they can cause is well documented. For instance, research has shown people with dementia who take these drugs are at a much higher risk of stroke.”
The commission said providing more adequate outside space and stimulating environments were some of the ways to help people cope.
Dr Lyons added: “Yes, this costs money, money to pay for the right environment and additional care but surely that is money well spent in the long run. Giving people drugs to make them more manageable must never be a primary reason for giving these drugs.”
Stella Clark, medical director for Primary Care at NHS Fife, also called for national guidelines to be drawn up to reduce the prescription of anti-psychotics in people over 65.”
A Care Inspectorate spokesman said: “The National Care Standards clearly lay out the responsibilities for care services to maintain detailed records of any medication prescribed to the people who use services, such as care homes for older people.”