ELDERLY patients in care homes across Scotland are being prescribed powerful drugs for long periods of time without proper checks on whether the medication is needed.
In some cases, frail patients are being kept on multiple and potentially harmful doses for up to two decades without doctors or staff questioning whether they are necessary.
The disturbing reality in Scottish care homes is revealed by the Royal Pharmaceutical Society in Scotland (RPSS) in a report which calls for more powers for pharmacists to review patients’ medical records. Pharmacists say they are becoming “increasingly concerned” about patients’ safety.
Around 40,000 elderly Scots live in care homes, where their health needs are the responsibility of staff, local doctors and pharmacists who dispense the medicines, but have no control over long-term monitoring.
Drugs regularly handed out to elderly patients include anti-psychotic medicines for dementia. These are classed as high-risk because of their links to heart problems and strokes, yet some patients remain on these far longer than is required. Other drugs could be causing drowsiness and dizziness, leading to falls and loss of appetite.
The findings are being examined by government ministers, who said they may introduce changes later this year.
The study, “Improving Pharmaceutical Care in Care Homes”, warns patients are often kept on a mix of drugs for health problems that may have resolved over time.
Pharmacists are not currently permitted to view patients’ medical records, but the RPSS believes that if they were, they could review patients’ drugs more easily, helping to bring down Scotland’s massive £1.2 billion prescribing bill.
The report says it “identifies a number of issues that require immediate action across Scotland. These include reducing inappropriate anti-psychotic and psychoactive medication and high-risk medicines.
“The RPS believes that a radical examination and change in how pharmaceutical care is provided in care homes by pharmacists in Scotland is urgently required.”
It adds: “As the proportion of older people in Scotland continues to grow, alongside the increasing frailty of those living longer, we need to address the health and social care needs of this population in a way that is accessible, appropriate to their care needs and also financially sustainable.
“In recent years, pharmacists and others have become increasingly concerned about aspects of medicines safety and appropriateness in the care home setting.”
AnnaMarie McGregor, professional support pharmacist for the RPS in Scotland, said doctors and care home staff needed to communicate better to halt the problem.
She said: “We have an ageing population suffering chronic conditions who are given a number of drugs to manage these. But by the time people reach the age of 80, they often can’t manage this mix of drugs because they are older.”
She added that patients on drugs with side-effects are often given more medication to counteract these, remaining on the prescriptions for many years.
Yet in many cases the original problem may have got better without health professionals checking conditions such as high blood pressure, which can resolve over time.
Politicians, patients’ groups and charities involved in elderly care said the need for action was urgent. Henry Simmons, chief executive of Alzheimer Scotland, said: “The dangers of inappropriate or long-term prescribing without regular review are clear: an increase in falls due to dizziness and unsteadiness, an almost doubling of mortality rates and double the risk of stroke in people with dementia.”
Dr Richard Simpson, Labour’s health spokesman, called for a “significant rethink”. “The worry for families is that GPs, with the best will in the world, just don’t have the time to carry out the checks that are needed.”
Ranald Mair, chief executive of Scottish Care, which represents care home providers, said: “What is important for patients and their families is that medication is kept under review and there has to be an improved approach to that.”
Dr Andrew Buist, deputy chairman of the British Medical Association’s Scottish GP Committee, said family doctors understood that elderly patients in nursing homes had particular needs.
“It is important that GPs work with pharmacists to review individual patient prescriptions and reduce the number of medicines they’re taking, where appropriate.
“It is essential that these discussions are had in partnership with the patient and their relatives, so that there is clear understanding about why changes are made,” Dr Buist added.
A Scottish Government spokesman said the report will be fully considered by the Review of Pharmaceutical Care of Patients in the Community in Scotland team, which is expected to report to the Scottish Government in October this year.