Care homes ‘resort’ to anti-psychotics for some residents

A new study has indicated that some people are given anti-psychotic medicine in nursing homes because of poor resources and a lack of training by those providing care.

The study, led by Kieran Walsh of the Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, looked at the determinants of appropriate, evidence-based, anti-psychotic prescribing behaviours for nursing home residents with dementia, based on a sample of 27 participants from four nursing homes involved in the care of residents.

It found: “On one hand, neither healthcare workers nor family members wanted to see residents over-sedated and without a quality of life. Conversely, the reality of needing to protect staff, family members, and residents from potentially dangerous behavioural symptoms, in a resource-poor environment, was emphasised.”

However, while the role of Hiqa was praised it also found that “GPs in particular felt that there was over-regulation by Hiqa, resulting in increased administrative burden, which did not necessarily translate into good care”.

According to the study: “Participants struggled to find solutions to Behavioural and Psychological Symptoms of Dementia (BPSD) other than antipsychotics in part because they felt that they lacked necessary training.

“Nursing Home staff struggled with the daily management of BPSD and some admitted that they needed antipsychotics to cope. GPs often felt out of their comfort zone and regularly needed input from specialists.”

There was also a “fear of negative consequences” if anti-psychotics were not prescribed. It said: “The overall picture was one of poor resources in Nursing Homes.

“The physical environment was believed to have a profound impact on residents. Some participants believed that if the environment was better suited to meet the needs of the resident, then there would be less of a need to prescribe.”

According to one consultant geriatrician interviewed for the study: “I think if we had properly designed purpose-built modern dementia units that allowed us to offer a different environment than the standard ward environment… I do think that would be far more humane and you’ll probably get better overall results than resorting to the old-fashioned chemical restraints.”

The research, entitled Exploring Antipsychotic Prescribing Behaviors for Nursing Home Residents With Dementia: A Qualitative Study, concluded: “It is evident that greater policy and institutional support is required to help stakeholders strike that ‘fine balance’ and ultimately make better prescribing decisions. Development of national clinical guidelines may be one appropriate policy intervention.”

The findings came as the 28th Alzheimer Europe Conference in Barcelona heard Irishwoman Helen Rochford, chair of the European Dementia Working Group, refer to the inappropriate prescribing of psychotropics to people with dementia as a possible example of human rights violation.