Nursing homes ‘sedating for convenience’

An elderly man living in a nursing home was medicated because he was upset having being informed of the death of his wife.

The claim was made by SAGE, the support and advocacy service for older people in Ireland.

“A resident in a nursing home was given medication when he became upset on hearing of the death of his wife,” said SAGE manager Mervyn Taylor yesterday.

SAGE is currently holding its summer team meeting in Athlone and one issue raised was the prescribing of medication for the convenience of nursing home and hospital staff rather than for therapeutic reasons.

“In another case an older patient in a hospital was medicated to encourage her to adapt to continence pads — when she was still continent but needing assistance of two staff to go to the toilet,” said Mr Taylor.

“We have identified many cases of sedatives being given to prevent wandering during the day or night — primarily for the convenience of staff.”

Dr Shaun O’Keeffe, consultant geriatrician at University College Hospital, Galway, also raised the issue at yesterday’s meeting.

“Unfortunately, we continue to see inappropriate use of medications for just these reasons,” said Dr O’Keeffe.

He explained that the dangers of using medication in this manner have been well documented.

For example, treating people with dementia by using antipsychotic medications for just three months will result in the death of one person in 100 and a stroke in one in 60, he warned.

Dr O’Keeffe said these findings have resulted in new recommendations about how these drugs are used.

The recommendations include that such medication should be used as a last resort, for short periods of time, and to treat specific problems.

The distinction between medication for therapeutic reasons versus medicine to restrain a certain behaviour is not understood among the general public, said Dr O’Keeffe.

He said the lack of clarity between the two forms of use is not understood by some staff in care facilities either.

“Chemical restraint and misuse of psychoactive drugs is a violation of personal and bodily integrity and a breach of Article 3 of the European Convention on Human Rights,” said Dr O’Keeffe.

“It is, unfortunately, being used as a first rather than a last resort in too many cases.”

He referred to the Department of Health’s strict stance on the matter, as well as that of the Health Information and Quality Authority (Hiqa).

Mr O’Keeffe said: “The Department of Health policy document, Towards a Restraint Free Environment in Nursing Homes, unequivocally states, ‘chemical restraint is always unacceptable’.

“Hiqa’s Guidance for Designated Centres — Restraint Procedures (October 2014) also warns of ‘the use of medication... to sedate the person for convenience or disciplinary purposes’.”

Dr O’Keeffe called for any future legislation in relation to care to deal with the issue of “chemical restraint”.


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