Doctors want ban on drugs leading to dementia deaths

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Antipsychotics are leading to the premature deaths of as many patients with dementia as those helped by the prescribed drugs, a senior geriatrician says.

Renewing a call for antipsychotics to be avoided as the first treatment for behavioural and psychological symptoms of dementia, President of the Australian and New Zealand Society for Geriatric Medicine (ANZSGM), Associate Professor Eddy Strivens, told YourLifeChoices the drugs were of little value to patients not suffering psychosis.

The drugs, which are strong tranquilisers, were designed to treat people with schizophrenia and bipolar disorder who largely experienced hallucinations or delusions.

Dementia patients displaying agitation or aggression may be reacting to an unmet need rather than showing symptoms of psychosis, Prof Strivens said.

“The ANZSGM wants to stimulate the conversation around reducing the use of antipsychotics because there is evidence linking them with a risk of increased morbidity,” he said.

“Often, a patient with dementia may be reacting to something in their physical environment and this is mistaken for psychotic behaviour.

“The patient may merely be precipitated by hunger, thirst, bright lights, constipation or side-effects of other medications.

“In some people, confusion can arise from having a salt or electrolyte imbalance in their blood, as is sometimes seen with diabetics or patients with thyroid problems.”

Prof Strivens believes that before antipsychotics are prescribed, a thorough assessment of the patient ought to be conducted by their GP or specialist.

“They need to look at the behaviour and decide whether it is a consequence of an unmet need,” he said.

“Then they can go about designing an alternative treatment involving person-centred care.”

Figures showing that prescriptions of antipsychotics had grown almost 360 per cent in the 24 years to 2016 have drawn criticism that Australian doctors are over-medicating patients with the strong sedatives.

“We believe they don’t work well and practitioners ought to consider non-drug interventions first,” Prof Strivens said.

Referencing a UK report by Professor Sube Banerjee, of London’s King’s College, he said that national leadership was required to begin rolling back the use of the drugs in nursing homes.

Restricting the use of anti-psychotics is one of a five-plank manifesto called Evolve that the ANZSGM supports.

According to the document: “People with dementia may exhibit aggression, resistance to care and other challenging or disruptive behaviours. In such instances, the modest effectiveness of atypical antipsychotics may be offset by the higher risks for adverse events and mortality. Non-pharmacological interventions can be an effective substitute for antipsychotic medications. Use of these drugs should therefore be limited to cases where non-pharmacologic measures have failed and patients pose an imminent threat to themselves or others.”

Do you think that prescribing antipsychotics to dementia patients can solve their behavioural issues? Who benefits most from these sedative drugs: the patients or their carers? Do you think prescribing antipsychotics should be more tightly regulated?

Opinion: Government must review lethal dementia treatment

More than a decade after warnings were issued about doctors inappropriately dosing dementia patients with strong sedatives, it is astounding that they need to be reminded to stop this abhorrent practice, again.

Lately, the Australian and New Zealand Society for Geriatric Medicine (ANZSGM) has had to issue another alert that anti-psychotic drugs can precipitate the deaths of patients with dementia. When will practitioners supposedly caring for frail, elderly patients stop this abuse?

These patients are likely to be in residential care or hospitals. The peak body advocating for best-practice care of these patients is alarmed at the rampant prescription of antipsychotics. And we should worry, too, because there, but for the grace of God go all of us, at some future point.

Antipsychotics help patients with bipolar or schizophrenic disorders. The drugs ameliorate the downside of their delusionary thoughts. But if you do not suffer these psychological illnesses, then those medications will not ease your suffering. They may quell certain  behaviours – agitation, aggression – but they will do nothing to address the underlying cause of distress, according to various studies. Some of those studies even suggest that they will pre-empt death, if a patient is misdiagnosed and improperly medicated.

Sadly, the unmet needs of patients with dementia are in many cases being ignored for the sake of the convenience of their carers and medical practitioners. Patients are being drugged into a pliable, stupefied state so that they can be “managed” more easily.

According to the ANZSGM, what practitioners ought to be doing is more closely examining why these patients are troubled. Prominent geriatricians are suggesting that these patients are expressing a frustration about their physical environments or uncontrollable bodily functions.

The organisation is pleading with those who care for frail, elderly patients to more closely examine the needs of this vulnerable cohort. They want to see better assessments, more non-drug therapies, treatments that focus on psychological remedies, and improved attention to the very personal needs of this growing demographic.

And let’s face it … more of us are going to end up in that category as modern medicine keeps some of our vital functions working while others deteriorate.

What our society needs is a more incisive look at how to manage dementia patients without stripping them of their last remaining cognitive abilities, and precipitating their deaths through the prescription of dangerous tranquilisers.

I’m calling out the Minister for Aged Care, Ken Wyatt, to do something meaningful with his responsibility towards elderly Australians. If he fails to address this growing problem, future generations may judge his ministry as responsible for the early demise of thousands of people.

What are you going to do, Mr Wyatt? Are you going to ban the automatic prescription of strong tranquilisers for patients with dementia? Are you going to mandate better assessment of how to meet the needs of the growing number of patients suffering from dementia? Tell us, Minister. Because if you call yourself the Minister for Aged Care, you better be doing something constructive for the vulnerable people you have been charged to advocate for.

(article updated 25/01/18 10.30am)

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Total Comments: 55
  1. 0

    Interesting dilemma. Most doctors are in the pockets of big pharma

  2. 0

    If I had dementia I would want to be put down

    • 0

      I could be unkind & suggest that many doctors want to keep you alive, because they have to stop charging you after your death.

      Thus those who give anything that improves your life short term, even if it kills you sooner, are by far the best to have.

      Personally I’ll take a year of reasonable cognitive life rather than 5 of being a vegetable.

    • 0

      Even if you wanted to put down, Virginia, it has to be your choice and your permission not someone else’s decision.

    • 0

      She can decide that before she loses her mind and state her wishes in a formal document.

  3. 0

    The ANZSGM proposals definitely sound a bit better than Dame Edna Everidges’ instructions to the nursing home she was taking her dear old Dad to, (forced to, he’s a bit past you know) – ‘just hose him down once or twice a day and roll him up in some carpet, he’ll be no trouble”.
    Well, some doctors need to be put on the spot and have explained to them that that was a joke, to bring peoples attention to certain inhumane attitudes, not an injunction to behave likewise.

  4. 0

    That’s the trouble with going into any kind of care/medical facility, control is removed from you to the medica staff who can dose you without your permission.

    • 0

      Sorry Triss but you are not correct. In Australia, no one can “dose you” without your permission in any care/medical facility. If you have been deemed to have lost capacity by doctors – the ability to make informed decisions for yourself regarding financial or health matters due to brain damage/dementia – and previously you had made an Enduring Power of Attorney or an Advanced Health Directive naming personal care attorney/s, then this person/these people legally take over and look after your medical care. If no EPOA is in place, in Queensland a court appoints a guardian to do this. Personal Health Attorneys and Guardians appointed by courts cannot force you to take medication. Whilst doctors may prescribe medication and care staff may bring it to you for you to take, no one can force you to take any medication.

    • 0

      But the article seems to read that patients have been receiving massive amounts of drugs without they, or their families, being properly informed of the side effects. Had they had that information, in many cases permission would have been refused so technically patients were medicated without their informed consent.

    • 0

      Drugs in aged care or medical facility have to be given at the prescribed dose and if this is found not to happen, charges are laid. These anti-psychotic drugs would have been administered over a long term and would have had a cumulative effect. As the drug breaks down it is still effective in a person’s system. Every drug that we take has potential side effects and this even includes natural remedies. All prescription drugs either have an information brochure enclosed or a link for you to go online to get the information brochure. This brochure states all the side effects. I always check the medication prescribed for my Mum to see what it is supposed to do, its dosage and its side effects. Anti-psychotic drugs have long been known to have an adverse effect on dementia patients so this article is not new news. Please don’t think that if you have to go into care, over dosing on drugs is going to happen to you.

    • 0

      We’re talking about doctors prescribing to dementia patients here…. how much real say does such a patient get in their medications?

  5. 0

    The comment about most doctors being in the pockets of big pharma is absolute rubbish. Fake news at its worst.In 40 years of practice I am yet to find myself in anyone’s pocket, and this applies to the vast majority of my colleagues.
    I am pleased that action is being taken to reduce the use of antipsychotics in the elderly. However most aged care facilities are grossly understaffed, having a handful of poorly paid care givers without the necessary training to manage difficult behaviours, and these days there is often no registered nurse available. Action needs to be taken on staffing, and of course education of nurses, carers and GPs in the correct assessment and management of the aged. It all costs money, and it is up to the Government and owners of aged care facilities to deal with the deficiencies in staffing and training by improved funding.

    • 0

      Totally agree with your views on facilities…. while ever these are profit based, and geared to ensure maximum profits for the ‘owners’, these problems will persist.

      The problem, of course, is that additional training and staffing will cause a rise in costs, so it’s a very difficult path, and would require massive funding by government, too much of which would, as usual, be subverted into too many pockets along the way.

      As in Aid funding – sometimes less than 5% reaches the coal face, so any government funding call needs to be very carefully looked at and kept under constant review – another cost factor.

      Where do we go with aged care? The current system is working in a minority of cases, but what are the alternatives? State-funded and operated institutions?

    • 0

      Yes agree with this observation. As an RN all my working life with a stint in aged care the biggest problem with caring for dementia patients is both understaffing and lack of good education and training in staff. Badly handled dementia patients can react aggressively quite easily thus leading to pressure on doctors to prescribe medication in order for staff to more easily handle these people. I can’t see this situation improving in the near future with cuts to aged care funding.
      The other difficult scenario is a lone carer doing it tough caring for a family member with dementia. Although they have the benefit of knowing the person well the stress over time may well lead to medication use to manage very challenging behaviours

  6. 0

    Well – when you apply subjective opinion voodoo in determining that a patient is ‘psychotic’, and it is somehow convenient to do so – it becomes easy to ignore the person and just give them something to quieten them down. Most doctors are highly unqualified to determine the true mental state of a patient, and making it ‘easier’ for the staff is not the name of the game.

    Everyone in health care, down to the lowest assistant in nursing, imagines him or her self to be a reincarnation of Sigmund Freud or the equivalent of the most highly qualified and experienced doctors, and I’m sure many of these doctors giving out these pills just take the word of staff for the condition.

    It’s an appalling commentary on the way older patients, with or without dementia, are viewed by those handed the power and responsibility to care for them.

  7. 0

    Yes, good that anti psychotic drugs lead to premature death. I will put myself down if I get a diagnosis of dementia.
    A relative with dementia is taking anti psychotic drugs to stop her attacking her husband. She is now calm and he is a lot safer.
    why keep us alive past our use-by dates in an over populated world. It is cruel and unethical.

    • 0

      Totally agree Jennie. Once you get dementia unless you have heaps on money and the best of care its all downhill and the quicker you can check out the better. I have seen my friends partner in a pension only facility and the kindest thing would be for him to die because he has is no quality of life, shrivelled to half the man he used to be it is so pathetic to see what he has become.

  8. 0

    Leaving aside the psychotic element, people (and they are above all, people, not just patients) with Alzheimers reach a stage where they are totally unaware of their surroundings and are suffering. I know from experience that doctors will increase the morphine dosage and end the unnecessary suffering. This is, of course, illegal but it cannot be detected and even if it could, it would be classified as a mistaken dosage rather than murder.

    There are many things to consider with this post and I’m sure that I will agree with most of those who want to put forward a good reason not to end someone’s life. My single point with this is that the doctor’s kindness ended the life of a dear person who was suffering and was probably only days away from Nature taking its course. Euthanasia is not ending a life, it is ending suffering.

    • 0

      In full agreement with you Old Man, having also been through having to watch,care and live through my late wife’s Alzheimers and Cancer.

    • 0

      Here is the horror story…. had a visit from an old school friend who was a nurse and is now retired. A lady we both know, who became matron of several hospitals before suffering a ‘breakdown’ and losing it all… used to steal the morphine in the drugs cabinet and replace it with water. Whether she used it or sold it for cash I don’t know… but apparently she stole heaps of other stuff as well.

      Now THAT is a scary thought.

    • 0

      Trebor, having worked for the Health Department and as a volunteer ambo this does happen, I can say in the ambulance service and the public hospitals drugs are carefully monitored. It will never be stopped but vigilance is the answer. Hospital staff and ambo’s do care and these addicts are found out.

    • 0

      Apparently at one facility they turned the keys over to the supervisor upstairs – she had spares cut.

  9. 0

    Yes, facilities DO have a DUTY OF CARE, but after spending 5 years nursing Mum through her ever more distressing dementia until her death last July, I’d want to be put out of my misery LONG before I reached the stage she was at. This article sounds more like the daughter is trying to keep her relative alive for HER sake, rather than allowing them to pass peacefully.

  10. 0

    My Mum has a seriously diminishing cognitive ability which is difficult to deal with, but she also has selective nastiness and abusiveness which is only directed at me, whilst my 3 brothers are held up as gods, despite rarely seeing her and doing nothing. I no longer have a life of my own. I deal with my Mum and her administrative and medical matters 365 days of the year, which are accompanied her frequent vitriolic spiteful attacks to me at a personal level. My Mum is 92. If I could give her a pill that would make her nice to me, even though it might shorted her life in the long term, I would do so.

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