It is long overdue that someone challenges the potential misuse of anti psychotic drugs with people with dementia. We have 340,000 people in Australia diagnosed with dementia in Australia and I have seen first-hand the turmoil they can cause if unchecked.
My Dad was prescribed an anti-psychotic that turned him from a generally happy, mellow person with memory loss and some occasional tears, into a raging bull with paranoia and hallucinations. This then resulted in 6 weeks in a locked ward in the RAH involving security teams on multiple occasions. We were told most people benefit from the drug, but 1 in 20 people have adverse reactions. I suspect this figure is much higher and many cases would go unreported. After insisting the drug be ceased, the behaviours and side effects reduced dramatically.
My concern is that there are several ‘go-to’ drugs on the market that are regularly prescribed without adequate follow up to determine the impact they have on the individual. Family members of people with dementia place complete trust in doctors to offer the best advice, or their ‘best guess’ to combat the behaviours and side effects associated with the disease. Dementia is an extremely complex and difficult progressive disease that has over 100 different types with varying symptoms, and we are in fact asking for a guess, as each case is different … This is dementia.
This blog is not intended to disrespect our doctors in anyway but moreso highlight the shortfalls in the current methods. The medical ‘follow up’ on patients is often reliant on a family member to try and express what they have seen (or heard from care staff) to the doctor in a 15 minute appointment and expect the doctor to make a call on potentially misguided or flawed information. If the patient resides in an aged care home the family will know very little. The family may not be educated in dementia and not know what to look for. Is every carer fully trained in dementia? If a carer unknowingly exaggerates or misinterprets a behavioural incident, the pending decisions may be the wrong ones.
If a resident grabs a carer’s arm is that agitation, aggression, violence or assault? I have personally seen all four words used for similar incidents. My concern is the consequences can potentially be disastrous for the person with dementia. If the relatives have minimal or no involvement with the resident they are at the mercy of the system, and may unnecessarily end up in a mental health facility.
I believe a pre-determined regular follow up after an anti psychotic medication is prescribed is the key. This could potentially reduce the behavioural incidents, which in turn relieves the pressure on the services and the health system overall. I believe the doctors need to directly contact the care staff, as they witness the changes in behaviours and reactions on a daily basis. The registered nurses administer the medications, but it is the front line staff that will be critical in the follow up reporting in conjunction with the nursing staff.
Every case is different and to change our healthcare methods that are well entrenched is not easy. It surely must be worthy of consideration in 2015 and beyond?