Thousands of nursing home residents and people with disabilities are being prescribed powerful psychotropic drugs every day. Much of this drug-use is appropriate and necessary. But a series of articles in The Irish Times has highlighted mounting evidence that many vulnerable residents are also being overmedicated .
The tranquillising effects of these drugs - in particular antipsychotics - make it easier for staff to handle patients who display aggression or other forms of challenging behaviour. But this medication is risky: research indicates it can double the risk of death and treble the risk of stroke among older people and those with dementia.
Agitation and distress among patients can often be an expression of unmet need, such as boredom, pain, or lack of stimulation. UK medical guidelines state these drugs should only be used when all other interventions have been exhausted and where disruptive behaviour poses a risk of harm.
But against a backdrop of spending cuts and understaffing, there is evidence to show powerful drugs are being used on a routine basis . For example, a recent national audit of dementia care in Ireland found that half of patients admitted from nursing homes into hospitals were on antipsychotics.
Faced with agitated patients and a lack of trained staff, some doctors say they feel compelled to provide a quick solution. In the process, they can find themselves in a tangled web of clinical evidence and ethical concern over how best to care for patients.
But there is another way. Studies increasingly show that person-centred care and therapeutic approaches are most effective in tackling challenging behaviour. But these options tend to cost more and rely on trained experts.
In the UK, a national campaign to tackle the problem has resulted in use of medication falling by more than half between 2008 and 2011. While the Health Service Executive says new guidelines are being drawn up, this is not enough.
We need stronger oversight, detailed targets for the education of drug use, backed up by regular audits. A much greater emphasis on the kind of therapy which can dramatically improve patients’ wellbeing is required. Above all, strong leadership is required if these issues are to be taken seriously.
The people affected by these practices are among the vulnerable in our community. At the very least they deserve safe treatment and a decent qualify of life. We have a duty to ensure their rights are protected.