Monday, November 16, 2009

Dementia drug Use 'killing many'

My thanks to a British reader who shared the following BBC report with me. The findings are disheartening but resonate with the course of care that my father has received in the nursing home. Widespread misuse of medication as a means for controlling patients has gone on for decades behind closed doors. In my Dad's case, the decline has been rapid, and now he can barely walk or feed himself because his aggression is controlled with anti-psychotic medication. The medical establishment should be held liable for this practice, which examined from a certain angle functions as involuntary euthanasia.

Dementia drug use 'killing many'
By Nick Triggle 
Health reporter, BBC News 

Needless use of anti-psychotic drugs is widespread in dementia care and contributes to the death of many patients, an official review suggests.

About 180,000 patients a year are given the drugs in care homes, hospitals and their own homes to manage aggression.

But the expert review - commissioned by ministers - said the treatment was unnecessary in nearly 150,000 cases and was linked to 1,800 deaths.

The government in England has agreed to take steps to reduce use of the drugs.

These include:

  • Improving access to other types of therapy, such as counselling
  • Better monitoring of prescribing practices
  • Guidance for families explaining what they can do if they are worried about drug use
  • Specialist training in dementia for health and social care staff
  • Appointment of a new national director for dementia to oversee the measures

The review - and the government pledge to take action - comes after long-running concerns about the use of anti-psychotic drugs.

Over the past 30 years, the NHS has increasingly turned to the treatment, which was originally aimed at people with schizophrenia, as it has struggled to cope with the rise in people with dementia.

'Different mindset'

There are currently 700,000 people in the UK with the condition, but this is expected to rise to one million in the next 10 years because of the ageing population.

The review, led by King's College London expert Professor Sube Banerjee, accepted that for some people anti-psychotic drugs would be necessary.

But it said they should be used only for a maximum of three months and when the person represented a risk to themselves or others.

Professor Banerjee estimated that of the 180,000 people given the drugs each year, only 36,000 benefited.

He said health and social care services needed to develop a "different mindset".

He believes if the steps the government has agreed to are followed, anti-psychotic drug use could be reduced by two-thirds within three years.

Care services minister Phil Hope agreed action was needed.

"We know there are situations where anti-psychotic drug use is necessary - we're not calling for a ban, but we do want to see a significant reduction in use."

Neil Hunt, chief executive of the Alzheimer's Society, said the long-awaited review was a welcome recognition of the scale of the problem.

He added: "This goes beyond quality of care. It is a fundamental rights issue.

"Our members tell us of enormous worry and distress over what is happening to their loved ones."

The Royal College of GPs - in most cases the drugs are prescribed by family doctors - admitted the situation was "unacceptable".

President Dr Steve Field said: "People deserve much better."

While the review was commissioned by the government in England, ministers elsewhere in the UK have agreed to study the recommendations.

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1 comment:

Medawar said...

The problem seems to be with patients admitted to hospital for other reasons, but who have dementia. They can be treated exclusively by personnel who have no specific training in coping with demented patients.

So, Medawar wasn't entirely wrong in thinking that the problem had been dealt with: it had been, in the very narrow confines of hospital units properly prepared to deal with demented patients.

There is a strong fascist streak within the medical profession, and in democracies it needs to be curbed. (Nearly all the founder members of the German Worker's Party that became the Nazis, were in fact: Doctors, Vets and Schoolteachers.)

It does seem, at long last, that ministers have understood that the profession is doing something wrong.

The most effective way of curbing arrogant doctors, is for the secretary of state to endorse a code of practice for treating demented patients, and to designate a "dementia nurse" in every hospital to ensure that all nurses know what it is.

Most nurses probably already know that the wrong thing is being done, but a document, endorsed by the secretary of state, would give them the ammunition needed to resist what is easily the most intolerant and arrogant profession in the world. Medawar has met drill sergeants who were more open to argument than some GPs!

The recent decision that England and Wales should work towards an all-graduate nursing profession, will ultimately give nurses the status to challenge doctors' decisions on both technical and moral grounds.

There are many very experienced and talented non-graduate senior nurses, but it's becoming obvious that it simply isn't good for patients if nurses are merely vessels of the doctor's will, and for them to be anything else, they need a degree behind them.

South Africa and Australia can be expected to move towards all-graduate nursing professions at least as quickly, but perhaps American doctors rather like ignorant and subservient nurses and change will take longer to happen there.