AAP FactCheck

Restoring confidence in public statements by independently testing and verifying the facts

Are psychotropic drugs becoming the preferred method of restraining nursing home residents?

By Holly Nott & Louise Evans

The Statement

“We have seen a significant shift from physical restraints to chemical restraint in the past ­decade, or even longer, so now it is hidden.”

Council on the Ageing chief executive Ian Yates, discussing a change in the method of restraining residents of nursing homes. January 15, 2019

The Analysis

An increase in the long-term use of antipsychotic drugs to control nursing home residents – revealed in a submission to the upcoming Royal Commission into Aged Care Quality – is systemic and masking true health issues, Council on the Ageing CEO Ian Yates says [1].

AAP FactCheck examined Mr Yates’ claim there had been a significant shift toward the use of chemical restraints in nursing homes over the past decade, and that this meant the full extent of restraint usage was hidden.

A 2009 study into psychotropic medication use in 44 Sydney aged-care homes, published in the Medical Journal of Australia, found more than 28 per cent of residents were taking antipsychotic medications. The researchers noted that six years earlier in 2003, drug use in the same group was 24 per cent [2].

A 2014 report commissioned by Alzheimer’s Australia found overuse and inappropriate use of chemical restraints with “about half the number of people in residential aged care facilities and up to 80 per cent of those with dementia receiving psychotropic medications”. The evidence further suggested some medications were prescribed inappropriately [4].

Research conducted over the two years to 2016 by The Wicking Dementia Research and Education Centre’s Dr Juanita Westbury examined the overuse of medication in 150 Residential Aged Care Facilities (RACF) around Australia. It found about two thirds of RACF residents were prescribed psychotropic medications [3].

Also in 2014, an Australian Senate Committee Report into dementia care [5] found “a troubling trend” in the increased use of chemical restraints as a management tool for behavioural and psychological symptoms of dementia. The report included anecdotal evidence of “increasing reports of the use of restraints, particularly chemical restraints in aged-care settings”.

Evidence from the Department of Health and Ageing then confirmed to the committee “the use of PBS-listed antipsychotics is growing at a higher than expected rate. It is growing at a higher rate in the elderly … In February 2013 it (the drug utilisation subcommittee) found that there is a high and inappropriate utilisation of antipsychotics in the elderly.” [5]

Mr Yates’ assertion that the increased use of chemical restraints was “hidden” was supported by Elder Rights Advocacy’s evidence to the same Senate committee. The ERA said: “General Practitioners (GPs) were prescribing drugs at the behest of facilities who are insufficiently staffed to deal with people with dementia: As staffing pressures appear to mount – that is the message from the industry – they are using it as a soft restraint. It is not that soft but you do not see it and that is the only difference in it.” [5]

These studies and reports listed above and dating back to 2003 support the claim that there has been an increase in the use of chemical restraints to control elderly residents in aged-care facilities over the past decade or longer. There is also evidence pointing to chemical restraints being overused, prescribed inappropriately and hidden. There was no evidence to establish a decrease in the use of physical restraints in elder care, nor to demonstrate a correlation between a decline in physical restraints and an increase in the use of chemical restraints.

The Verdict

Mostly True – Mostly accurate, but there is a minor error or problem.

The References

  1. January 15, 2019 article published in The Australian newspaper. https://www.theaustralian.com.au/national-affairs/health/nursing-home-residents-doped-for-years-at-a-time/news-story/1fb477661e70d5285ab3978e6525a5a9
  2. 2009 Medical Journal of Australia survey of psychotropic medication use in Sydney nursing homes https://www.mja.com.au/journal/2011/194/5/2009-survey-psychotropic-medication-use-sydney-nursing-homes?0=ip_login_no_cache%3Dbea2e3fb8938bda268c1c8d946d26ab1 and 2012 article in The Conversation, dealing with the same research. https://theconversation.com/chemical-restraint-in-aged-care-homes-linked-to-early-death-7593
  3. May 2018 RedUSe: Reducing antipsychotic and benzodiazepine prescribing in residential aged care facilities. By Juanita Westbury et al. https://www.mja.com.au/journal/2018/208/9/reduse-reducing-antipsychotic-and-benzodiazepine-prescribing-residential-aged
  4. March 2014 report for Alzheimer’s Australia: The Use of Restraints and Psychotropic Medications in People Dementia. https://www.dementia.org.au/files/NATIONAL/documents/Alzheimers-Australia-Numbered-Publication-38.pdf
  5. March 2014 Australian Senate Committee Report into Care and Management of Younger and Older Australians Living with Management and Behavioural and Psychiatric Symptoms of Dementia. Chapter six. https://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Community_Affairs/Dementia/Report/c06

Revision History

  • First published January 17, 2019 12:33 AEDT