Scots care regulators: Review drug regimes in older people’s homes

The Care Commission and Mental Welfare Commission in Scotland have called for a review of prescriptions of antipsychotic drugs for people with dementia in Scottish care homes.

The call comes after the care regulators found widespread evidence that people with dementia were often wrongly prescribed antipsychotic drugs to control their behaviour. They added that these types of prescriptions should be “a last, not a first, resort”.

No regular reviews

In a report published today, the Care Commission and Mental Welfare Commission said many people had been on the same medication for some time without regular review. For example, 91 people had been taking the same antipsychotic dose for more than a year.

The care regulators called for doctors and pharmacists to review all prescriptions for antipsychotic drugs for people with dementia “with a view, wherever possible, to stopping the drug, or trying a suitable alternative”.

Poor record-keeping

The regulators ordered  24 homes to improve their medication ordering, after finding that none of the 30 they had visited had a system for recording medicines that could provide a complete, up-to-date record of all medicines ordered, whether they were taken, and what was disposed of.

Also, in the sample of care plans they examined, the regulators found no records of visits from pharmacists to see people living in care homes.

The report also found that about a half of people never went out of their care home and another quarter rarely went out.

‘Harmful’ side effects

Alzheimer Scotland chief executive Henry Simmons said this was “appalling”. He was also “particularly disturbed that the inappropriate prescribing of anti-psychotics continues”, and said the drugs had “extremely harmful side effects”.

The regulators also pointed to a lack of dementia-specific training among care home staff, with only 10 managers having completed a recognised dementia training course.

Simmons said training would require significant investment, but would result in “considerable” long-term savings, particularly in reducing inappropriate prescribing.

Sector response

Scottish Care, the body that represents Scotland’s residential care providers, said homes were increasingly taking in “the most frail and most needy”, given the focus on keeping older people at home in the community.

But it was a “collective task” to improve services, involving not just care providers but also families, government, local authorities, social work, health services, GPs and pharmacists.

It also said the sector was “already struggling” with rates of £460 per week for publicly funded residential care and £540 for care with nursing, so there would be “significant resource issues” for homes to provide individualised activity programmes and managing challenging behaviour.

Up to 67,000 people in Scotland have dementia and around 40% of them are in care homes or hospitals.

More information

Full report: Remember, I’m still me

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