Dementia - the cost of anti-psychotics? Panorama BBC 1

Discussion in 'ARCHIVE FORUM: Support discussions' started by JPG1, Nov 1, 2010.

  1. serena

    serena Registered User

    Jul 17, 2010
    69
    Hampshire
    Dementia - the cost of anti-pyschotics

    I just hope that the Panorama programme can be used by the Alzheimer's Society for an immediate platform launch for their Campaigns 'Putting Care Right in Care Homes' and 'General Hospitals'.It is an ideal opportunity to raise the profile of Dementia and increase awareness in the Public Mind. A National Debate about aging population, rise of Dementia, its treatment and repercussions for sufferers and their families.Many thanks for listening Serena/(Heather Pearson on Facebook):)
     
  2. Sandy

    Sandy Registered User

    Mar 23, 2005
    6,847
    From what I gather, it is GP's who write the majority of NHS prescriptions:

    http://www.nhs.uk/chq/Pages/1629.aspx?CategoryID=68&SubCategoryID=161

    But my understanding, watching last night's programme, was that many requests for medical intervention were triggered by requests from care homes who were struggling, for whatever reasons, to meet the needs of their residents.

    The premise is, I suppose, if a home is better able to meet the needs of it's residents, even those with complex needs, they are less likely to call on the GP for assistance.

    Take care,
     
  3. JPG1

    JPG1 Account Closed

    Jul 16, 2008
    3,396
    Tina, I don’t think anyone wants to see anyone ‘drugged up’ or over-medicated, so I’m with you there all the way. I’m with you also in the thinking you’ve done about what is best for your husband and for you, in dealing with Ken’s dementia.

    Nobody is against medication for real problems that can only be dealt with by medication, and for presenting problems that need to be addressed immediately and with care. Then monitored and supervised.

    Jancis, (can’t remember which thread you posted your question to) no care home can prescribe antipsychotic medications. Only a GP or a Consultant or similar can dole out a prescription. (Having said that, it is occasionally the case that care homes have been known to give to another resident medications that were never prescribed for that resident, but which were prescribed for another resident. It is hopefully rare, but it may not be rare for all I know. It may be common practice.)

    If I’m wrong, I’m sure someone will let me know, but I think that the Panorama programme was trying to address the fact that in “many/some/a few/more than a few/too many” care homes – care homes that are surviving on bare minimum staffing levels, and where the staff are not sufficiently trained to deal with the demands of dementia – it is sometimes the case that they place demands on the GP or the Consultant to prescribe ‘something’ to enable the care home, the care home staff, the care home in general to handle the demands of dementia.

    That’s not fair to the resident. That’s not necessarily ‘in the best interests’ of the resident.

    And that’s where the GP/Consultant has the responsibility to prescribe only those medications that are seen to be required for that particular patient’s presenting problems, in the best interests of that particular resident.

    Beckyjan wrote “I agreed to my husband being prescried Quetiapine. The Consultant discussed this with me and I raised questions like stroke risk and over sedation. It was all explained very thoroughly and I am happy we took that route.

    Yes, he is very sleepy some of the time, but he was prior to the drugs and I believe that is part of the dementia.”

    It is part of BeckyJan’s husband’s dementia. No doubt about that. But it may not be part of everybody else’s dementia. Everyone’s different; everyone’s reaction to drugs is different;

    Everyone’s dementia is different.

    And that’s why, IMHO, the prescribing of any single drug/medication/tablet has to considered seriously and with reference only to the needs of the individual patient.

    GPs/Consultants are not allowed to be pressurised into prescribing to help the care home to ‘manage better’ a resident if there are other ways that could/should be employed. Namely, increase staffing levels, increase training, increase the interaction between resident and staff, increase the quality and content of the care given.

    But there should be no system in place which increases the potentially damaging effects of a medication to the patient unless that is an an unavoidable risk.

    Burstow said “We need to have a relentless focus on the quality of care.” Nobody can argue with that.

    PS to Moderators: would it be possible to merge the two threads that are discussing this issue? Thank you in advance.
     
  4. Jancis

    Jancis Registered User

    Jun 30, 2010
    2,567
    Hampshire
    Sandy, thank you for your thoughts on this. But how can a nursing home buck the system and not dole out medication if a GP has prescribed it? How do they manage to gain the authority to do this? I am not against the principle of this, on the contrary.
     
  5. Sandy

    Sandy Registered User

    Mar 23, 2005
    6,847
    They do have to follow the GP's directions about prescribed medication, but if they think that they can manage the person with dementia without medication, then they ask the GP or consultant to review the medication with a view to reducing it/eliminating it.

    The manager of the home did say that there were anti-psychotics in that trolley for those residents who's dosages were being reduced, under a medic's supervision.

    If the home deviated in any way from the prescribed medication schedule it would reflect very badly on their inspection by the CQC, so everything has to be sanctioned by a medic.
     
  6. Jancis

    Jancis Registered User

    Jun 30, 2010
    2,567
    Hampshire
    My goodness, so is it really down to initiatives from the CH about what they think they might be able to cope with? That is a very brave initiative! No wonder not many homes opt to risk their ability to cope. This doesn't sound right to me.
     
  7. mowood

    mowood Registered User

    Dec 27, 2009
    373
    West Yorkshire
    Spot on as ever JPG.
     
  8. Just thinking

    Just thinking Registered User

    May 7, 2008
    152
    North west
    Panorama

    I daresay the drugs discussed in the programme do have a beneficial effect for SOME people but I think the main point of the programme was to highlight unnecessary or over-use and the importance of regular close monitoring and for the drugs only to be used for limited periods of time. The scandal is that not enough safe-guards are in place to ensure they're used properly.

    The home featured in the programme was exemplary and one that all others should aspire to. The owner/manager shows such understanding,compassion and good old common-sense in her approach to the residents and most importantly, STAFF TRAINING which in my experience is so often sadly lacking. Well done! The happiness on the face of the lady receiving an ice-cream was priceless!
     
  9. Just thinking

    Just thinking Registered User

    May 7, 2008
    152
    North west
    Perhaps it's time to look for a new nursing home if you as a family, are not happy with the current one? The programme highlighted that there are places out there that believe these drugs don't have to be used. Also, given what was said about them only being used for as shorter time as possible, perhaps the current home would consider taking your loved one off them. Good Luck.
     
  10. Just thinking

    Just thinking Registered User

    May 7, 2008
    152
    North west
    Lots of 'little voices' add up to ONE BIG VOICE!...so let's all keep shouting.
     
  11. Just thinking

    Just thinking Registered User

    May 7, 2008
    152
    North west
    One more point: The lady who said about being perceived as a 'trouble maker' when striving for better care for her hubby. I've felt the same way as well as feeling intimidated. When I did complain the manager of Mums place had her re-assessed to move her elsewhere. I fought against that but that cloud still hangs over me and I feel I have to keep schtum. It's not right. Where else in society would we pay huge amounts for a service and yet not have the right to complain if it wasn't up-to-par??
     
  12. Tender Face

    Tender Face Account Closed

    Mar 14, 2006
    5,379
    NW England
    What is the (financial) cost of anti-psychotics versus the cost of the type of ‘real care’ shown in the programme...?

    With ‘care’ being stripped every which way, at home or in community or even LA homes, is this not the road we hurtling down whatever Burstow says? :eek:

    Kaz, x
     
  13. sunny

    sunny Registered User

    Sep 1, 2006
    598
    Comes to something when the guy with overall responsibility for GP's Prof. Steve Field says the system "is a disgrace".

    some of these drugs have been I think around since the 1950's. That is a long time and a lot of people have been prescribed them.

    I notice the nurse in charge of the Birmingham care home featured is psychiatric trained, but I dont think that is the same with other care homes, I am wondering why psychiatric trained nurses are not in ordinary care homes with dementia units. She sounded particularly enlightened which is heartening.
     
  14. JPG1

    JPG1 Account Closed

    Jul 16, 2008
    3,396
  15. Norrms

    Norrms Registered User

    Feb 19, 2009
    5,317
    Male
    Torquay Devon
    Rant on !!

    Hiya all, i refrained from saying anything about the panorama programme until i had watched it a couple of times so i didnt have a "knee jerk" reaction,

    IT WOULDNT HAVE MATTERED
    18,000 people are on these drugs and 1,800 which is (When i went to school 10% are thought to have died as a direct result of these drugs !!! Never in my life can i remeber feeling so utterly shocked and revulsed !!

    Lets get this into perspective

    If 18,000 people were precribed Calpol or Asprin and as a result 1,800 of them died of possible connections to the drugs mentioned, there would be such a huge public outrage, it would and (could) be classed as Culpable manslaughter. yet because it involves older people who have dementia anyway there doesnt seem to be any outrage about this at all. What kind of world are we living in ??

    When are people going to wake up and realise that one day the person on the tv who cant lift his or head up to be fed could be them one day, or if not, their own mother/father/ wife husband ect!!

    I`m not saying there isnt a place in the health field for such drugs, but its got to be reviewed as soon as possible.

    This HAS to be looked at and his promise of cutting them back by two thirds by next year will be closly watched, ESPECIALLY BY ME!!!!

    Sorry, i dont usually rant away but this has really got me going !! LOL LOL
    Best wishes, Norrms and family xxxxxxxxxx
     
  16. PaulS

    PaulS Registered User

    Oct 22, 2010
    5
    Aylesbury/ London
    I missed the programme but have been catching up with it on the iplayer. Very poignant timing and it raises huge questions that have long since needed answers. These drugs certainly need very careful monitoring since the side effects seem as wide and varied as they patients to whom they are prescribed. A huge concern for all of our future health care
     
  17. TinaT

    TinaT Registered User

    Sep 27, 2006
    7,095
    Bolton
    #57 TinaT, Nov 3, 2010
    Last edited: Nov 3, 2010
    Mental health issues seem to always be in a 'catching up' state. Psychiatric units still employ 'shock treatment' therapies with some good/bad results on many patients, (not I hasten to add on diagnosed dementia patients). No one as yet knows why they work, if they work at all, and who is best to receive such treatment.

    It seems to be the same state of affairs with dementia drugs. I do agree with Norms, such figures of death directly attributed to these drugs amongs the general population would cause a public outcry.

    If the residential care of dementia patients was much, much higher up on the public social concience level, then the misuse of drugs used solely to make residents managable when they could be managed in a different way without such drugs, would not exist.

    xxTinaT
     
  18. CraigC

    CraigC Registered User

    Mar 21, 2003
    6,630
    London
    #58 CraigC, Nov 3, 2010
    Last edited: Nov 3, 2010
    I too just caught up on iplayer
    http://www.bbc.co.uk/iplayer/console/tv/b00vz22h
    Not sure how long it will be available.

    Good programme in my opinion and it covers a lot of the problems we had with prescribing and the block from the medics when we tried to get dad off them. Lot of people spoke a lot of sense on the programme but actions speak louder than words and I get tired hearing all the promises and political arguments. We just need more money invested all round and more homes like Spring Mount :(

    No one should have to take someone out of a care home, or move a relative to another care home (as we did ) to get the drugs reviewed or discontinued.

    On a positive note, there were some very special caring individuals on this programme. Its always very touching to see people really care and who have to deal with this illness on a day-to-day basis. Some of the documentary was very raw and real in my opinion.

    Kind Regards
    Craig
     
  19. Sandy

    Sandy Registered User

    Mar 23, 2005
    6,847
    Hi Norrms,

    Looking at the news story on the Alzheimer's Society's website, it looks like the number of people with dementia on these drugs is much higher at nearly 150,000:

    http://www.alzheimers.org.uk/site/scripts/news_article.php?newsID=824

    So that would make the percentage something like 1.2% - not good by any means, but a lot less than 10%.

    Take care,
     
  20. Sandy

    Sandy Registered User

    Mar 23, 2005
    6,847
    The Alzheimer's Society also has this page of questions to ask about anti-psychotics for people with dementia or their family members/carers:

    http://www.alzheimers.org.uk/site/scripts/documents_info.php?documentID=1191&pageNumber=2

    For what it's worth, I think one thing that the programme did not address was the suitability of these drugs for treating psychotic behaviour (such as delusions and hallucinations) that do sometimes occur in dementia - a point that Nebiroth made earlier.

    The Merck Manual of Geriatrics (a highly-respected medical reference) says this on the subject:

    http://www.merck.com/mkgr/mmg/sec5/ch40/ch40a.jsp
     

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