Paul Burstow elderly person

5 http://www.richimag.co.uk/hrioa/ elderly person living in a care home is likely to receive four times as many prescription items as a person living in their own home. As many as 1 in 5 admissions to hospital are linked to inappropriate drug therapy.
2.6 Particularly at risk are elderly people with dementia. Behaviour such as wandering, poor self-care, restlessness, impaired memory, depression without psychosis, uncooperativeness and agitation that is not dangerous, are common features of the disease. There are no medical reasons for prescribing antipsychotics in such cases. Managing challenging behaviour without trained staff is no excuse for reliance on chemical solutions. Until more trained staff are in post, there will continue to be calls for even more use of antipsychotic medication, to the detriment of the patients well-being.
2.7 In December 2001, following direction by the Labour Government, the National Institute of Clinical Excellence were set to issue guidance concerning the cost and clinical effectiveness of atypical antipsychotic medication for people with schizophrenia. This guidance has now been postponed until March 2002.1 Older people that do not suffer from schizophrenia have been left out. The National Service Framework for Older People and the National Minimum Standards published in March 2001 are steps in the right direction. But they will fail to deliver change for older people unless there is rigorous monitoring and enforcement, yet there are scant resources to do this. Furthermore, international evidence suggests annual reviews of prescribing to older people are inadequate, and that harm can be done to an older person in far less time than a year.
2.8 Successive studies have demonstrated the need for a step-change in the way medication is used in the care of the elderly. The chemical management of older people is a scandal. It denies older people their dignity, and robs them of a better quality of life. Pressure on care providers is not an excuse for inappropriate use of medication. GPs and care home managers should be jointly accountable for safeguarding the interests of the vulnerable elderly people in their care.
Recommendations
2.9 The Department of Health must commission urgent quantitative and qualitative research into the extent and reasons for the overuse of antipsychotic medication in different care settings.
2.10 The National Institute for Clinical Excellence must prepare and publish guidance on the use of antipsychotic drugs and non-drug alternatives in the care of older people. This would include the development of a model for drug list revisions in care homes, to automatically evaluate drug lists according to a quality indicator, and keep track of the drug lists and changes made to that list. The quality indicator should also serve as guidelines for prescribers.
2.11 Review the National Service Framework and National Minimum Standards for care homes to ensure that the standard on medication, (standard 9), provides for prescribing reviews at least every three months. All prescribing decisions must be clearly documented with the reasons for the use of the medication set out in full. By evaluating the Scottish