The abuse of older people, often referred to as elder abuse, is defined by the World Health Organization as a single or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust which causes harm or distress to an older person.
Over the last few years and since the Aged Care Royal Commission into Quality and Safety, there has been a spotlight on medication management, particularly in psychotropics and PRN use.
- Of 11,368 surveyed, 61% were taking psychotropic medications regularly
- More than 30% surveyed were charted for benzodiazepines and 22% for antipsychotics.
- More than 41% were prescribed antidepressants.
- Over 30% were charted for PRN benzodiazepines and 11% for PRN antipsychotics.
- More than 16% were taking sedating antidepressants.
(Australian & New Zealand Journal of Psychiatry 1–12 DOI: 10.1177/0004867418758919 Psychotropic prescribing in Australian residential aged care)
Recognising when medications become abuse rather than an intervention.
Medication abuse can occur when medication is overused, underused or misused and can result in harm to the person or may or may not have been prescribed for the older person.
For Example, research has shown that the high rate of medications prescribed ‘PRN’ or as ‘required’ and that PRN and regular prescribing of psychotropic medications can be associated with a; loss of balance and low blood pressure leading to a significantly higher risk of falls, over sedation and increased confusion.
So what does this mean? In effect, the practice of prescribing psychotropics (for example, benzodiazepines) with the intention of reducing adverse effects may inadvertently increase the risk of harm.
What can we do to prevent this? As health care professionals, we should, where possible, investigate and utilise non-pharmacological strategies to manage the behaviours and or symptoms of the individual before prescribing psychotropics as an intervention.
The Royal Commission into Aged Care Quality and Safety also identified that the inappropriate use of psychotropic medicines is a significant quality and safety issue, and using psychotropics such as antipsychotics and benzodiazepines to influence or control an identified behaviour is considered a restrictive practice.
The latest data Oct-Dec 21 highlights that;
- 20.7% of aged care consumers received antipsychotics.
- 11.1% had a diagnosis.
- 9.6% had no diagnosis.
In addition, 38.3% of consumers were on Polypharmacy of nine or more medications.
To reduce polypharmacy and psychotropic medication and delivery and management of medications you can look at ensuring;
- the appropriate dose has been prescribed in conjunction with the consumers’ risk factors and consumer profile.
- the care staff’s currency of knowledge in medication management.
- appropriate tests are occurring which impact dose levels to be administered (e.g. Warfarin requires regular INR tests, Insulin requires Blood Glucose levels to be monitored).
- timely administration of the medication prescribed.
- medications are used for what they are intended and not misused.
- only those medications ordered for the consumer is administered.
- pain relief is given as prescribed and effectiveness recorded.
- the prescriber is kept informed regarding any changes to the consumers’ profile or condition.
- regular case conferences to discuss the possible outcome of deprescribing to reduce Polypharmacy were applicable.
- behaviour management plans are in place that detail non-pharmacological strategies to manage behaviours.
- an active Medication Advisory Committee (MAC) is established who discusses, identifies and addresses issues.
- a relationship with a clinical pharmacist is established to undertake RMMR’s and liaise with the prescriber on findings.
- you establish a robust clinical governance committee where high-risk consumers can receive a deep clinical file review and assessment.
- you have real-time reports that can give the care team visibility over consumers’ health profiles.
- you implement an electronic medication management system that ensures transparency for the consumer and compliance and visibility between the pharmacy, prescribers and providers.
In addition, Consumer health literacy can often contribute to medication misuse. There are several strategies to ensure consumers are well informed and fully understand the correlation between their health and the medication they are being prescribed. They are;
- Fact Sheets
- Quality use of medicine information (OPAN)
- General Practitioner providing information on the medication being prescribed during visits
- Case conferences
- Clinical Pharmacist available to discuss medications with the consumer
As an aged care service provider using an electronic medication management platform, you will have increased visibility over medication charting, administration, and reporting enabling you to identify elder abuse associated with medication management.
As discussed, Polypharmacy and Psychotropic drug use are just two areas that can impact consumers and, where used incorrectly, can lead to elder abuse and consumer harm.
Raising awareness through education is an important component of addressing elder abuse related to all forms of abuse, including medication management. In addition, it is essential for organisations to have robust policies and processes in place for staff to identify and respond to elder abuse, whether it be in medication management or any of the other forms of abuse such as;
- Physical Abuse
- Sexual Abuse
- Emotional or psychological
- Financial Abuse
BESTMED is working with over 420 aged care providers nationally to support care staff and consumers to reduce the risk of harm associated with medication management.
If you need support with medication management, reach out by emailing firstname.lastname@example.org