from several chronic illnesses at the same time and they therefore
require many medications. However, in the case of this kind of
polypharmacy, possible medication interactions are exponentially
increased. Furthermore, age makes the human organism more
susceptible to side-effects, in part because the effect of many
medications changes. The NPM would like to sensitise those involved
with regard to these problems, and contribute to a reduction of
medication-based restrictions of freedom.
The topic of inadequate, inappropriate, not indicated, usually off-label
use of psychotropic medication on geriatric patients with behavioural
disorders due to dementia, which is a hardship for them and for their
environment, has been the subject of critical remarks for years. The
commissions have also pointed out these facts and circumstances.
In order to make the discussion more objective, the NPM would like to
state the following:
Psychotropic medication belongs to those categories of medications
that are prescribed most frequently in nursing homes. Without a
doubt, treatment with psychotropic drugs can serve the well-being of
nursing home residents and contribute to an improvement of their
quality of life, provided that therapeutic standards are implemented
responsibly, and clearly defined indications are taken into
consideration.
It was found by the commissions (and this is in line with international
study results) that the inappropriate use of psychotropic medication
correlates with specific patient characteristics that cannot be
considered as medically relevant factors. This includes residents’
behavioural abnormalities, such as constant restlessness or
aggressiveness. Given this background, it is suspected that
psychotropic medication is also misused for the purpose of
tranquilising residents. In its report from 2014, which is publicly
accessible, the Viennese Care Home Commission (Wiener
Heimkommission) stated, verbatim, about this subject: “Certainly,
psychotropic medication is given with the intention (not to say
“indication”) of restricting freedom. There are signs that not all, but a
substantial portion of psychotropic medication is prescribed
inadequately, inappropriately and are not indicated to an
unacceptable extent.”
Findings by the
commissions
There are hardly any figures or research regarding the situation in
Austria.
The NPM considers treatment with a psychotropic medication to be
inadequate if it is prescribed in a dose that is too high or over a period
that is too long, if no adequate monitoring is carried out, if there is no
clear (medical) indication and/or if serious side-effects occur.
Risk assessment
39
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