If unsuitable or too many medications are given concurrently and are
perhaps overdosed as well, this can result in serious behavioural
problems and ailments. Interactions of psychopharmacological
medications are difficult to assess and high doses of some drugs can
build up in the body as they are not metabolised and eliminated fast
enough by the elderly. The possibilities for treatment with drugs are
multi-facetted and include not only the timely use of a suitable drug,
but frequently stopping use or gradually reducing the dose of
unsuitable or no longer necessary drugs. Regular control of the list of
medications with regard to necessity, interactions, side effects, etc.
should be a matter of course. Individual needs and the respective
situation of so-called “difficult patients” require a great deal of
attention and sensitivity.
The commissions have uncovered cases where drugs were prescribed
in the case of “restlessness” without a traceable diagnosis. In almost
all of the incidents monitored in detail, the documentation in the
nursing homes did not contain any indication whatsoever of a medical
briefing or explanation or the patient’s consent. In many cases, the
staff did not even realise that giving sedatives with the purpose of
tranquilising or immobilising the person affected could be a measure
depriving them of their liberty, that there were drugs with fewer side
effects, etc. Accordingly, there were also no reports made to the
residents’ representatives.
Therefore, the NPM appealed to both the Federal Ministry of Health
and the Austrian Medical Chamber in 2014. The Federal Ministry of
Health intends to ask the Austrian Medical Chamber to include these
topics in continuing education programmes for doctors. Additionally,
this should become a focus in continuing education for public health
officers.
Federal Ministry of
Health and Austrian
Medical Association
take measures
The Austrian Medical Chamber has made detailed remarks regarding
this problem area and promised to re-examine the current continuing
education programmes.
The NPM welcomes these measures; however, it sees an even more
urgent need for action and research beyond this, in order to ensure
state-of-the-art treatment with drugs in nursing homes, but also in the
care of the very elderly at home.
Deficits in obtaining informed consent and in the prescription of drugs.
Restrictions of freedom by way of drugs are not recognised.
More specific education of doctors with regard to treatment of elderly patients with drugs is
necessary.
Research is needed with regard to drug safety for the very elderly both in and outside of
stationary long-term care.
34
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