National Preventive Mechanism Supply of medication The commissions have repeatedly found that there are deficits in nursing homes regarding prescription of medication, informed consent and measures that deprive people of liberty by way of drugs as defined in the Nursing and Residential Homes Residence Act. Persons with dementia often experience increased restlessness, disorientation or high activity levels in the late afternoon and evening. With the progression of the disease, it often happens that those affected wake up several times during the night and want to get up. Sleep is interrupted for a lengthy period of time by activity resulting from night time disorientation. Those affected become lost as to time and place, believe it is time to get up and want to undertake work that they had been accustomed to in the past. They forget that they were in bed, they no longer know where they are, and want to go home. The lack of sleep at night is compensated by increased phases of sleep during the day. Currently, residents of nursing homes are frequently in their beds by late afternoon, having been given sedating medication. However, sleep disorders in persons with dementia cannot be treated by way of drugs alone. Rather, medication to improve sleep must be combined with treatment of the dementia (e.g. with anti-dementia drugs), treatment of physical or psychological secondary illnesses and non-drug treatments. Non-drug treatments are important The too uncritical use of sleeping pills and tranquilisers has serious negative health consequences and significantly restricts the mobility and quality of life of the elderly. The commissions have objected to this many times and recommend a quarterly regular inspection of drug plans in order to make the use of medicinal products safer. The commission saw the lack of psychiatric diagnoses by specialists as the main reason for prescriptions and doses of psychopharmacological medications that did not appear transparent, but also the fact that the general practitioners practicing in nursing homes often refused to consult psychiatrists. Doctors who treat behavioural changes and the psychological consequences of dementia must be very aware not only of the effects of certain psychopharmacological medications and their particular impact on seniors, but also of any harmful side effects they may produce in the elderly. They must also know how behavioural and mood disorders can be created and changed by social and psychological conditions. This requires concepts that promote structuring the day by creating stimulating living spaces, needsbased mobilisation, communication, participation in the community, etc. This includes scheduling opportunities to access the outdoors during the day. 83