MEDICATION
Curbing The Chemical Cosh
Many care workers are overstretched and demand for services is rising, so the temptation to pacify diffi cult patients with medication can be hard to resist. Professor June Andrews from the DSDC tells Tanita Cross why the quick fi x won’t help patients or staff in the long term.
Using sedatives to keep patients calm should be a last resort. Unfortunately, in a short-staffed and underfunded care sector, the use of such potent drugs is more prevalent than anyone would like. Horror stories about older people in particular being plied with fatal doses of sedatives to control unruly behaviour make headlines too often. A common theme in these stories is that alongside other illnesses and physical conditions, patients suffer from dementia.
According to Professor June Andrews, Director of the Dementia Services Development Centre (DSDC) at the University of Stirling, it is a lack of understanding that leads some care workers down the path to medication: “The majority of care home residents have dementia and when a person with dementia is distressed they behave in ways that are uncomfortable for others. This may mean that the person with dementia is restrained by using ‘the chemical cosh’.”
A recent report on dementia care from the Care Quality Commission (CQC) found aspects of variable or poor care in nine out of ten care homes and hospitals. In response, the Alzheimer’s Society’s Chief Executive, Jeremy Hughes, commented: “Developing staff and helping them understand the needs of people with dementia are vital if we are to improve the care people receive.”
Given the complexity of dementia and the fact that symptoms can vary
- 38 -
greatly from person to person, it is vital that care staff are fully trained in caring for dementia sufferers. This includes knowing how to deal with irregular behaviour without having to resort to the drug store. “If you want to control disturbed and agitated behaviour, the fi rst step is to work out what it is that is distressing the resident,” says Professor Andrews. “Untreated pain is the most common cause. The person may have toothache or ill-fi tting dentures, they might have a headache or any of the usual aches and pains of old age but are unable to tell you about it.”
The damage that dementia can do to a person’s ability to communicate is a signifi cant obstacle for care workers. People with dementia often have increasing diffi culty speaking and they may eventually lose the ability to speak altogether. For this reason, staff must keep trying to communicate with them and use alternative, non-verbal means of doing so, such as expression, touch and gestures.
Professor Andrews also highlights numerous environmental factors that can have a strong infl uence on the behaviour of dementia sufferers. “Disturbing behaviour is often caused by the environment. Just improving the light level can make a huge difference,” she explains. “The noise in the place might be alarming them, or they could be bored or needing the toilet. It might be too hot or too cold. Want of exercise can make people agitated, and just getting
out to a garden makes a huge difference.”
The attitude of staff can also have an impact: “The behaviour is sometimes a response to staff not knowing how to support people with dementia appropriately. The behaviour of staff can ‘set off’ distressed and agitated behaviour in residents.” Training care workers to treat dementia sufferers appropriately and check environmental factors should be a priority for homes and hospitals – and one which, according to Professor Andrews, “should make a real difference to the use of sedation”.
Of course, as Professor Andrews acknowledges, the use of sedatives is not wholly in the home’s control as they are prescribed by GPs. Nevertheless, it is the people caring for patients on a daily basis who have the knowledge and power to step in and ensure that doctors are not too quick to fi ll out a script. In the long run, solving the root cause of a problem will make care workers’ jobs easier and allow patients to enjoy the good quality of life they deserve.
For more information on working with people with dementia, visit the DSDC’s website.
www.dementia.stir.ac.uk
www.tomorrowscare.co.uk
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48