The concerns with chemical restraint


The interim report released by the Aged Care Royal Commission provides a damning indictment into what is happening in both the aged care and home care sectors.

  • Summer 2019
  • Partners

Of note was the whole section dedicated to what is termed "restrictive practices" including chemical restraint and the role that medications play. It also mentions that “the regulatory barriers capping the frequency at which accredited clinical pharmacists can review aged care residents’ medications need to be changed to boost patient safety”.

Chemical restraint is defined as the use of any type of medication to restrict an individual’s movement or freedom and may be used to manage agitation or aggression, or sedating an individual.

The usual medications associated with this are anti-psychotics - e.g. risperidone - and benzodiazepines - e.g. oxazepam.

In some instances, these medications have a specific diagnosis associated with their use, e.g. anti-psychotics prescribed for schizophrenia, or benzodiazepines for short term use (less than 2 weeks) to manage anxiety. In those circumstances the use of these medications is appropriate.

Medications should be used as the last step in treating someone who has behavioural and psychological symptoms of dementia (BPSD). Only risperidone is approved for use in BPSD (and only for those people with a diagnosis of moderate to severe dementia of the Alzheimer’s type) for up to 12 weeks where non-drug measures have been unsuccessful.

The impact of BPSD


BPSD can be distressing for the patient, their family and their carers, and it can be difficult to manage. Symptoms include:

  • Verbal outbursts
  • Aggression and/or agitation
  • Sleep disturbances
  • Wandering/pacing
  • Disinhibited behaviours e.g. removing clothes
  • Psychosis

Unless the person’s behaviours put themselves or another person in the home at immediate risk of harm, then the role of non-drug treatment should be first line and all appropriate options exhausted before medication is considered.

If you or a family member has dementia and it is deemed necessary to prescribe one of these medications, then the aged care home must seek consent prior to administering the medication. This can be directly from the resident, or from the person who is legally responsible for them. Currently this can be verbal consent.

There should be clear instructions as to when, why and how often the medication can be administered as well as the need to monitor for benefits and side effects.

In most cases if there is no response after four weeks then the antipsychotic or sedative medication should be reviewed with a view to reducing and then ceasing the dose. Even if there is a positive response, the medications should be reviewed every three months to identify if there is a need to continue.

An accredited consultant pharmacist can support your GP with these reviews through a process called a Home Medicines Review (HMR) which is fully funded by the Government. Read more about Ward MM at nationalseniors.com.au/wardmm


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  • Summer 2019
  • Feature

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