Chemical restraint as behavioural euthanasia: case studies from the Royal Commission into Aged Care Quality and Safety
Abstract Background The prescription of psychotropic medication to older people living with dementia in residential aged care has become an increasing concern. The use of prescription medication is often prefaced as a way of preventing harm to self and others. However, the use of such medications ha...
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| Format: | Article |
| Language: | English |
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BMC
2023-07-01
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| Series: | BMC Geriatrics |
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| Online Access: | https://doi.org/10.1186/s12877-023-04116-5 |
| _version_ | 1827894896319528960 |
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| author | Patricia Cain Pelden Chejor Davina Porock |
| author_facet | Patricia Cain Pelden Chejor Davina Porock |
| author_sort | Patricia Cain |
| collection | DOAJ |
| description | Abstract Background The prescription of psychotropic medication to older people living with dementia in residential aged care has become an increasing concern. The use of prescription medication is often prefaced as a way of preventing harm to self and others. However, the use of such medications has been considered a way of managing some of the behavioural and psychological symptoms of dementia. Using a large secondary data set, this study aimed to identify the precursors and mediating factors that influence the use of chemical restraint of older people in residential aged care. Methods Publicly available documents from the Australian Royal Commission into Aged Care Quality and Safety were used as the data corpus for this study. Keywords were used to search over 7000 documents to extract a set of topic-related content. We identified the cases of seven people in respite or permanent residential aged care who had been prescribed or administered psychotropic medication under circumstances that appeared to demonstrate chemical restraint. All documents relating to the cases were collated for our data set. A descriptive case study approach to analysis was taken. Results Four key descriptive patterns were identified: labelling and limits to tolerance, pushing prescription as a solution, coverups and avoiding consent, and family’s fight for liberty. Triangulation across the data and academic literature supports the findings. Conclusion Our findings provide some insight into how chemical restrain happens. Featuring throughout the cases were reports of a lack of workforce capacity to care for and support residents exhibiting dementia behaviours. Prescription of psychotropic medications featured as a “first resort” care solution. Family and friends found such approaches to care unacceptable and frequently challenged the practice. Where consent for prescription was explicitly denied, more covert approaches are demonstrated. Family awareness, presence, and advocacy were key to challenging the practice of chemical restraint. Shortfalls in the capacity of the current workforce come into play here. However, workforce shortcomings can no longer mask this ubiquitous practice. Just as importantly the spotlight needs to be turned on the prescribers and the providers. |
| first_indexed | 2024-03-12T22:13:44Z |
| format | Article |
| id | doaj.art-6e59449862d04ff5a9f3deffb5fb2918 |
| institution | Directory Open Access Journal |
| issn | 1471-2318 |
| language | English |
| last_indexed | 2024-03-12T22:13:44Z |
| publishDate | 2023-07-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Geriatrics |
| spelling | doaj.art-6e59449862d04ff5a9f3deffb5fb29182023-07-23T11:26:15ZengBMCBMC Geriatrics1471-23182023-07-0123111210.1186/s12877-023-04116-5Chemical restraint as behavioural euthanasia: case studies from the Royal Commission into Aged Care Quality and SafetyPatricia Cain0Pelden Chejor1Davina Porock2Centre for Research in Aged Care, School of Nursing and Midwifery, Edith Cowan UniversityCentre for Research in Aged Care, School of Nursing and Midwifery, Edith Cowan UniversityCentre for Research in Aged Care, School of Nursing and Midwifery, Edith Cowan UniversityAbstract Background The prescription of psychotropic medication to older people living with dementia in residential aged care has become an increasing concern. The use of prescription medication is often prefaced as a way of preventing harm to self and others. However, the use of such medications has been considered a way of managing some of the behavioural and psychological symptoms of dementia. Using a large secondary data set, this study aimed to identify the precursors and mediating factors that influence the use of chemical restraint of older people in residential aged care. Methods Publicly available documents from the Australian Royal Commission into Aged Care Quality and Safety were used as the data corpus for this study. Keywords were used to search over 7000 documents to extract a set of topic-related content. We identified the cases of seven people in respite or permanent residential aged care who had been prescribed or administered psychotropic medication under circumstances that appeared to demonstrate chemical restraint. All documents relating to the cases were collated for our data set. A descriptive case study approach to analysis was taken. Results Four key descriptive patterns were identified: labelling and limits to tolerance, pushing prescription as a solution, coverups and avoiding consent, and family’s fight for liberty. Triangulation across the data and academic literature supports the findings. Conclusion Our findings provide some insight into how chemical restrain happens. Featuring throughout the cases were reports of a lack of workforce capacity to care for and support residents exhibiting dementia behaviours. Prescription of psychotropic medications featured as a “first resort” care solution. Family and friends found such approaches to care unacceptable and frequently challenged the practice. Where consent for prescription was explicitly denied, more covert approaches are demonstrated. Family awareness, presence, and advocacy were key to challenging the practice of chemical restraint. Shortfalls in the capacity of the current workforce come into play here. However, workforce shortcomings can no longer mask this ubiquitous practice. Just as importantly the spotlight needs to be turned on the prescribers and the providers.https://doi.org/10.1186/s12877-023-04116-5Chemical restraintAged careDementiaRoyal CommissionCase studyPsychotopic medication |
| spellingShingle | Patricia Cain Pelden Chejor Davina Porock Chemical restraint as behavioural euthanasia: case studies from the Royal Commission into Aged Care Quality and Safety BMC Geriatrics Chemical restraint Aged care Dementia Royal Commission Case study Psychotopic medication |
| title | Chemical restraint as behavioural euthanasia: case studies from the Royal Commission into Aged Care Quality and Safety |
| title_full | Chemical restraint as behavioural euthanasia: case studies from the Royal Commission into Aged Care Quality and Safety |
| title_fullStr | Chemical restraint as behavioural euthanasia: case studies from the Royal Commission into Aged Care Quality and Safety |
| title_full_unstemmed | Chemical restraint as behavioural euthanasia: case studies from the Royal Commission into Aged Care Quality and Safety |
| title_short | Chemical restraint as behavioural euthanasia: case studies from the Royal Commission into Aged Care Quality and Safety |
| title_sort | chemical restraint as behavioural euthanasia case studies from the royal commission into aged care quality and safety |
| topic | Chemical restraint Aged care Dementia Royal Commission Case study Psychotopic medication |
| url | https://doi.org/10.1186/s12877-023-04116-5 |
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