Centre for Research in Aged Care, School of Nursing and Midwifery, Edith Cowan University, 270 Joondalup Drive, 6027, Joondalup, WA, Australia.
BMC Geriatr. 2023 Jul 19;23(1):444. doi: 10.1186/s12877-023-04116-5.
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.
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.
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.
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.
在养老院中为患有痴呆症的老年人开精神药物处方已成为越来越令人担忧的问题。使用处方药物通常是为了防止对自己和他人造成伤害。然而，这种药物的使用已被认为是管理痴呆症的某些行为和心理症状的一种方式。本研究使用大型二级数据集，旨在确定影响养老院中老年人使用化学约束的因素和中介因素。
本研究使用澳大利亚老年护理质量和安全皇家委员会的公开文件作为数据语料库。使用关键词搜索了 7000 多份文件，以提取一组与主题相关的内容。我们确定了 7 名在临时或永久性养老院中接受精神药物处方的案例，这些人在似乎表现出化学约束的情况下接受了处方或管理。将与案例相关的所有文件都整理到我们的数据集中。我们采用描述性案例研究方法进行分析。
确定了四个关键的描述性模式：标签和容忍极限、将处方作为解决方案、掩盖和避免同意以及家庭争取自由。跨数据和学术文献的三角测量支持了这些发现。
我们的研究结果提供了一些关于化学约束如何发生的见解。贯穿案例的是有关缺乏劳动力来照顾和支持表现出痴呆行为的居民的报告。精神药物处方作为“首选”护理解决方案。家人和朋友认为这种护理方法不可接受，并经常对此提出质疑。当明确拒绝处方同意时，会采用更隐蔽的方法。家庭的意识、存在和倡导是对化学约束实践提出挑战的关键。目前劳动力的能力不足在这里发挥了作用。然而，劳动力的不足再也掩盖不住这种无处不在的做法了。同样重要的是，焦点需要转向处方者和提供者。
