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Australian experts warn against the use of sedatives to contain Covid spread in aged care
Calla Wahlquist Published onThu 13 Aug 2020 03.30 AEST
Researchers fear drugs like Valium will be used to confine aged care residents to their rooms in understaffed facilities with coronavirus outbreaks.
Experts say sedatives that reduce a person’s respiratory rate can make a patient who is already battling Covid-19 much sicker. Photograph: Alamy Stock Photo
The aged care regulator is investigating a Melbourne aged care home following reports it used sedatives to manage the behaviour of some residents who had tested positive for Covid-19.
The federal aged care minister, Richard Colbeck, said the Aged Care Quality and Safety Commission was “investigating the situation at Glenlyn” care home in Glenroy after allegations were reported in The Australian.
The newspaper alleged some residents considered to be “wanderers” had been given sedatives to ensure they remained in their room and did not spread the virus, after an attempt to have positive residents moved to hospital was rebuffed.
“The Morrison government has been working to improve the safe use of medicines and reduce the inappropriate use of chemical restraint in residential aged care, but notes that the situation at Glenlyn involves residents with very complex medical and care needs at a very difficult time,” Colbeck said in a statement late on Tuesday.
Glenlyn has 11 cases of coronavirus among residents and staff. The nursing home has been contacted for comment.
The use of sedatives to manage the behaviour of aged care residents with dementia or cognitive issues was tightened last year after the royal commission into aged care heard that homes were turning residents into “zombies” with a heavy reliance on chemical restraints and psychiatric drugs.
Aged care experts warned in March that the use of sedatives could increase in homes following a Covid-19 outbreak, because of understaffing and the need to confine people to their rooms to prevent the virus from spreading.
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Prof Joseph Ibrahim, the head of the health law and ageing research unit at Monash University, said that prediction appeared to have come true in some homes, while other homes have reduced their use of sedatives because being closed to visitors had stabilised the routines of people with dementia.
But he said that despite aged care homes being required to report on the use of sedatives and psychiatric drugs, there is no publicly available data showing how, and indeed if, their use has changed in facilities that have experienced a Covid-19 outbreak. Ibrahim said it’s not clear whether drugs prescribed by doctors at state hospitals, which have been brought in by the Victorian government to oversee and supplement the aged care workforce, would also be reported to the aged care quality and safety commissioner.
The Australian reported some aged care facilities were using sedatives to prevent residents who had tested positive to Covid-19 from “wandering” because state hospitals had turned down their request to transfer all positive residents to hospital. Ibrahim, who was also quoted in that report, said the use of sedatives was “concerning”.
“If it’s acceptable to sedate someone so they are not a risk to others, how do you reconcile that with the fact that it’s OK to keep residents in a home when they have tested positive to the virus and may also pose a risk?” he said.
As of Wednesday there were 1,932 active cases of Covid-19 in Victoria linked to 122 outbreaks across the aged care sector. Some 476 people from aged care have been transferred to hospital.
Ibrahim said Valium and other benzodiazepines reduce a person’s respiratory rate, which could impact on the already suppressed breathing of a person who is battling Covid-19. “They may make the sick worse,” he said.
The Royal Melbourne hospital, which manages in-reach services at a number of aged care homes, said residents who test positive to Covid-19 are cared for in their home and transferred to hospital if their condition deteriorates.
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“In some cases where residents are prone to agitation and delirium, medications can be used to ensure the safety of themselves, other residents and the staff,” a spokesperson for the hospital said.
The hospital disputed claims that palliative care medication had been prescribed for patients who did not need it, saying it was only prescribed to people nearing the end of their life.
Maryann Curry, the clinical services director at Bupa Aged Care, said that swiftly transferring Covid-positive residents to hospital was critical to controlling an outbreak. But she said there were some some situations where that was “proving extremely challenging”.
“At a critical time like this, when days or hours can potentially make the difference to patient outcomes, we need to be able to rely on a hospital system that listens to and responds to our residents and those who care for them,” she said.
Curry said they did not use sedatives to enforce self-isolation.
“We don’t introduce new medications as a substitute for not being able to transfer our residents to hospital to receive the care they need,” she said. “This is inappropriate and not something that we endorse. The right care must be given at the right time, and in the right setting.”
Ibrahim said an argument repeated a number of times by the Victorian premier, Daniel Andrews, that people with dementia could be upset by being moved from their home in aged care to the unfamiliar environment of a hospital, did not apply to aged care homes whose routines were already “radically changed” due to a Covid-19 outbreak.
“How much of a routine do you think currently exists at a place like St Basil’s?” he said.
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Age discrimination commissioner Dr Kay Patterson said decisions around the management of Covid-19 patients “should not be influenced by ageist attitudes or stereotypes which devalue older people and in turn devalue their lives”.
“Decisions should be made on the principle that all lives, regardless of age, are of equal value.”
The deputy national chief medical officer, Dr Nick Coatsworth, told reporters that any suggestions there was an “attitude of futility towards death in residential aged care in Australia is, frankly, insulting to the entire Australian community, who locked down to prevent deaths amongst our most vulnerable”.
But Coatsworth said the outbreak in Melbourne, and any future outbreaks would lead to more deaths in the aged care population.
Sixteen of the 21 people with Covid-19 who died in Victoria overnight were connected to the aged care system.
https://www.theguardian.com/australia-n ... -aged-care
