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An experienced nurse practitioner labelled the potential reduction in the use of antipsychotic medication a “blunt instrument” for dying patients suffering from dementia during a symposium held in Melbourne last week.

Juliane Samara made the comments at the ANMF Victorian Branch’s symposium on the use of physical and chemical restraint in aged care, held on Tuesday, 25 February.

A practitioner who works in palliative care, Ms Samara acknowledged that there were problems with the over-prescription of antipsychotic medication in the aged care sector, but queried whether it was a scapegoat for other issues given their usefulness in easing symptoms for dementia patients facing the end of their life.

“Are antipsychotics the real problem, or are they just the easy target here because [of] complaints, and because that’s the one that’s the most visible?” Ms Samara asked.

She pointed to letters sent out from government regulators to prescribers in the wake of the Aged Care Royal Commission as an example of the “blunt instrument” approach she alluded to.

“They sent this letter… to tell us about new resources to support the care of people in residential aged care who have dementia,” she explained.
“There is no mention anywhere in these resources… or acknowledgement, of dementia as [a] life-limiting illness or that people are going to die with dementia.

She said such actions had influenced health decisions at aged care facilities, citing an occasion in palliative care when she was asked to obtain chemical restraint permissions from families and guardians, something she felt was unwarranted.

“We don’t always use medications according to their label and their PBS syndication: We have some things that we use off label,” she explained.

“To have that conversation with [the patient’s] family around chemical restraint, when I’m prescribing something for nausea, made no sense at all, but that’s what I was being asked to do.”

Ms Samara also explained that for patients in palliative care experiencing dementia symptoms late in life, the use of antipsychotics was crucial in mitigating the worst of their symptoms, which are often fuelled by traumatic experiences.

She added that antipsychotics were used reluctantly, but for good reason, using the example of an aged care resident with dementia whose death was made easier with the prescription of anti-psychotic medication.

“I think the harm of not prescribing them [anti-psychotics] was much greater than prescribing them,” she summarised.

Ms Samara also noted that palliative care, with its focus on quality of life, is different from other forms of medicine.

“We’re about making sure people have a good death… Often in the medical system death is seen as failure,” she said.