Dangerous drugs given to elderly without consent

report on psychiatric treatment of elderly in rural Wales

PIRU’s preliminary report (Trick and Treat – psychiatric medication in old age in rural Wales), published Wednesday 23 June 2004, indicates that:

  • some doctors, including GPs, are regularly prescribing powerful anti-psychotics to some of their elderly patients. The elderly are particularly vulnerable to the serious, and sometimes fatal, side effects of these drugs.
  • elderly patients have, in some cases, been given anti-psychotic and other drugs without the doctor obtaining their agreement or their valid consent.
  • anti-psychotics appear, in some cases, to have been given without good clinical reason. This has included doctors, particularly GPs visiting nursing homes, apparently:
    1. prescribing anti-psychotics for illnesses for which the anti-psychotics are not recommended, such as for depression.
    2. providing a highly questionable diagnosis, such as concluding that a patient with temporary confusion was suffering from a psychotic disorder.
    3. providing the wrong anti-psychotic.
  • anti-psychotics have been prescribed in cases where the patient’s condition, and/ or other drugs being taken, indicated that this might have been inadvisable, such as to a patient with severe respiratory disease.
  • according to the patients and relatives, none of the GPs offered a talking treatment as an alternative to an anti-psychotic. Cognitive Behavioural Therapy, for instance, can be useful for reducing paranoid ideation and an effective treatment for depression in older people.
  • some of the patients had been informed of some of the possible less serious side effects of anti-psychotics, such as drowsiness, but none recall being told about the more serious ones, such as the potentially fatal Neuroleptic Malignant Syndrome.
  • some of the patients developed, after taking the drugs, symptoms consistent with the side effects of anti-psychotic medication, including abnormal body and facial movements.
  • there also appear to have been possible problems with the use of hypnotic drugs in the elderly, such as their use being associated with falls and injuries.

Recommendations

On the basis of preliminary findings so far, we recommend that the following possibilities be considered (along with other recommendatoions in the report):

  • a greater focus on prevention, including addressing the social and health factors asoctiated with mental illness in old age. For instance, our research suggests that, in some nursing homes, it would be useful to facilitate greater social support among the patients themselves.
  • In view of the particular susceptibility of the elderly to side effects, non-drug approaches, including talking treatments, should be the first line of treatment for possible psychoses (unless there is good reason why they should not be).
  • medical professionals need to more carefully follow guidelines on consent, such as, in particular, from the General Medical Council, and better monitoring is required to ensure that this happens.

Rupert Harwood, author of the report, said:

“Some GPs appeared to be prescribing powerful anti-psychotics to the elderly with a frightening lack of caution”.

“Mental illness is not an inevitable disease of old age. Approaches that work for younger people, such as talking treatments, also work for older people.”

Quotes from interviews (all names changed, along with some other identifying details)

Barbara Williams, relative of 81 year old patient:

‘He was quite shocked when we found he’d been given an anti-psychotic. We could find …. no record of him agreeing to it.’

Eileen James, who had been a patient in community unit.

‘I hid it in my top pocket so I didn’t have to take it… I wasn’t loosing my marbles’.

– ends –