Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1697632226696.pdf (Australia)
Case stories involving anti-psychotic medications- Elder Rights Advocacy Case Story 1 We received a call from the daughter of a male resident, Mr B who has Alzheimers and who, over a period of 5 weeks was moved 3 times between a hospital and 2 different facilities.

Mr B found these changes very distressing and his behaviour reflected this so when he entered permanent aged care his GP prescribed a combination of anti- psychotic medications to control his behaviour ( Risperidone, Haloperidol and Avanza).
Mr B’s daughter made repeated requests to the Director of Nursing (DON), and to the treating GP for the anti- psychotic medication combination to be discontinued as she could clearly see a decline in her Father’s condition and an increase in his hallucinations, level of agitation and frequency of falls.

Senior staff at the facility reassured her that they knew what they were doing and that she should not worry.
Mr B’s daughter informed the facility of the practical methods used by the family to successfully help their Father feel more at ease and to lessen his agitation.

Mr B has macular degeneration in his left eye and so it is important that he be approached from the right hand side.

Football videos, family photographs and favourite food would usually all help to settle his mood and minimize his confusion.
Six weeks after her Father entered permanent care Mr B’s daughter received a phone call from the DON who told her to “take a deep breath and brace yourself”.

Mr B had thrown a chair through a window, no-one was injured but he was now locked in the courtyard for everyone’s safety.

An ambulance had been called and Mr B was going to be taken to the nearest psychiatric unit.
When the Ambulance arrived the officers refused to transport Mr B without a Div.1 nurse accompanying him due to his being so heavily sedated.

On arrival at the Psychiatric unit the Haloperidol and Avanza were immediately ceased, 3 weeks later the resident returned to the facility with a behaviour management plan and no anti- psychotic medications.
Mr B’s family had lost all faith in the facilities ability to properly care for him and so asked the advocate to assist them at the next scheduled care plan meeting to assure that Mr B’s rights and needs were prioritized and clearly documented for the reference of all staff.

The meeting took place, a new care plan was developed with new management strategies and Mr B was able to be cared for without further incidents.
Case story 2 A current situation involves Mr Jones and his wife, Elle who has been placed on Haloperidol, following her entry to an aged psychiatric unit and some ‘aggressive’ behaviour when she initially entered aged care from her home.

Mr Jones has had previous experience of his wife receiving Haloperidol while at home, which did not seem to be helpful in settling her behaviours and affected her adversely in his view.
He was not consulted about the prescribing on this occasion, although he holds a Medical Treatment Power of Attorney, and since her permanent placement she has remained on this medication.

Mr Jones has attempted to speak to the doctor about his concerns regarding the side effects of the medication, and the fact that he does not see it helping his wife.

The DON agrees with him that the medication does not seem to be calming his wife, and in fact may be making her ‘worse’.
The doctor is refusing to discuss any changes, or to take on any information about Elle and her previous reactions, or current concerns raised by Mr Jones or the DON about the use of Haloperidol in this situation.

Mr Jones is seeking to change the treating doctors and also to gain another opinion, which is supported by the DON.The advocate has been assisting him to understand his rights to refuse treatment under the Medical Treatment Power of Attorney.
The advocate has also informed him about his right to attend any future assessment done by the Aged Care Assessment Team to provide information about his wife, her reactions to medication and his concerns.

This story continues.

Mary Lyttle, Chief Executive Officer.

Care and management of younger and older Australians living with dementia and behavioural and psychiatric symptoms ofdementia (BPSD)Submission 30 - Attachment 1