– It is a completely clear and fairly certain experience that you sometimes use antipsychotics to calm the patient down, when more personnel could be used. That’s what specialist doctor and researcher Bjørn Lichtwarck says at Sykehuset Innlandet. He gives guidance towards nursing homes, and says that a modest increase in staffing will make it easier for everyone who is at work. Studies show a large difference in the use of antipsychotics in Norwegian nursing homes, on average up to 20 per cent of patients with dementia receive these tablets. Some common side effects are uncontrolled movements, shuffling gait and crooked back and neck. The medicine increases the risk of stroke. Environmental measures must always be tried first, but then there must be enough people at work. – We know that antipsychotics are a solution that is often chosen when you do not have the staffing required to look after the patients without medication, says union leader Lill Sverresdatter Larsen of the Norwegian Nurses’ Association. MAJOR CHALLENGE: The lack of staffing is serious, says union leader Lill Sverresdatter Larsen of the Norwegian Nurses’ Association. Photo: Rune Stoltz Bertinussen / NTB She sees that the pressure on each individual health worker is increasing. There are now only 2 out of 365 municipalities that do not lack nurses. – The challenge of obtaining sufficient staffing and expertise is both real and serious, says Lill Sverresdatter Larsen. She is up to one thing. – The use of tablets must be adapted to the patients’ needs, and not an organization that has too few staff. news has received a lot of feedback, including from health workers, after we reported on the extensive use of antipsychotics in Norwegian nursing homes. Three women with dementia suffered serious side effects at a nursing home in Namsos. Warns against incorrect medication At the county office of the Norwegian Nurses’ Association in Trøndelag, members talk about the use of these tablets, but it is not a big topic, says county leader Kenneth Sandmo Grip. – We hear from time to time that this type of drug is used almost too sparingly in an understaffed department. Antipsychotics are intended for the treatment of people with serious mental disorders, such as schizophrenia. In Norway, only Risperdal is proposed for short-term use in dementia patients with Alzheimer’s, in national guidelines. Nevertheless, other types of antipsychotics are also given outside the approved indication. Such tablets can only be used for a few weeks and only if the patient is harming himself or others, or has severe psychosis. – If medication prescribed by a doctor is distributed, where good professional assessments have not been made, either before starting or during the treatment, then it is incorrect medication that should not happen, says Sandmo Grip. He says that the job is to alleviate and treat, and not to cause ill health and damage. – As a nation, we are in the midst of an announced nursing crisis. The Nurses’ Association often hears from members that there are not enough people, he says. Focus on drug use Department director for health and welfare in KS, Åse L. Snåre, says they pay close attention to drug use in Norwegian nursing homes. – There is clearly an area for improvement, we are aware of that, she says. The doctor at the nursing home has professional responsibility, and staffing should not determine medication use, says Snåre. Nor is she aware that this is the case. – That this should be a consistent practice, we are not aware of that. FOCUS ON MEDICINE USE: Department director of KS, Åse L. Snåre, believes it is important to look at the overuse of drugs in nursing homes. Photo: KS – What does KS think of the fact that antipsychotics are occasionally given to calm down patients with dementia, when there are few employees at work? – KS does not want to, and does not believe that anyone will defend such a practice as is pointed out here, says Snåre. She believes the main picture is that good services are provided in elderly care. KS works to ensure the municipalities the best possible conditions. – The normal is not low basic staffing – but in pressured situations and with high sickness absence and many substitutes, challenging situations can clearly arise, says Snåre. She says that overuse of drugs in nursing homes and among the elderly is an important area to focus on and work on. Sometimes it may be necessary to give this type of medicine, when patients with dementia have anxiety or delusions. A small increase in basic staff is needed Specialist doctor and researcher, Bjørn Lichtwarck, says that no major boost is needed to create peace and recovery, without the use of antipsychotics in dementia sufferers. – A fairly modest increase in basic staffing will have quite a large effect, he says. Often there are probably two carers who are responsible for a group of eight to eleven residents. If this factor is increased by just one extra carer, it will be of great importance, he believes. – Then you want to avoid residents being left sitting alone, because that is often when unrest arises, he says. In addition, the residents have absolutely necessary needs covered, such as going to the toilet on time. Getting calm from environmental measures DOESN’T NEED A BIG LIFT: A small increase in staffing will make it easier to find time for environmental measures, says doctor and researcher Bjørn Lichtwarck. Photo: Private Bjørn Lichtwarck works as a doctor in the geriatric psychiatric department at Sykehuset Innlandet. He is also a researcher associated with the Research Center for Age-Related Functional Impairment and Disease. Studies show that personalized environmental measures are beneficial for people with dementia, he says. It reduces anxiety and improves the quality of life when there is time for a conversation or newspaper session, or you can go for a short walk. Sleep can be improved if a cup of hot drink is given before bedtime. – Today’s staffing limits the possibility of adopting environmental measures. There have been a number of investigations/reports from nursing homes in recent years which support this, says Lichtwarck. He believes that more knowledge is also needed about various environmental measures. The differences between nursing homes are large, studies show. – We see that some nursing homes have a high consumption of antipsychotics, while others often have half the consumption per resident, says Bjørn Lichtwarck. He says that it is unfortunate that there is no national overview of the use of medicines in nursing homes, because it could help to reduce the differences.
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Dementia patients receive tablets when there are few nurses on duty – news Trøndelag
