Hand in hand, she walks with her husband Tor Flasnes at the nursing home in Namsos. The woman looks down at the floor. She can no longer see straight ahead. The neck has been broken. It is a side effect of the tablets she was given. The inspection report from the State Administrator is now ready. The conclusion is that the doctor broke national guidelines on the short-term use of Risperdal. Instead, the woman received the tablets morning and evening for eight months. In several cases, news has written about the extensive use of antipsychotics in Norwegian nursing homes, to reduce anxiety in patients with dementia. The 62-year-old’s doctor continued to give her tablets – and was aware that the wrong position in her neck could be a side effect, according to an inspection. Relatives were not told that distortion is a common side effect of the tablets she received. This doctor knew it, and suspected that the bias was a side effect. Photo: Eivind Aabakken Three husbands from Namsos have shown what happens when this type of tablet is given over a long period of time. Bente (70) suffered open wounds on his face and a swollen tongue. A woman in her early 60s developed a crooked back, but it became straight again when the use of Risperdal stopped. This doctor was not aware that bias is a common side effect, it has been established after a previous inspection. The third woman (62) whom we meet at the nursing home this day was permanently injured. These types of tablets have dangerous side effects. There is not enough warning in the current national guidelines, says her former colleague Wenche Frogn Sellæg. Does not use any medicine now. The husband is a good support. – It is terribly sad that it has to be like this. She is very injured after the wrong use of medicine, says Tor Flasnes. She got better when she was moved to a sheltered ward at Namso’s health center – without the use of antipsychotics. Now she only gets painkillers for the wrong position in her neck. She seems calm and compliant and is very happy to have visitors. The two traveled together in nursing homes for almost ten years, to reduce the use of this type of medicine for patients with dementia. Photo: Eivind Aabakken This day former colleague Wenche Frogn Sellæg comes to visit her. For years, the two worked together to reduce the use of this type of tablet in nursing homes. Frogn Sellæg is a former geriatrician and minister. She has read the new inspection report. – I think this is one of the strongest statements I have read from any State Administrator. Here they demonstrate point by point what has been done wrong all along. Strong meeting at the health center Frogn Sellæg admits that it is tough to meet her at the health center. The 62-year-old worked as a nurse. She received an honorary gold pin from the Norwegian Nurses Association and has a doctorate. It shows diplomas in her room at Namso’s health center. – She has worked on these things. The techniques used and the way to treat people with dementia. Just watch the dementia choir as they blossom. This was one of her main messages. Her doctor receives a strong warning. The inspection report states that the doctor was aware that the wrong position in her neck could be a side effect. Both he and another doctor had noted that in the medical record. Despite this, the doctor increased the dose of Risperdal. The state administrator writes that it was unjustifiable to increase the dose of Risperdal, when it was suspected that a very unsightly neck was a side effect. Tablet use was only stopped after the husband took the woman to a neurologist at Namsos Hospital. Nevertheless, the doctor continued to give her another type of antipsychotic (Haldol), despite this being advised against at the hospital. That too was unjustifiable, writes the Statsforvalteren. Now the doctor receives a strong warning. County doctor Jan Vaage at the State Administrator concludes that the doctor breached the requirement for proper treatment of the woman at Namso’s health centre. Photo: Eivind Aabakken – If in the future we receive new complaints that indicate that the practice has not been adjusted, these cases could have an impact on any stronger reaction from the supervisory authorities. This is written by county doctor Jan Vaage at the State Administrator in Trøndelag. The woman’s husband, Tor Flasnes, believes the case is serious and should have consequences for the doctor. Doctor believes the dose was low The doctor writes in a statement in the supervision case that the lowest effective dose was tried for as short a time as possible. The dose was increased to 2 mg per day, but was low and within the range where one should be observant of this type of side effects, writes the doctor. This is the second time in a short time that the doctor has been ordered to change his practice. The doctor also gave antipsychotics to Bente, who suffered serious side effects at the health centre. Conclusion after inspection by her doctor In the third and last inspection report at Namso’s health center, errors after errors are demonstrated, when a woman (62) with dementia was given Risperdal. This is the conclusion from the State Administrator: The doctor breached the requirement for proper treatment. The doctor breached the requirement to inform next of kin. The doctor breached the requirement to obtain information from next of kin. The woman was permanently affected by the medicine Changing guidelines There will now be a comprehensive review of national guidelines for the use of antipsychotics for people with dementia. It will involve clinicians working with patients, relatives and patients if possible. This is according to department director Morten Græsli in the Norwegian Directorate of Health. – Then it will be relevant to consider several different formulations, to see if we can be even more clear, says Græsli. Last week, the first change came. Several serious supervision cases due to long-term treatment mean that longer use beyond six weeks from now on should be justified separately by doctors. Previously, such tablets could be discontinued after six to 12 weeks. Department director for guidelines and professional development in the Directorate of Health, Morten Græsli. Photo: Norwegian Directorate of Health No warning in Norway In the US, the health authorities (FDA) already issued a warning in 2008 – against using all types of antipsychotics in elderly people with dementia. The reason was serious reported side effects. Nevertheless, such a warning did not appear in Norway in the guideline from 2017, but its use was to be very restrictive. A working group set up by the Directorate of Health wrote in an internal memo that knowledge about side effects is small, because the follow-up period in the studies is short (10–12 weeks). Knowledge of long-term use beyond that is limited. This is a drug that is primarily used in psychiatry for patients with severe psychosis. How to work with new guidelines Researchers and other experts, especially at the National Center for Aging and Health, must follow the development of new knowledge until the revision of new guidelines in 2025. – The Norwegian Health Authority’s assessments and reports and possibly other reports will form part of the knowledge base, when we are looking at the audit. That’s according to department director Morten Græsli in the Directorate of Health. Thinks there must be a warning In Norway, Risperdal is recommended as a first choice for patients with Alzheimer’s dementia. It should be the last thing you give, when everything else has been tried first. – It is not understood how big that limitation is, and it is not progressing well enough, says former geriatrician Wenche Frogn Sellæg. The tablets can be given if there is “a great suffering pressure”. – You use such a dangerous medicine based on a definition of what the individual carer thinks. It is a very unfortunate expression when you want to limit the use of a drug. – Should there also be a warning in Norway? – Yes to the highest degree, and I hope this story is a warning, says Wenche Frogn Sellæg after the visit to the nursing home. She recognizes her former colleague, Wenche Frogn Sellæg. Photo: Eivind Aabakken Today’s national guidelines Recommendation: Weak (Used when different choices may be correct depending on the patient and situation). Environmental and psychosocial measures aimed at psychotic symptoms, agitation and aggression must, as a general rule, have been tried before drug treatment, with the exception of crisis situations. Agitation which appears as aimless verbal activity and/or motor restlessness, and which is of a non-aggressive nature, is generally not recommended to be treated with drugs. People with Alzheimer’s dementia, vascular dementia or mixed Alzheimer’s dementia/vascular dementia Can be treated with atypical antipsychotics for psychotic symptoms and aggressive agitation – in cases where the patient is perceived to have a significant level of distress/aggressiveness, or to be a danger to themselves. Of atypical antipsychotics, risperidone (Risperdal) is suggested as first choice (approved with indication), while aripiprazole (outside approved indication) or olanzapine (outside approved indication) is suggested as second choice. Patients with dementia with Lewy bodies or dementia with Parkinson’s disease. It is suggested that antipsychotics are not offered to these patients as they often tolerate such drugs particularly poorly. Trial discontinuation: After 6 weeks at the latest (Academic update in February this year, previously it said 6–12 weeks) Source: Directorate of Health. Guidelines for the use of antipsychotics in the elderly with dementia. Last revised in 2017. Changing routines in Namsos Namsos municipality is now in the process of changing its routines. From this year, a pharmacist is employed at Namso’s health centre. It should be safe to grow old and sick in Namsos, says mayor Amund Lein (H). – We really must apologize to everyone involved in the case, says Lein. He says the municipality has learned from the case. Measures have been initiated and several internal guidelines have been changed. Amund Lein (H) became mayor of Namsos after the last election last autumn. He says that the municipality has learned from what happened at the health center. Photo: Jøte Toftaker Upheld Husband Tor Flasnes was upheld in the complaint he sent to the State Administrator, the new supervisory report shows. Both the doctor and the municipality gave inappropriate treatment to the wife, who became permanently crooked in the neck. He chooses to be open about what has happened. – It is not possible to do anything more about it, other than trying to prevent it from happening to more people, says Flasnes. Husband Tor Flasnes appreciates that his wife now receives good care at the health center, without the use of medication. Photo: Rita Kleven Brag to the carers now Now he brags about the carers. The contrast is stark to how it was. At most, there were four carers who kept her during the evening shift in another department at Namso’s nursing home, the inspection report shows. Risperdal was given. – It was awful. She had to be scared. It was an assault, the husband believes. He believes that the most important thing is that environmental measures should be tried before medicines. That is what his wife worked to achieve as a nurse. It’s what works for her now. She has been given a separate room at the health center with a view of the city. – Now she only uses painkillers for the injuries. The gaze and eye contact are back. I am very happy with the care she is getting now. Log from the evening care From the log in February 2024: “Cooperative for evening care.” We sing and dance.” “A nice evening where we sang and danced. She sang along and laughed.” Procedure: It is important that it is organized in advance, so that the duration is as short as possible. Can be one or two carers. Then one can gain trust, while the other carries out the maintenance. His wife is very happy to have visitors. She seems trusting and cheerful. Photo: Eivind Aabakken
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Now the rules are changing – news Trøndelag – Local news, TV and radio
