Elderly care home patients given ‘chemical cosh’ drugs

Side-effects of antipsychotic drugs in Ireland may be linked to dozens of deaths, strokes

Thousands of older people in nursing homes are being administered powerful sedatives to subdue challenging behaviour.

Most of these psychotropic drugs are not authorised for use on over-65s or people with dementia because they can double the risk of death and treble the risk of stroke.

Under medical guidelines, these drugs – which make it easier for staff to handle agitated patients – should be used as a last resort when behaviour poses a risk of harm. But an Irish Times investigation into the use of these so-called "chemical cosh" drugs has established that:

Up to one-in-three residents in some Irish nursing homes are being administered psychotropic medication, based on previously unreleased pharmacy records and new research.

Psychologists and psychiatrists who work in the system have found a culture in which these drugs are used on a routine basis to control the disruptive behaviour of older people and those with disabilities.

The side-effects of antipsychotic drugs in Ireland may be linked to dozens of deaths and more than 100 stroke-like events each year, based on international research.

Brian Lawlor, professor of old age psychiatry at Trinity College Dublin, said this powerful medication should only be used once potential causes of challenging behaviour – stress, pain or side-effects of other drugs – had been ruled out.

“Medication like this is being used too widely in long-stay settings – that’s what the evidence is showing,” he said.

Only one antipsychotic drug – risperidone – is licensed to treat dementia in very specific circumstances for up to six weeks.

In most cases, the use of antipsychotic drugs in managing behaviour among patients is unlicensed.

A spokesman for the Department of Health said this was not uncommon practice and reflected the fact that there were “not enough approved products to deal with every medical need”. He said nursing homes were required to report use of psychotropic medication on a quarterly basis as a method of monitoring restraint.