Does pain matter in the Australian Royal Commission into Aged Care Quality and Safety? A text mining study

Atee, Mustafa; Andreotta, Matthew; Lloyd, R.; Whiting, Daniel; Alford, Ms. Marie; Morris, Thomas

doi:10.1016/j.ahr.2023.100126

Cited by 1 publication

(1 citation statement)

References 18 publications

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“…We are neither the first to use evidence from this Royal Commission for scholarly analysis [ 69 , 70 ], nor are we the first to investigate the topic of dementia behaviours and restraint [ 71 ]. However, to our knowledge, we are the first to systematically search all the hearings and exhibits and perform in-depth qualitative analysis.…”

Section: Discussionmentioning

confidence: 99%

Chemical restraint as behavioural euthanasia: case studies from the Royal Commission into Aged Care Quality and Safety

2023

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Background The prescription of psychotropic medication to older people living with dementia in residential aged care has become an increasing concern. The use of prescription medication is often prefaced as a way of preventing harm to self and others. However, the use of such medications has been considered a way of managing some of the behavioural and psychological symptoms of dementia. Using a large secondary data set, this study aimed to identify the precursors and mediating factors that influence the use of chemical restraint of older people in residential aged care. Methods Publicly available documents from the Australian Royal Commission into Aged Care Quality and Safety were used as the data corpus for this study. Keywords were used to search over 7000 documents to extract a set of topic-related content. We identified the cases of seven people in respite or permanent residential aged care who had been prescribed or administered psychotropic medication under circumstances that appeared to demonstrate chemical restraint. All documents relating to the cases were collated for our data set. A descriptive case study approach to analysis was taken. Results Four key descriptive patterns were identified: labelling and limits to tolerance, pushing prescription as a solution, coverups and avoiding consent, and family’s fight for liberty. Triangulation across the data and academic literature supports the findings. Conclusion Our findings provide some insight into how chemical restrain happens. Featuring throughout the cases were reports of a lack of workforce capacity to care for and support residents exhibiting dementia behaviours. Prescription of psychotropic medications featured as a “first resort” care solution. Family and friends found such approaches to care unacceptable and frequently challenged the practice. Where consent for prescription was explicitly denied, more covert approaches are demonstrated. Family awareness, presence, and advocacy were key to challenging the practice of chemical restraint. Shortfalls in the capacity of the current workforce come into play here. However, workforce shortcomings can no longer mask this ubiquitous practice. Just as importantly the spotlight needs to be turned on the prescribers and the providers.

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Section: Discussionmentioning

confidence: 99%