Dáil Éireann Debate, Friday - 16 September 2016
1003. Deputy Fergus O'Dowd asked the Minister for Health the number of persons over 65 years of age who were prescribed Olanzapine, Quetiapine Fumarate or Risperidone in 2014, 2015 and 2016 to date; the number of persons diagnosed with dementia or Alzheimer's disease; the number of persons prescribed this medication who were resident in nursing homes; and if he will make a statement on the matter. [24377/16]
View answer1004. Deputy Fergus O'Dowd asked the Minister for Health the national policy in relation to the prescribing of Olanzapine, Quetiapine Fumarate or Risperidone drugs to persons over 65 years of age in 2014, 2015 and 2016; the way in which data in relation to the prescription of these drugs is analysed and checked, in both private nursing homes and HSE nursing homes; if evidence of over prescription has been identified and reported on; the action taken as a result; the number of these persons that were diagnosed with dementia and or Alzheimer’s disease; the number of persons prescribed this medication that were resident in nursing homes; and if he will make a statement on the matter. [24378/16]
View answerI propose to take Questions Nos. 1003 and 1004 together.
The Irish National Dementia Strategy, published in December 2014, included estimates and projections for the number of people in Ireland with dementia by age Group, as follows:-
“ The prospective ageing of the Irish population will lead to an exponential increase in the number of people with dementia in the years ahead. Based on CSO population projections over the next 30 years and applying the EuroCode age/gender-specific dementia prevalence rates, the Table below shows the expected increase in the numbers of people likely to present with dementia in Ireland.
Estimated number and projected growth in the number of people with dementia in Ireland by age group, 2011-2046
|
Age group |
2011 |
2016 |
2026 |
2036 |
2046 |
|
30-59 |
2,866 |
2,935 |
2,869 |
2,864 |
2,991 |
|
60-64 |
1,200 |
1,301 |
1,615 |
1,906 |
1,896 |
|
65-69 |
2,776 |
3,287 |
4,020 |
4,876 |
5,645 |
|
70-74 |
4,604 |
5,532 |
7,442 |
9,378 |
11,188 |
|
75-79 |
7,475 |
8,213 |
12,560 |
15,928 |
19,692 |
|
80-84 |
10,958 |
12,265 |
17,868 |
25,364 |
33,196 |
|
85+ |
17,970 |
21,260 |
31,085 |
52,512 |
77,549 |
|
Total |
47,849 |
54,793 |
77,460 |
112,828 |
152,157 |
Note: Estimates for 2011 based on Census of Population 2011. Projections for 2016 to 2041 based on CSO (2013) Population and Labour Force Projections, 2016-2014, Stationery office, Dublin, Table 3, page 40 and EuroCoDe (2009) Age and gender specific dementia prevalence rates. (Source: Pierce, M. et al. (forthcoming). Prevalence and Projections of Dementia in Ireland, 2011. Genio Ltd., Mullingar).”
Medication Safety is a major focus of the Department of Health and a National Medication Patient Safety Forum has been established in the Department. However, this Medication Safety Forum has not to date specifically addressed the issues raised by the Deputy..
The National Dementia Strategy refers to the use of anti-psychotic medication as follows:
"50% of patients admitted [to acute hospitals] from nursing homes were on anti-psychotic medication; and "The reason for use of anti-psychotic medication was only recorded in 50% of cases;
The Strategy also states that
"Dementia is often accompanied by behavioural and psychological symptoms (BPSD), (sometimes known as behaviours that challenge) such as agitation, aggression, disinhibition, wandering and sleep disturbance and these can occur at any stage of the illness. These behaviours can pose significant challenges for staff and other patients and can be dangerous and distressing for the person with dementia. While these behaviours are common, they can be transient and can sometimes be addressed by non-pharmacological interventions. There are occasions, albeit for a minority of cases, where pharmacological treatments may be required. Pharmacological and non-pharmacological treatments and interventions should go hand-in-hand. People with dementia are more likely to experience psychopathology during the course of their illness and in some cases the use of psychotropic medications is appropriate in conjunction with environmental interventions. However, anti-psychotic drugs should only be used when all other non-pharmacological interventions have first been tried and exhausted (NICE Guidelines). While the use of antipsychotic medications can be effective at controlling BPSD, they are not without risk and if prescribed should be reviewed at regular intervals and discontinued when clinically indicated"
Priority Action 4 of the National Dementia Strategy states that: "The Health Service Executive will develop guidance material on the appropriate management of medication for people with dementia, and in particular on psychotropic medication management, and make arrangements for this material to be made available in all relevant settings, including nursing homes." Under the National Dementia Strategy Implementation Programme, the HSE will set up a working group to inform the development of best practice guidelines to address this priority action.
National policy on restraint, including chemical, physical and environmental restraint is set out in “Towards a Restraint Free Environment in Nursing Homes” , published in 2011, and available on the Department of Health website. Government policy is to eliminate the use of restraint, or where this is not possible, to restrict the use of all forms of restraint to those exceptional emergency situations where it is absolutely necessary. Where restraint is necessary it should only be applied in accordance with the law and best professional practice.
The Health Act 2007 (Care & Welfare of Residents in Designated Centres for Older People) Regulations, 2013 contain provisions relating to 'Medicines and pharmaceutical services' and provide that where restraint is used, it is used only in accordance with national policy. All nursing homes are required to have a written policy on restraint and to keep detailed records of all occasions on which restraint is used. These records must be available for examination by HIQA, the independent statutory body with responsibility for the registration and inspection of nursing homes.
The Regulations underpin HIQA's National Quality Standards for Residential Care Settings for Older People, which have been approved by the Minister for Health and are available on HIQA's website. Standards 14 & 15 set out what is required of a service provider in relation to medication management, and monitoring and review of medications.
Standard 21 sets out what a service provider should do in response to challenging behaviour, while promoting the best outcomes for the resident. Procedures for managing challenging behaviour should be based on staff knowledge of the residents, including any communications difficulties. Where a resident's behaviour presents a risk to himself or others, a care plan should be prepared, based on the individual's assessed needs and this should be reviewed regularly. All staff should have the training and skills, appropriate to their role, to enable them to respond to challenging behaviour. Positive (i.e. non-restrictive and non-pharmacological) interventions are the preferred options. Expert advice should be sought where necessary, including before beginning a course of psychotropic medication, and specific guidelines are provided on the use of psychotropic medication.
*Chemical restraint” is defined as "the intentional use of medication to control or modify a person’s behaviour or to ensure a patient is compliant or not capable of resistance, when no medically identified condition is being treated; where the treatment is not necessary for the condition; or the intended effect of the drug is to sedate the person for convenience or for disciplinary purposes. The appropriate use of drugs to reduce symptoms in the treatment of medical conditions such as anxiety, depression, or psychosis, does not constitute restraint. Chemical restraint is always unacceptable."
The specific questions raised by the Deputy regarding current numbers diagnosed with dementia, and those relating to the frontline management of relevant prescribing are service matters and have accordingly been referred to the HSE for direct reply.
