Disturbing methods of treating older people in care settings are common practice. John Pring hears a first-hand account and looks into what can be done

When Barbara Pointon left her husband Malcolm at the hospital for some respite care, he could walk several miles a day, despite having Alzheimer's disease.

When she returned a fortnight later to pick him up, he couldn't stand, his eyes were glazed over and his clothes were soaked in urine.

She soon discovered why - staff had increased his dose of the anti-convulsive drug Epilin, and started him on four new drugs, including an anti-psychotic and a sedative.

"I was so angry," says Mrs Pointon. "I had handed over a fit and active Malcolm and here he was deprived of his mobility because of over-medication."

On the advice of an Alzheimer's Society outreach worker, she asked for him to be taken off all the new drugs. The hospital agreed, and four days later he was able to walk again.

This type of over-medication of older people in care settings has now been highlighted by the Liberal Democrat MP Paul Burstow.

Last month, he published a report* that suggested more than 80,000 people in nursing and care homes are kept sedated with anti-psychotic drugs for no good medical reason.

These drugs reduce psychotic experiences such as delusions and hallucinations, but also act as a sedative.

Staff often use this "chemical cosh" simply to make it easier to cope with residents who have become restless, uncooperative or depressed, rather than trying to discover the root causes of their behaviour, says Burstow. He blames "serious shortages of specialist staff".

His report followed the launch of a new awareness campaign by the older people's charity Counsel and Care, which called on care staff to minimise the use of restraint.

And a study by Professor Mary Marshall, reported in the British Medical Journal in August, found that carers looking after people with dementia - who make up three-quarters of those in long-term care - need better training and support.

Dr Adrian Treloar, a consultant and senior lecturer in old age psychiatry at Memorial Hospital, London, believes medication of people with dementia should be monitored by specialists, and the dosage kept as low as possible.

"The National Service Framework for Older People (a government programme to improve care) requires specialist input in such patients and I believe such services need to be further developed," he says.

Although home managers defend themselves by explaining that GPs are the ones prescribing the drugs, campaigners say care staff could do much more to look for alternatives to the "chemical cosh".

It was a problem Barbara Pointon was to confront a second time as she struggled to look after her husband.

When she was no longer able to cope with the wandering, the loss of social skills, and the aggression that stemmed from his frustration, he was admitted to a nursing home.

Within a few months, his body became so stiff and rigid that he had to spend most of the day lying on his bed.

Mrs Pointon discovered that a consultant's recommendation to halve his dose of Epilin - because his weight had dropped - had been ignored three times in six months.

"The GP clearly colluded with the staff, who obviously felt Malcolm was easier to handle if he was off his feet," says Mrs Pointon.

After she complained, the dose was finally reduced and staff agreed to ask her before changing his medication again. Within a week, he was able to sit in a chair.

Since March 2000, Mr Pointon has been living back home in south Cambridgeshire with his wife. "His mobility has gone," she says, "but it has gone of its own accord and not because of the medication."

But the problem is not simply one of over-medication. Many homes find other ways of restraining older people, claim campaigners.

Some only heat small parts of the building, to keep clients in one or two rooms all day. Others remove residents' walking aids, lock exits on both sides, install handles which make it difficult to open doors, or make inappropriate use of new technologies suchas closed-circuit cameras and sophisticated alarms and buzzers.

Julia Cream, head of public affairs for the Alzheimer's Society, says: "The good homes are using new technologies well but there is lots and lots of bad practice out there where people are restricted in their freedom, cannot go outside and have no choice where they go at all.

"Where homes do have enough good quality, trained, specialist staff, the care is excellent and the drugs are minimised."

Les Bright, deputy chief executive of Counsel and Care, says: "There needs to be a constant reviewing of the balance between enabling people to be safe and secure in the environment they live in, alongside the opportunity to take as many risks as are reasonable."

A spokeswoman for the Department of Health said the excessive use of drugs was "unacceptable", and it was considering referring the issue to the national Institute for Clinical Excellence. The heads of both the Registered Nursing Home Association and the National Care Homes Association failed to comment.

Meanwhile, Mrs Pointon has reached her own conclusions. "My rule of thumb has been to keep the medication as low as you can get away with," she says. "I think the key is training staff on how to deal with challenging behaviours."

• *Paul Burstow's report Keep Taking the Medicine is available on his website at www.zyworld.com/paulburstow
• Counsel and Care's guide for care homes, Residents Taking Risks: Minimising the Use of Restraint, £5, tel: 020 7241 8555, or free from the website www.counselandcare.org.uk
• The charity will also be organising four conferences on the subject in Surrey (30 Jan), Bristol (14 Feb), York (27 Feb) and Edinburgh (7 March). Places cost £82.25. To book call 01904 709706.

Posted: 13 Feb, 2002