Sleeping pills and antipsychotics given less to the elderly in institutional long-term care

Harriet Finne-Soveri

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Over the past decade, the degree to which antipsychotic drugs are administered to old people in long-term care facilities in Finland decreased by 10 percentage points (from 36% of all individuals receiving such treatment to 26%), while the regular use of sleeping medications came down by more than 20%-points (from 41% to 19% - i.e. the incidence of such treatment was more than halved).
      Regardless of the decline, the patients’ symptoms did not appear to increase and they did not exhibit any sleep disorders, according to the Resident Assessment Instrument (RAI), a standardised assessment system developed to improve the care of the elderly.
      The purpose of the RAI system is to measure the quality and efficiency of long-term elderly care facilities.
     
The results of the assessment indicate that the elderly have been given medicines unnecessarily, says Harriet Finne-Soveri, the head of the ageing and services unit at the National Institute for Health and Welfare (THL).
      Antipsychotic drugs are associated with a range of side-effects, including rigidity and apathy.
      Persons suffering from dementia may experience hallucinations, and antipsychotic drugs are used to prevent them. Another symptom of dementia is constant wandering. Antipsychotics have been used even for this problem, even though they have no effect on it, says Finne-Soveri.
     
As a result of excessive medication, a large amount of money has also been wasted.
      The new RAI results cover a total of 160 long-term care facilities.
     
When patients arrive in these facilities, they are often in a fairly bad condition and their average life expectancy is three years.
     
The findings of the RAI assessment indicate that the level of long-term elderly care improved over the current decade.
      Since 2001, rehabilitative nursing has increased by nine percentage points, while the restricting of old people’s daily mobility has decreased by four percentage points, even though the incidence of dementia patients among the elderly residents has grown over the same period.
      In addition, the follow-up assessment showed that the proportion of those residents whose body mass index is below 20 has become appreciably smaller in the course of the current decade. In other words the risk of malnutrition has decreased.
      At the beginning of the decade, one in three old people in long-term care had a body mass index below 20.
     
In spite of the positive development, the long-time care of the elderly remains a major challenge, admits Dr. Pekka Puska, Director General of the National Institute for Health and Welfare.


Previously in HS International Edition:
  Expert calls for independent body to evaluate care of the elderly (12.3.2007)
  One in three institutionalised old people suffer from malnutrition (1.9.2005)
  Helsinki´s homes for the aged suffer from acute shortage of nursing staff (5.8.2005)

See also:
  Many pensioners suffer debilitating effects from prescription medicines (24.3.2006)

Links:
  FinRAI
  National Institute for Health and Welfare (THL)

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