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“Fading away”

How aged care facilities in Australia chemically restrain older people with dementia
Aged care Dementia Pharmaceuticals Australia

Human Rights Watch documented the use of various drugs used in chemical restraint, including antipsychotic drugs, benzodiazepines, and sedative-hypnotic drugs, sometimes known as “tranquilizers,” “sleeping pills,” or “sedatives”; and opioid analgesics, also known as narcotic painkillers.

Clinical studies in the United States have found that antipsychotic drugs increase the risk of death in older people with dementia. Benzodiazepine use in older people is associated with increased risks of falls, pneumonia, and death. The government of Australia has not approved the use of many of these drugs in older people, citing these studies.

As best as Human Rights Watch can determine, staff in the aged care facilities where we conducted research did not seek or secure informed consent prior to giving these medications. Informed consent requires a decision based on a discussion of the purpose, risks, benefits, and alternatives to a medical intervention, as well as the absence of pressure or coercion in making the decision. Individuals receiving medication should only receive it after they have given their free and informed consent in accordance with international human rights standards.

In addition, family members who have powers of attorney (legal authority to act on another’s behalf) to make decisions on behalf of their relatives in aged care facilities told Human Rights Watch that facility staff did not seek their informed consent for the medications used as chemical restraints. Many relatives said they only learned that their relatives had been given medications after they received pharmacy bills listing the medications. 

Australia’s existing legal and regulatory framework is inadequate to protect older people in aged care facilities from chemical restraint; it explicitly allows it. Until the introduction of a new regulation by the Commonwealth Minister for Senior Australians and Aged Care that came into effect on July 1, 2019, there was no regulation of chemical restraint in aged care at all. The regulation purports to minimize the use of physical and chemical restraint, but it does not because it does not prohibit chemical restraint, guarantee the right to informed consent, or provide for a complaint mechanism when a person has been chemically restrained.

The Australian government should end the use of chemical restraints as a means of controlling the behavior of older people in aged care. The government should develop support and interventions, including person-centered care, for persons experiencing agitation, emotional distress, or challenging behaviors in aged care facilities. Any new law should also ensure informed consent for all treatment and ensure independent monitoring and effective, accessible, independent complaint mechanisms, including for individuals in aged care facilities and their families. 

Key recommendation:

Parliament should enact legislation to prohibit the use of chemical restraints as means of controlling the behavior of older people with dementia or for the convenience of facility staff. The legislation should include:

  • Mandatory training for all aged care facility staff in dementia and alternative methods and skills to de-escalate unwanted behavior and support the needs of people with dementia;
  • Adequate minimum staffing levels to provide support to older people; and
  • Adequate enforcement mechanisms to protect older people’s rights.
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