Use of opiates in aged care
This month we will hear from Loren de Vries, our Senior Practitioner who leads the Commission’s Behaviour Support and Restrictive Practices Unit.
Recently I have been discussing the use of opioids in aged care with our Chief Clinical Advisor, Dr Mandy Callary. Dr Callary noted her concerns about situations where opioids are inadvertently used to manage a person’s behaviour. Opioids are strong painkillers, but they can also have a sedating effect. Examples of the most commonly prescribed opioids in aged care are Targin (oxycodone and Naloxone) and Buprenorphine.
Before I share our observations on the use of opioids, I’d like to provide some background on why the Commission maintains a strong interest in the use of restrictive practices in aged care.
Restrictive practices and human rights
Freedom of choice and movement is a fundamental human right. As we age and access formal aged care services, there are some additional protections under the Aged Care Act to make sure that aged care providers do not unnecessarily restrict that right. The obligations around use of restrictive practices make sure that providers consider all the alternatives to manage a person’s behaviours before restricting a person’s free choice and movement.
Unfortunately, not long ago, many people in residential aged care were routinely subject to unacceptable levels of restraint. The examples highlighted through the Royal Commission showed how physical and chemical restraints can become normalised in aged care settings. As a result, providers and workers may not see the harm that these practices can cause.
The importance of vigilance
As a Nurse Practitioner specialising in behaviour support, I have seen too many instances where a person’s dignity and respect were compromised because of something done by an aged care worker. To be clear, there was never a deliberate intention to mistreat the older person. Rather, staff were just using the techniques they were taught which had become standard in their workplace. That’s why the most effective and efficient regulatory response by the Commission – at least in the first instance - is education and guidance. This approach has led to positive outcomes, not just for the people receiving care, but also for staff, with many going on to advocate the benefits of behavioural care planning to others in the sector.
What my experience has shown me, both in my role in the Commission and as a Nurse Practitioner working with aged care providers, is the need for vigilance. Well-intentioned practices can gradually become routine and ‘just what we do around here’, without questioning their impact. Dr Callary and I agree that opioids have their place in managing a person’s persistent or chronic pain where the medication is used under specialist supervision and is subject to regular review. However, there is a problem when opioids are used for their sedating effects rather than for pain relief. Undue sedation in older people often carries with it additional risk of harm and clinical deterioration.
The other important point to make about opioids is that many people still experience some pain when taking these medicines. That means that clinicians working with older people to decide how best to manage their pain should also be thinking about other strategies such as movement-based therapy, that have been shown to lessen pain, improve function and improve quality of life. It’s worth remembering that sometimes opioids can even make pain worse in the long term.
Next steps
For these reasons, we at the Commission will be taking a greater interest in how opioids are being used in aged care. We want to make sure that providers, prescribers and aged care workers are all being suitably vigilant about the use of opioids so that where this medication is prescribed and used for an older person, the reason is to enhance rather than diminish that individual’s quality of life.
For more information on the Behaviour Support and Restrictive Practices Unit and our resources, go to our website.
Until next time…
