Sedative cocktails fed to the elderly

A chemical cocktail of sedative drugs is being mass prescribed to elderly people living in nursing and residential homes to keep them quiet and make them easier to manage, according to a report.

The practice of "switching the patients out with the lights" is causing increasing concern among medical and charitable organisations, according to the report by the Royal College of Physicians. More than 90 per cent of residents of the homes are prescribed drugs, and nearly half are taking major tranquillisers and other sedatives.

Dr Michael Denham, consultant geriatrician at Northwick Park Hospital and chairman of the working party that produced the report, said there had been a six-fold increase in places in private and voluntary homes since 1983, fuelled by a 30 per cent decline in NHS long-term care, which had placed a severe burden on local GPs.

"I fear that in some homes these drugs are being used like a chemical ball and chain to keep patients quiet. These are very frail physically and mentally ill people and virtually the entire lot are on medication, with a large proportion on sedatives. It is a growing cause for concern."

National guidelines on prescribing drugs in the homes should be reviewed and closer monitoring introduced, possibly by giving overall responsibility to one or two GPs for each home, the report says. Dr Denham cited the example of one resident who reported "feeling alive again" after being weaned off a sedative.

The report, Medication for Older People, says that the over-65s are being prescribed 50 per cent more drugs than a decade ago. The annual number of items prescribed to older people has risen from 14.6 on average in 1985 to 21.8 in 1995. The cost of each prescription rose from pounds 4.10 to pounds 7.55 and accounted for almost half the increase in health authority drugs bills over the decade. Although older people make up 18 per cent of the population they receive 45 per cent of all prescriptions dispensed.

The report, an update of an earlier one published in 1984, says that the rapid growth in prescribing to the elderly suggests many patients are receiving inappropriate or unnecessary treatment as well as placing an increasing burden on the NHS drugs bill.

Adverse reactions are three times more common among the over-60s compared with the under-30s, mainly because they take more drugs. Innovations by the pharmaceutical industry have greatly increased the range of medicines suitable for older people but "more attention must be paid to making sure the medicines given are both suitable and effective," the report says.

Dr Denham said doctors under pressure tended to have a reflex response to certain conditions such as dizziness in older people and prescribe a tranquilliser without investigating further. "If you leave them on tranquillisers they may end up with symptoms of Parkinsonism ... There is a tendency to treat the symptom rather than the disease."

However, underprescribing is also a problem, driven by some doctors' ageist approach to treatment. The report says there is evidence that older people benefit more from drugs for heart conditions and high blood pressure than younger people, yet they are less likely to receive them.

"It is sad to note that ... the attitudes of some doctors [remain] fixed to the concept of chronological age rather than biological age - the capacity of an individual to benefit," it says.