‘branded says family
risperidone could be used, but was told other drugs did not work as quickly as furosemide.
She says the GP claimed her father’s psychosis was the worst case he’d seen, which she believes is ‘‘bollocks’’.
The GP did not respond to a request for comment.
Dr Bryan Betty, medical director of the Royal NZ College of General Practitioners, says dementia is a very difficult, complex therapeutic area complicated by the rest home environment and issues such as staffing levels.
‘‘There can be situations in rest homes where there can be a bit of pressure exerted to maybe use medication with a patient due to staffing issues,’’ Betty says.
‘‘It’s generally accepted now with dementia and behavioural problems that basically well trained staff, environmental approaches... is the number one way to deal with the issue, but in reality sometimes that isn’t the case.’’
In recent years, he says there has been a push for regular medication reviews, especially in rest homes.
‘‘The whole practice of deprescribing or pulling back on medications as patients get older is really coming to the forefront of general medical practice now. Sometimes the side effects of the medication start to outweigh the benefits.’’
Anti-psychotics need to be used ‘‘judiciously and carefully’’ with dementia patients as there is a higher mortality rate in that group, as well as side effects such as falls, agitation and drowsiness.
The Mary Doyle home was purchased by the Arvida Group in 2017. Spokesman Jeremy Nicoll says he can’t comment on individual cases but notes that GPs or nurse practitioners – not care home staff – prescribe medication.
‘‘Arvida Group has an interest in reducing the use of anti-psychotics for all residents, and in particular for those with dementia and a zero tolerance policy to the use of chemical restraints,’’ Nicoll says.
The Star-Times could not reach the geriatrician who prescribed Mullinder’s antipsychotic medication.
Dr Ian Hosford, a psychogeriatrician who did not see Mullinder but was consulted about his medication, says he can’t comment on an individual for ethical and privacy reasons.
Generally speaking, he says, it’s important to look at what the person’s behaviour was like before admission to the rest home
‘‘If they had a tendency to be aggressive or resistive, this is likely to be worse when they are being cared for by a bunch of strangers in a strange environment.
‘‘This increased aggression is likely to start immediately and needs to be addressed immediately or the home may not be able to continue to care for them.
‘‘I do not know what actually happened, but that may be why he was placed on risperidone quickly – and if it did not have a rapid effect, it may have needed to be increased quickly before the situation escalated further.’’
Parkinson says her father started to show symptoms associated with concomitant use of risperidone and furosemide, including breathing difficulties and fluid build-up.
A hoist was needed to shower and toilet him.
‘‘He did have health issues, but I think the use of this furosemide and risperidone together – I do feel they killed him in the end. He went down pretty quick.’’
In the years since his death, Parkinson says she has struggled to come to terms with what happened. It bothers her that her war hero father’s life ended that way.
‘‘I think he deserved better, definitely. I felt I failed him, that I didn’t pursue [the medication issue] as much as I could have. I had blind faith in the... medical profession.’’
She’s concerned that rest homes aren’t providing staff with enough training and are driven by a profit motive.
‘‘I think if you were to look at the balance sheets of some of those places, you’d find they’re raking the money in.’’
Her advice to other families? ‘‘Persevere. Don’t accept a brush off answer – push and keep pushing and don’t give up. Question every medication given to their family member.’’