Rest home drug ordeal for war hero
Relatives of a veteran of the D-Day invasions are concerned about the medication he was given in a Hawke’s Bay rest home. Tony Wall investigates.
In the mugshot taken by the Nazis, Trevor Mullinder grins as if it’s his wedding day. The guards at the Stalag Luft 1 prisoner of war camp in northern Germany had told him not to smile for the photo – so he did anyway.
‘‘Dad was a bit of a rebel,’’ says his daughter, Lorraine Parkinson.
Mullinder had flown Mosquito bomber raids over France in support of the D-Day invasions in June 1944. Shot down over France five days after the initial invasion, he was captured by the Nazis and taken in an open cattle wagon to the prison camp, where he spent the rest of the war.
On his return to New Zealand he served in the Air Force for many years before teaching maths and English at Hastings Boys’ High and eventually retiring to a lifestyle block. Around mid-2011, Mullinder was diagnosed with mid-stage dementia.
‘‘He wasn’t wandering away or anything, he was just a bit confused and he used to get a bit crotchety,’’ says Parkinson.
His wife, Phyllis, had her own serious health problems so the family decided to put him into the Mary Doyle rest home in Havelock North. He entered the home in March 2012 and died three months later aged 93. The home has since been purchased by the Arvida Group.
Parkinson and her siblings believe the medication their father was given in the home – a potentially dangerous combination of an anti-psychotic and a heart failure drug – may have hastened his demise.
She is speaking out as part of a Sunday Star-Times investigation into the use of anti-psychotics in rest homes. Several families have come forward with similar stories of elderly loved ones being routinely given the drugs – sometimes without the family’s consent – when their behaviour became difficult.
‘‘I don’t want this happening to other people,’’ Parkinson says.
Mullinder was often distressed in the nursing home and his family believe he went back to his prisoner of war days in his mind.
He would plot ‘‘escape routes’’ and on one occasion wouldn’t let two nurses carrying a vacuum cleaner pass him in the hallway, perhaps thinking it was some kind of torture device, Parkinson believes.
‘‘They complained about him. I was told they were very frightened.’’ Mary Doyle management, Mullinder’s GP and a psychogeriatrician decided to try him on a small dose of the new generation anti-psychotic risperidone, one of the most common antipsychotics in rest homes.
Parkinson says she had power of attorney for her father’s medical matters and welfare, but wasn’t consulted.
In the US, risperidone is not approved by the Food and Drug Administration for use in dementia patients, but is often prescribed off-label. Here and in Australia, it is the only antipsychotic registered for behavioural and psychological symptoms of dementia.
Parkinson says it felt like staff hadn’t taken enough time to get to know her father. ‘‘They just didn’t have any understanding of him as a person, of his psychological trauma during the war – none of that was taken into account. I think that’s what annoyed us the most – that he was being branded as a difficult person.’’
Medical charts show Mullinder was started on a very small dose – 0.5mg – which was increased to 2mg and then 4mg.
The last increase happened in one day – the family say that was faster than recommended for their father’s weight.
They were particularly concerned that Mullinder was also being prescribed 40mg of the diuretic furosemide, to treat fluid build-up around his heart.
According to Medsafe advice, caution should be used when combining the two, as studies have found the mortality rate for elderly people taking the drugs together is more than double that of risperidone alone.
Parkinson says a nurse at the home approached her with concerns.
‘‘She took me into a private room and took a book out of a cabinet and said ‘I’m really worried about your father’s medication’. She said ‘I don’t know what you can do about it’.’’
Parkinson rang her father’s GP, asking if a diuretic not contraindicated with 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 antipsychotics 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.’’
‘‘I think he deserved better, definitely. I felt I failed him... I had blind faith in the... medical profession.’’ Lorraine Parkinson