What is chemical restraint in aged care?

Case scenario

Sylvia, 67, has lived in a residential aged care home for several years. She has bipolar disorder and is currently taking olanzapine to control manic symptoms. In the late afternoon, she often becomes agitated and restless, so is charted for prn oxazepam 7.5 mg. She is given this several times a week on average.

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Background

‘Chemical restraint’ was a term many pharmacists tried to avoid for years, especially those who worked to recruit aged care homes for deprescribing interventions or who educated nursing staff about psychotropic use. They often sought to be neutral, so as not to imply that staff were deliberately restraining or sedating residents.

And yet Directors of Nursing (DONs) were much more upfront about the topic. Many would categorically say there was no chemical restraint used. Yes, they had high rates of psychotropic use, but all the prescribing was for residents diagnosed with dementia. Likewise, all benzodiazepines prescribed were to treat anxiety or insomnia. To them, if you could attribute a diagnosis to psychotropic use, it was not considered ‘chemical restraint’.

Despite a multitude of state and federal parliamentary inquiries reporting high and prolonged psychotropic use in aged care,^1–3 targeted research on this topic,^4,5 and a dedicated Human Righ