NURSING home patients with dementia who are incapable of consenting to treatment are being given psychiatric drugs illegally because doctors are not aware of the rules or do not have the time to follow them, research has found.

A study of 77 patients in three nursing homes in southern Sydney found more than 70 per cent had been given drugs such as antidepressants, anti-psychotics, mood stabilisers or benzo-diazepines without their written consent or that of their families.

Under the NSW Guardianship Act, when an adult is incapable of giving consent, next of kin must be contacted. The study, published yesterday in the International Journal Of Geriatric Psychiatry, found that consent had been sought and properly documented in only 6.5 per cent of cases.

"This is alarming and probably more widespread than this study indicates," Henry Brodaty, a professor in aged care mental health, said yesterday. "Most of the doctors were unaware of the guardianship laws or they just found it too time-consuming to seek written consent. Even if they were delegating the task to nurses, it still took up a considerable portion of their time."

Administering psychotropic drugs to a patient more than three times a month was classed as major medical treatment under the act and required written consent, but most nursing homes were too busy or understaffed to fulfil this requirement.

"As far as we know, nothing bad has happened yet, but the rate of compliance is very low so obviously changes need to be made," Professor Brodaty said.

"Nursing home staff need more education in this area or, if the regulations are too onerous, then we need to change the law, which at the moment is not very effective."

Valid consent must be obtained in all cases, medication charts should be altered to include a tick box for consent, and some drugs could be reclassified so that verbal consent only is required, the study found.

"The laws were put in place to prevent potential abuse and it is far easier to nurse someone who is not agitated or wandering, but with the advent of new drugs, the capacity for abuse has been reduced," Professor Brodaty said.

"Antidepressants really should be classed as a minor treatment which would only require verbal consent from the next of kin, as could small amounts of sleeping tablets."

More than 50 per cent of patients in nursing homes are regularly prescribed psychotropic drugs. About 81 per cent of the patients in the study had been prescribed anti-psychotic drugs and 34 per cent took benzodiazepines.

"If your child requires treatment, you want to be monitoring it and asking questions, so I don't see it is any different with families of dementia patients," Professor Brodaty said.

"And it would be prudent of doctors to follow the rules because if something does go wrong, at least they are afforded some protection."

Source: Sydney Morning Herald - Kate Benson, Medical Reporter