"Antipsychotics for my elderly parent"

My parent was admitted into Box Hill hospital with a broken arm. Within a month they deteriorated so much that they were in palliative care. In emergency I specifically informed them that my parent must not have any antipsychotics. The geriatrician in one of the wards seemingly thought they knew better and gave my parent 12.5mg of quetiapine. The first meeting we had the geriatrician said they only gave 2 doses. I stressed my parent must not be given any. Despite my objection they gave quetiapine again for 3 more days. My parent went into a coma and never recovered.

I believe quetiapine is a complex anti-psychotic. The manufacturer indicates that it is contra indicated in dementia induced psychosis. In addition it warns against using it in the elderly as it can cause death. Even though relatively small dose was given this dose is a big dose in a frail elderly patient. OK you want to calm the patient but there are other calmatives available. Yet I feel this was not considered. I feel this is similar to other stories I have heard in the media.

I believe my parent’s misfortune began at Elizabeth gardens nursing home. The first night I believe they had a fall and the night staff did not document it. My parent’s fractured arm was discovered on the 3rd day because they were in excruciating pain. I believe some staff denied that my parent had a fall. A week later admitted to the fall. I think there is rampant ageism in the health sector. I feel the health system sees older people as a burden, not as people to respect.

My parent had a very slow growing kidney cancer and cancer induced dementia. I think it is time people get more respect from the health system. It seemed to me the doctor did not know the fundamentals of medicine. I felt that some of the answers they had to my questions were inadequate.

I believe there is high tendency to prescribe opioids too. Again without understanding doses in the frail elderly. Because my parent had a frown I believe they assumed my parent was in a lot of pain and wanted to give them opioids. I had to argue with a clinician, different from the one that prescribed the quetiapine. I recall the clinician had the audacity to tell me that under human rights they could override my instructions and give my parent opioids. Of course with what I believe to be the clinician's lack of understanding of pharmacokinetics I feel that would have killed my parent then and there.

I recall one general physician told me that my parent should have cleared quetiapine from their body after a week. I was shocked. I told the staff I believe those pharmacokinetic studies are done on 25 year old university students not on frail old people who haven’t opened their bowels for more than a week. As I understand it, quetiapine has hepatic metabolism and is excreted from the bowel. I felt it was clear they were not familiar with the drugs they were prescribing.