Neurocognitive Disorders: Medical Illness or Mental Disorder: Examining the Mental Health and Wellbeing Act 2022 (Vic) Using Neurocognitive Disorders.

Victoria has new legislation, the Mental Health and Wellbeing Act 2022 (Vic) (MHWA) to govern the care and treatment of people with mental illness that came into effect on 1 September 2023. It takes a human rights approach with a focus on person-centred care. The definition of mental illness encompasses conditions such as dementia even though it is rarely used to manage such conditions. How would the management of dementia and associated conditions change if these conditions were managed under the MHWA? This article uses dementia to examine the differences between the new MHWA, the Medical Treatment Planning and Decisions Act 2016 (Vic) and the Guardianship and Administration Act 2019 (Vic) and how the human rights approach taken by the MHWA might inform future directions in managing dementia.

Supportive/Substitute Decision-making and Capacity in Victoria: Compliance with Australia's Obligations under the CRPD?

The Convention on the Rights of Persons with Disabilities (CRPD) restates human rights through the lens of disability. One of the key rights relates to equality before the law. This has been interpreted as requiring the abolition of substitute decision-making regimes. As a signatory, Australia has agreed to implement the rights set out in the CRPD. In Australia, the laws relating to substitute decision-making and legal capacity vary from State to State. This article examines how the laws in Victoria compare to Australia's CRPD obligations and, hence, whether Victoria is compliant with or in breach of the CRPD. It concludes that, while on the surface Victoria is in breach of Australia's CRPD obligations, Victorian legislation is making significant efforts to operationalise a human rights approach to decision-making.

Management of Behaviours in Dementia: Treatment or Restraint?

The use of antipsychotic medication in the management of behaviours of concern in dementia is complex. Antipsychotics may be part of medical treatment or be a restrictive practice. The uncertainty around consent for restrictive practices exposes patients to the risk of antipsychotic use without consent and doctors to the risk of liability. This situation is even less clear in Victoria following the ruling in HYY [2022] VCAT 97. This article examines the process of consent, the potential liabilities and possible defences. It concludes that changes are needed to the process for obtaining consent to use antipsychotic medications for restrictive practices, especially in Victoria.

Psychotropic drug-induced falls in older people: a review of interventions aimed at reducing the problem.

Falls are a common health problem for older people, and psychotropic medications have been identified as an important independent fall risk factor. The objective of this paper was to review the literature relating to the effect of psychotropic medications on falls in older people, with a particular focus on evidence supporting minimization of their use to reduce risk of falls. A literature search identified 18 randomized trials meeting the inclusion criteria for the review of effectiveness of psychotropic medication withdrawal studies, including four with falls outcomes. One of these, which targeted reduced psychotropic medication use in the community, reported a 66% reduction in falls, while the other studies demonstrated some success in reducing psychotropic medication use but with mixed effects on falls. Other randomized trials evaluated various approaches to reducing psychotropic medications generally or specific classes of psychotropic medications (e.g. benzodiazepines), but did not report fall-related outcomes. Overall, these studies reported moderate success in reducing psychotropic medication use, and a number reported no or limited worsening of key outcomes such as sleep quality or behavioural difficulties associated with withdrawal of psychotropic medication use. Reduced prescription of psychotropic medications (e.g. seeking non-pharmacological alternatives to their use in place of prescription in the first place or, for those patients for whom these medications are deemed necessary, regular monitoring and efforts to cease use or wean off use over time) needs to be a strong focus in clinical practice for three reasons. Firstly, psychotropic medications are commonly prescribed for older people, both in the community and especially in the residential care setting, and their effectiveness in a number of clinical groups has been questioned. Secondly, there is strong evidence of an association between substantially increased risk of falls and use of a number of psychotropic medications, including benzodiazepines (particularly, the long-acting agents), antidepressants and antipsychotic drugs. Finally, the largest effect of any randomized trial of falls prevention to date was achieved with a single intervention consisting of weaning psychotropic drug users off their medications.

Description of an orthopedic-geriatric model of care in Australia with 3 years data.

AIM: Orthopedic-geriatric units have been established worldwide to improve the care of older patients admitted with fractures. This study describes one type of orthopedic-geriatric model which has been implemented in Victoria, Australia, named the Orthopedic Aged Care and Rehabilitation Service (OARS) and evaluates patient characteristics and outcomes including inpatient mortality. METHODS: Eight hundred and thirty-four consecutive admissions under OARS between May 2003 and May 2006 were analyzed. RESULTS: Mean age was 76.6 years, the majority of patients were female (73%) and had come from home (77%). Fractured neck of femur represented 51% of all fractures managed by OARS followed by lower limb fractures (20%) and upper limb fractures (13%). The majority of patients required inpatient rehabilitation (49% of patients overall and 61% specifically for fractured neck of femur). Inpatient mortality for all fractures was 2.5% and specifically 3.5% for fractured neck of femur. CONCLUSION: The OARS model involves close liaison between orthopedic and geriatric teams and promotes a multidisciplinary approach. Mortality rate for fractured neck of femur was lower than the state average, suggesting that combined orthopedic-geriatric care can improve outcomes.