Dr Daniel Allan, a psychiatrist for elderly people, this week told a health select committee of the challenges getting appropriate care for people with dementia in more isolated parts of Southland.
He said he was having to use anti-psychotic medication for people with dementia and it was a regular thing among other colleagues too, even though it was a last resort option, caused by a lack of places for them to go.
Dr Allan told RNZ having to relocate people three to four hours' drive away from their communities and loved ones was a sign of an unhealthy aged care sector.
"There's lots of other things, like late diagnosis, misdiagnosis, difficulty finding rest home beds in these places, but sedation is one of the problems we also face."
He said a common scenario was a patient might need a higher level of care, such as needing to go into a dementia hospital for the highest level of care.
"That may not be available in the locality in which I'm working, often in Southland."
If the patient was from a rural area, medical professionals were faced with the problem of whether they sent the person a long way from their whānau for the last period of their life, he said.
"Sometimes families will ask for any medication that can be used, which is against our best practice and a very difficult thing for us doctors to do."
Allan said there were serious medical side-effects from sedating people with dementia.
"It's the last option any doctor would want to utilise. We know there's increased rates of stroke, falls, pneumonia, cardiovascular disease, it's not good, but I guess we're weighing that up against the person being sent away to a place away from family."
There must be significant risks in behaviour for doctors to consider sedation, he said.
"Often there is agitation and violence, but a lot of that in a good well-resourced place could be ameliorated with adequate non-pharmacological care.
"Often we can see that in urban centres but out in these rural places where there's less of that expertise we're left with little other choice."
Asked if patients were in effect being subdued, he agreed.
"It's probably one of the greatest moral injuries we face as doctors in the sector, it's very difficult."
Doctors felt conflicted about it, the alternative would be to do nothing and end up in a worse situation, he said.
Regarding the Dunedin Hospital rebuild and the discussion on whether psycho-geriatric beds were needed, he said it was another sign of an unhealthy aged care sector.
"We do tend to rely more on our medical colleagues to be able to manage community issues, we're often placing people in medical wards and medical beds and using psychogeriatric wards in hospitals when we could be perhaps managing this better in the community.
"I think those beds are very important. We will definitely need those in the future and it's a worry to hear they may not be provided."
