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Why are antipsychotics so regularly given to people with dementia?

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27 January, 2014

When reading about the background to the upcoming NICE guideline on medication use in residential homes (due March 2014), I was surprised to find that, despite the fact that the majority are not licensed for use in people with dementia, this is a widespread practice.

Risperidone, which is commonly used to control some distressing behavioural and psychological symptoms of dementia, is licensed only in specific circumstances and only for up to six weeks.

A review in 2009 found that around 180,000 people with dementia in the UK alone are prescribed antipsychotic medication, and it is suggested that two-thirds of these are prescribed them inappropriately.

Having nursed patients taking anti-psychotic medication, I am only too aware of the serious and life-changing impact extrapyramidal side-effects can have on those taking them. These risk of these side-effects increase with age. In addition, there is an associated risk of cardiac arrest and stroke.

At times, antipsychotics may be helpful to a person with dementia in the short-term. But it appears they are often used as a first-line response to some of the more difficult to manage symptoms of dementia. This raises the question as to whether they are prescribed to help the person with dementia, or to help those caring for them.

Changes clearly need to be made. Agitation and aggression may be caused by an underlying health problem that the person is unable to communicate, or this may be how the person is expressing their fear and confusion. One-on-one time with a person who is clearly distressed can help to alleviate these symptoms, but this is only possible if staff or family members are available.

None of this is new. The National Dementia and Antipsychotic Prescribing Audit has been gathering this information since 2009. It therefore stands to reason that the NICE guideline will reflect five years of careful consideration.

 

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Readers' comments (5)

  • tinkerbell

    Only used as an absolute last resort with our consultant when every other option has been explored and failed and even then maybe not.

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  • It saddens me reading this article, that it is evident that the author has not lived with a family member suffering from the distressing and challenging aspects of Dementia/Altzheimers. As a registered nurse with a large number of years nursing experience, with a father who has deteriorating Altzheimers, I would advocate the use of antipsychotics with the appropriate patients. If it is a case of patients having to live in a home as the family can not manage the distressing symptoms and challenges that the disease process brings, or being able to be cared for in their own environment by people who love them and put their best interests at heart, then the use of antipsychotics is paramount. To watch your relatives distress at being in a home away from all their known world, is distressing.
    It's about time that health professions started listening to the patients and carers of people with Dementia and Altzheimers and not look at care delivery from their own standpoints and beliefs.
    Lets now put the needs of the patient/family/carers first!

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  • in the residential home I have managed for the last 14 years we have a monthly review of residents with our Psychogeriatrician-because we have been so proactive in exploring other causes for the distressed behaviour including the likelihood that it is pain related we now have no residents prescribed anti-psychotics; however we have taken a very proactive approach to identifying their pain needs and having regular analgesia prescribed and administered.

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  • tinkerbell

    Samuel McMahon | 29-Jan-2014 2:01 pm

    Well done. So little emphasis is placed on this in the care homes I visit. I have to keep reinforcing how important it is. I am beginning to sound like a broken record in as much as every time I revisit I have to repeat it again and again and again and................................................. The GP's I am told by the homes are reluctant to px anything more than basic analgesia unless I put it in writing that this person needs a pain review as some GP'smoaning about the cost of pain patches. Ridiculous to say the least and unethical at the worst.

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  • I am a home manager who would love to never give antipsychotics. We always rule out the obvious like pain, urine or other infections, constipation, thyroid problems. We do blood tests U/E, LFT and everything else that would rule out any organic cause. We always see if there are any triggers or anything else that cause them distress too. If we had the funds and time I would love to have my care staff sit with them but this is impossible. We can sit with them for a while and even calm them down but I have some who need this intervention for a lot longer than the government would pay. In an ideal world with endless funds no one would need these drugs but when a service user needs one to one for most of their day and you only get Social service rates then we are left with no choice

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