One in five “difficult” care home residents are prescribed drugs, despite the National Dementia Strategy recommending a reduction in their use
A study published in the journal BMJ Open has discovered that elderly care home residents, many of whom have dementia, are still being overprescribed antipsychotic medication.
Prescription rate data from 2009 to 2012 was analysed from over 600 care homes across the country after the publication of the Bannerjee Report. This was a 2009 report commissioned by the Department of Health as part of the National Dementia Strategy to examine the use of antipsychotics. It discovered that there was a ‘substantial clinical risk’ associated with their overuse, including a higher risk of stroke, falls and even death.
However, despite the report, today’s study has found that the number of people receiving antipsychotics has not reduced, and in many cases, the length of treatment with them was excessive in over 77% of cases (the recommended time limit for antipsychotic use is six weeks). Moreover, many first-generation antipsychotics, such as haloperidol and chlorpromazine are still being used extensively, when there are safer types available, such as risperidone.
The research was carried out by Coventry, Warwick, Lancaster, City Universities and the University of East Anglia.
Professor Ala Szczepura, from Coventry University’s Centre for Technology Enabled Health Research, said:
‘Care homes remain the forgotten sector in UK policy debate around the use of antipsychotics. This appears to be due to a lack of systematic monitoring of prescribing data in these settings. Our study has not only identified a failure of the National Dementia Strategy to produce a sustained decrease in use of antipsychotics, it’s also shown large regional variations and has found evidence indicating that their use is higher in care homes in deprived neighbourhoods.
‘Looking forward, the Prime Minister’s challenge on dementia 2020 aims to further slash inappropriate prescribing of antipsychotics by 67%, and reduce variation across the country7. It’s clear from our research that to achieve this in care homes, a significant change is required in prescription culture and management of vulnerable people with dementia.’
Antipsychotics are tranquillisers which were created for schizophrenia patients to prevent hallucinations. They have been dubbed the ‘chemical cosh’ due to their sedative effects and are now routinely prescribed to dementia sufferers to control agitation.
However, previous research has shown that patients are up to nine times more likely to have a stroke and twice as likely to die early, and that the drugs hasten their mental decline. Care homes aiming to carry out person-centred care would argue that rather than treating the symptom – their agitation and aggression – you should try to discover the cause of their agitation and take steps to prevent it happening in the first place.
George McNamara, head of policy at the Alzheimer’s Society said:
‘This continued reliance on antipsychotics to manage behavioural symptoms of dementia is deeply worrying. Around 90% of people with dementia experience symptoms that affect their behaviour causing aggression, agitation, or even delusions and hallucinations. These symptoms can develop as part of their condition, but may also be caused by other factors – pain, discomfort, or unmet needs. When this is the case, prescribing antipsychotics treats the person with dementia as the problem rather than the root cause of their behaviour.
‘Antipsychotics increase the risk of stroke, falls and even death – it’s shocking that the evidence continues to be flatly ignored. With person-centred approaches and training programmes for care home staff, continued inappropriate prescribing is a step backward into the dark ages.’