Four Seasons cuts dementia drug use as sector awaits review

It is a year since the Department of Health announced a review of the use of antipsychotic drugs to manage the behaviour of people with dementia, particularly in care homes.

This followed concerns that drugs were being prescribed too freely to control behaviour such as aggression and wandering, were not being reviewed and were not being withdrawn as quickly as they should be. There was also evidence that side effects for people with dementia included increased risk of stroke and mortality.

No date for publication

The national dementia strategy, published in February, said the drugs review was likely to be published in spring 2009. But the Department of Health this week was unable to confirm when it would be released, although it said it would be out soon.

However, there has already been work on tackling the problem before any government recommendations on the issue are published.

Big cut in use at Four Seasons home

This month, Four Seasons Health Care revealed that the proportion of residents given psychotropic drugs – a wider category than antipsychotics – at its Ashcroft care home in Chesterfield had fallen from 92% to 28% since the start of 2008.

Caroline Baker, the provider’s dementia care services director, says those remaining on the drugs have had a reduction in either dosage or frequency, and she hopes most will be moved on to even lower doses or off the medication over time.

Baker says many residents were referred to the home from hospital where they were already being treated with psychotropic drugs.

Doll therapy

It carried out a drugs audit at the beginning of 2008, after which staff worked with GPs, psychiatrists and families to reduce medication, including through the use of alternative therapies, such as doll therapy.

This involves staff introducing residents to a doll to give them an opportunity for emotional attachments in the absence of loved ones. Baker says: “Staff were antagonistic towards it and felt, probably initially as I did, that it was treating people like children.”

She says it is also important to address the concerns of relatives who see a reduction in medication as liable to cause loved-ones stress or discomfort.

Brought ‘back to life’

Some relatives now see the reduction in drug use as bringing loved-ones “back to life”, by improving communication with them, she adds.

Ashcroft is part of Four Seasons’ Pearl (Positively Enriching and Enhancing Residents’ Lives) Specialist Dementia Services Scheme, an initiative launched in January 2008 to ensure residents with dementia are provided with specialist care.

Excellence Network winner

Its success in reducing the use of psychotropic medication across several homes led to it winning a training and development award last month in The Excellence Network, Community Care’s annual social care honours programme.

Pearl is being rolled out to 52 more Four Seasons homes over the next year. Baker says that the investment in training involved may make it difficult for smaller providers to replicate such reductions in drug use, although she insists lessons can be learned.

Training and guidance are priority

Others in the sector also point to improved staff training as a priority for the review.

Alzheimer’s Research Trust chief executive Rebecca Wood says: “Better training would mean that far fewer of these drugs would have to be given because people would understand better what tends to trigger aggression and agitation in people.”

Practitioners and campaigners also say guidance for clinicians on managing and reviewing prescriptions is vital.

Chair of the faculty of old age psychiatry at the Royal College of Psychiatrists, Dr Dave Anderson, says: “I think doctors are feeling uncertain now about how they are supposed to deal with the problem.”


Whatever its contents, the review must be published urgently so a strategy can be implemented to reduce drug use, says the Alzheimer’s Society.

Speaking earlier this month, chief executive Neil Hunt said: “Antipsychotics should only be used to treat severe symptoms in exceptional circumstances and only for short periods. The government must address this serious issue and publish its long awaited review.”

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