Dementia: Nurses highlight inappropriate use of antipsychotics

Three-quarters of nurses have seen people with dementia in general wards being prescribed antipsychotic drugs that double the risk of death, triple the risk of stroke and accelerate decline, a study has shown.

The Alzheimer’s Society research, which surveyed the views of over 650 nurses and 450 nurse managers, found more than three-quarters of respondents said antipsychotics were used always or sometimes. A quarter of nurses and a fifth of nurse managers said that antipsychotics were used inappropriately.

The charity said this was the first time evidence from the frontline had highlighted the scale of the problem. It follows a report last year by the all-party parliamentary group on dementia showing antipsychotics were inappropriately prescribed to up to 100,000 people with dementia in care homes in the UK.

Call to publish review

The findings have prompted the Alzheimer’s Society and 10 leading sector organisations to renew calls for the government to publish the results of a review of antipsychotics, which has been awaited for months.

In a joint open letter the grouping said: “The government must urgently publish its plans to tackle the over-use of antipsychotics. These plans must deliver better support for people with dementia and those working with them as well as cracking down on inappropriate prescribing practice.

“We need to make good care the norm and move away from resorting to dangerous drugs which can increase confusion and the risk of premature death. We must all work together to improve dementia care.  We cannot stand by while this scandalous abuse of vulnerable citizens continues.”

Delay in publication

The Department of Health announced the review in June 2008 following 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prescribed too freely to control behaviour such as aggression and wandering, were not being reviewed and were not being withdrawn as quickly as they should be.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.

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

A spokesperson added: “This is an important issue which directly affects the experience of people with dementia in all care settings, and we want to make sure that we get it right.”

There has already been work on tackling the problem before any government recommendations on the issue are published. Earlier this year Four Seasons Health Care revealed that the proportion of residents given psychotropic drugs – a wider category than antipsychotics – had fallen from 92% to 28% since the start of 2008 at its Ashcroft care home in Chesterfield.

Over-prescription is “abuse of human rights”

Neil Hunt, chief executive of Alzheimer’s Society, said: “The massive over-prescription of antipsychotics to people with dementia is an abuse of human rights, causing serious side effects and increasing risk of death.  These powerful drugs should only be used in a small number of cases.”

Dr Dave Anderson, chair of the Royal College of Psychiatrists’ faculty of old age psychiatry, said: “This is symptomatic of a health and care system ill-designed for people with dementia, yet 30 to 40% of older people admitted to a general hospital will suffer from dementia.

“The staff in general hospitals need access to dementia training and advice from a specialist liaison mental health team for older people if we are to eradicate this problem.”

Related stories

Alzheimer’s Society urges action to curb dementia drug use

Four Seasons cuts dementia drug use as sector awaits review

People with dementia wrongly given drugs, say MPs