The authors of a study into how antipsychotic drugs are given to dementia patients in UK care homes have called for “significant changes in culture” to how prescriptions are managed and monitored.
The research paper found no sustained reduction in antipsychotic prescriptions – used to regulate behavioural and psychological symptoms and also known as the ‘chemical cosh’ – to such patients in the four years following the government’s 2009 National Dementia Strategy (NDS). A report commissioned that year by the Department of Health as part of the NDS recommended a review of their use, because of potential serious side effects – including death.
The new study was produced jointly by five universities and drawn from prescribing data taken from more than 600 care homes across the UK between 2009 and 2012. It comes six months after the Prime Minister’s Challenge on Dementia 2020 targeted a 67% overall reduction in inappropriate prescription of antipsychotic drugs by 2019.
“The question here is is whether the Prime Minister’s Challenge will have an effect [given the NDS’s apparent lack of impact]”, lead author Professor Ala Szczepura, from Coventry University’s Centre for Technology Enabled Health Research, told Community Care. “There’s an opportunity here to think about the care home sector and how it can be supported.”
The report describes inappropriate antipsychotic prescription as a “marker of poor care”, and contrasts well-developed protections against physical restraint and deprivation of liberty with far sketchier ones when it comes to ‘chemical restraint’. As well as noting the overall persistence of antipsychotic drugs, it finds:
- That older, less safe drugs are still being used extensively, rather than second-generation medications recommended by the NDS
- That ‘excessive’ periods of prescription (lasting more than 12 weeks) rose from 69.7% of treatment courses in 2009 to 77% in 2012
- That care homes in the highest-prescribing 20% were more likely to be in deprived areas
- That care homes in the lowest-prescribing 20% were more likely to be served by a single GP.
Szczepura said that the findings indicate first of all how important it is that data continues to be gathered from the sector via new technology.
“There also needs to be a discussion about how to support care workers and clinical staff with training,” she said. “Some patients’ behaviour may be to do with pain they can’t articulate, not dementia, so can be treated with an analgesic instead.”
Szczepura added that the frequent practice of patients staying with their individual GPs, rather than identifying one surgery to look after a care home, makes implementing a consistent prescribing policy across homes very difficult and should be looked at.
George McNamara, head of policy at Alzheimer’s Society, described the continued use of antipsychotics to manage behavioural symptoms of dementia as “deeply worrying”.
“Antipsychotics increase the risk of stroke, falls and even death,” he said. “With person-centred approaches and training programmes for care home staff, continued inappropriate prescribing is a step backward into the dark ages.”
A spokesperson for the Department of Health said: “Reducing the use of antipsychotic drugs is a key commitment from the Challenge on Dementia 2020, and we are clear these drugs should not be used as a first resort.
“We are taking continued action to reduce inappropriate prescribing by making sure staff are trained to recognise and manage challenging behaviour in dementia patients. NHS England is also tackling the issue by recruiting specialist mental health pharmacists, and monitoring progress against our commitment to deliver a 67% reduction in antipsychotics by March 2019.”