Living with dementia magazine April 2011

In 2010, the UK government announced an ambitious goal of reducing the use of antipsychotics in people with dementia by two thirds by the end of this year. Here, Anne Corbett explains how the Society is supporting the Department of Health in reaching this goal.

Dementia affects people in many different ways and causes a variety of symptoms. The most challenging and distressing are the behavioural and psychological symptoms of dementia. About 90 per cent of people with dementia experience these symptoms and they can cause great distress to the person and their carer. They include aggression, agitation and psychosis.

It is important to remember that these symptoms are caused by an imbalance in the chemicals in the brain and that the person has no more control over them than they have over the other more tangible symptoms of their dementia.

Antipsychotic drugs

People with dementia are frequently prescribed antipsychotic drugs to address behavioural and psychological symptoms. This is particularly common in care homes in the UK, where two thirds of people with dementia exhibit challenging behaviours at any one time. Despite their widespread use, clinical trials have provided extremely limited evidence for any benefits of antipsychotics.

Furthermore, the drugs can cause dangerous side effects. These include reduced mobility, falls, stroke, worsening of dementia symptoms and even death. It is estimated that two thirds of prescriptions for antipsychotics are unnecessary and that many are continued for far too long.

The Society has welcomed the government's goal of reducing the use of antipsychotics and is working alongside the Department of Health to support medical professionals, care home providers, people with dementia and their carers in the hope of meeting that goal as soon as possible.

Often, GPs and specialists prescribe antipsychotics because there seems to be no alternative method for managing difficult behaviours, particularly in the stressful environment of a busy care home. In fact, research has repeatedly shown that person-centred care, which involves a more holistic, individualised, drug-free approach, can dramatically improve symptoms.

Alzheimer's Society research has also shown that a dementia-specific training programme for care home staff can reduce the use of antipsychotics by up to 50 per cent. The simple approaches promoted in the programme include spending just ten minutes a day interacting with a person, for example by talking about one of their interests, looking at photographs or sharing an activity together.

Targeting GPs

Building on this evidence, the Society is currently undertaking a rigorous piece of research to develop up-to-date clinical guidance for GPs and specialists on the best practice for prescribing antipsychotics. Based on the findings, the Society will develop a toolkit for GPs in the hope of empowering them to make the decision not to prescribe antipsychotic drugs.

The toolkit will provide clear advice based on the best research evidence, options for alternative approaches to improve symptoms and guidance on the best clinical practice in prescribing antipsychotics in cases where a prescription is appropriate. A key element of the toolkit will be to provide a structure for monitoring and stopping a prescription to help prevent the long-term use of these dangerous drugs.

Guidance for carers

We are also developing a new leaflet for carers to provide practical information on antipsychotic drugs as well as guidance on the questions carers should be asking their GP. This will give details about the names of antipsychotic drugs, when they should be used, why there are concerns about them, what the side effects are, and recommendations for alternative treatments.

Reducing the use of antipsychotics will not be a simple process but it is essential to take action to protect people with dementia from these harmful drugs. The Society is working hard to provide the best tools and support to make this a reality.

Key facts about antipsychotic drugs;

• Two thirds of antipsychotic drug prescriptions are unnecessary.
• Symptoms are often caused by manageable factors in the person's environment or medical conditions such as pain. These should be checked before using antipsychotics.
• Only one antipsychotic drug, risperidone, has been approved to treat people with Alzheimer's disease when they show severe behavioural symptoms and when other treatments have not helped. Risperidone is approved for use for periods of up to six weeks only.
• Other antipsychotic drugs can also be used to treat people with dementia but they are not approved. This is not illegal, but doctors must be able to explain their reasons for using them.
• A carers' understanding of the person's life history, interests and personality can be essential in deciding the best non-drug approaches.
• Antipsychotic drugs should only be used in the first instance if the person is very distressed or there is an immediate risk of harm.
  

The leaflet on antipsychotics and the GP toolkit will be available from May.