Survey reveals high incidences of aggression in care homes

It has prompted the charity to reiterate its call for more staff training and condemn the National Institute for Health and Clinical Excellence's (NICE) plan to deny people with dementia who have behavioural problems access to licensed drug treatments.

In the care homes surveyed:

• 73 per cent had records of a person with dementia being verbally or physically aggressive in the past three months, 22 per cent of care homes reported more than 10 incidences during this period.
• 35 per cent reported that a member of staff had been injured as a result.
• 89 per cent reported staff being distressed by people with dementia's behaviour and many staff suggested that the recorded incidences were the tip of the iceberg.

Clive Ballard, director of research at the Alzheimer's Society, says,

'This survey paints a bleak picture for both people with dementia and care home staff. Most people think that dementia is just a bit of memory loss but more than half of all people with dementia experience behavioural symptoms such as depression, delusions, loss of inhibitions or aggression. As this survey shows, disruptive or challenging behaviour is distressing for people with dementia, their families and for staff.

We are reiterating our call to tackle this issue now because recent studies have shown what helps people with dementia - staff training, psychological approaches and access to effective drugs yet nothing seems to be changing. The fact that aggressive incidents in care homes are so commonplace is extremely concerning as there is currently a failure to provide good quality dementia care. Around 40 per cent of people with dementia in care homes are prescribed neuroleptic drugs to relieve behavioural symptoms. These drugs are not licensed to treat dementia, and can have dangerous side effects.

Caring for someone with dementia is a skilled job, however, it is estimated that 75 per cent of people in care homes have some form of dementia yet only 10 per cent of care home staff have any form of dementia training. Also, things could get worse if NICE's proposal to ban the prescription of Ebixa on the NHS goes ahead. This is the only drug treatment licensed for people in the moderate-severe stage of Alzheimer's disease and it can reduce behavioural symptoms.

It is time to tackle this issue and think seriously about how we treat and care for people with dementia. It is vital that care home staff are trained in dementia care so that they can understand and manage these symptoms of dementia, and that treatments that may help are available on the NHS.'

People with dementia experience behavioural symptoms for a number of reasons: maybe as a result of physical discomfort, being unable to understand the world around them, or by damage to the part of the brain that regulates behaviour. Many of these symptoms can be relieved by training care staff and by treatment with anti-dementia drugs.

For more media information, contact the Alzheimer's Society press office.

Notes for editors

• Questionnaires were posted to 1,000 care homes. Response rate 20 per cent, 197 care homes, 4,142 care home residents with dementia: Specialist dementia care homes most likely to experience incidents, 83.6 per cent. 
• 22.9 per cent of care homes experience high number of incidents >10.
• The survey will also be published in The Journal of Quality Research in Dementia, the Alzheimer's Society E-Journal, May 2006.
• A study funded by the Alzheimer's Society and published in the BMJ last month, revealed that training can reduce the use of unlicensed sedative drugs used to treat behavioural problems.
• Behavioural symptoms can also be reduced by treatment with Ebixa (memantine), the only drug treatment licensed for people in the moderate-severe stage of Alzheimer's disease. (Licensed in 2002) This doesn't have the harmful side effects of neuroleptics and can also lead to improvements in cognition. Before NICE published its guidance on the only licensed drug treatments for people with dementia it asked for more information about how people with dementia with behavioural symptoms respond to the drugs. It ignored this data. Visit: http://www.nice.org.uk/page.aspx?o=appraisals.inprogress.alzheimersdisease
• NICE's appraisal committee is due to meet again on 27 April 2006.
• The Alzheimer's Society is the UK's leading care and research charity for people with dementia and their carers.
• Over 750,000 people in the UK have dementia. More than half have Alzheimer's disease. Dementia affects one in 20 people over the age of 65 and one in five over the age of 80.
• For information and advice on Alzheimer's disease or other forms of dementia call the Alzheimer's Society national helpline on 0845 300 0336.
• Our website address is: http://www.alzheimers.org.uk/.