Fresh calls to cut the use of "chemical cosh" dementia drugs
Experts have renewed calls for action to curb the use of antipsychotic drugs for people with dementia.
Around 180,000 people with dementia are thought to be prescribed antipsychotic drugs in the UK.
The drugs are designed to treat conditions like schizophrenia, but are often inappropriately prescribed to people with dementia to control symptoms like distress or agitation.
Research has shown that two thirds of prescriptions for antipsychotic drugs are unnecessary or inappropriate.
GPs have previously warned they are forced to prescribe the drugs, which can triple the risk of stroke and double the risk of death, because of a lack of alternative services to refer to.
The Dementia Action Alliance - a group of more than 50 health and social care organisations which includes the Department of Health - is now calling for immediate action to tackle the problem.
They recommend that all people with dementia who are receiving antipsychotic drugs should receive a clinical review from their doctor by 31 March 2012 to ensure that their care is compliant with current best practice and NICE guidelines and that alternatives to medication have been considered..
NICE recommended in November 2006 that people with Alzheimer's disease, vascular dementia or mixed dementias with mild-to-moderate non-cognitive symptoms should not be prescribed antipsychotic drugs because of the possible increased risk of cerebrovascular adverse events and death.
Additionally, people with DLB (Dementia with Lewy bodies, a type of dementia closely linked to Parkinson's) with mild-to-moderate non-cognitive symptoms, should not be prescribed antipsychotic drugs, because those with DLB are at particular risk of severe adverse reactions, says NICE.
To achieve a reduction in the use of these drugs, the Dementia Action Alliance is calling on eight groups, including people with dementia and carers, GPs, leaders in care homes and pharmacists, to sign up to commitments outlining how they can play their part in ensuring reviews take place.
To support progress towards achieving this call to action, the Dementia Action Alliance has produced best practice guidance for people with dementia and carers and health and social care professionals on the use of antipsychotics.
Dr Clare Gerada, Chair of the Royal College of General Practitioners, backed the calls for action.
“Dealing with very agitated or aggressive patients can be distressing, and it can be difficult knowing what to do for the best of the patient, but antipsychotics should in most cases only be used as a last resort, and for the short term.
“Antipsychotics have potential to do real harm to patients, including an increased risk of stroke.
“There are viable alternatives - including behavioural therapies - that we should encourage wherever possible to ensure the care our patients receive is appropriate, in their best interests and does not cause them harm.”
NICE's quality standard on dementia can play a key role in helping GPs and carers to reduce inappropriate antipsychotic prescribing.
Dr Tim Kendall, an expert in mental health who led the development of the dementia standard, said that it would help to reduce the number of patients on antipsychotic drugs.
“We need to look for the factors that might be causing challenging behaviour in dementia patients and address those problems.
“Those caring for dementia patients should also be trained so that they can deal with challenging behaviour so that they do not need to offer antipsychotics.
“If people with dementia are given good quality care, then the use of antipsychotic drugs should drop.”
9 June 2011