7 things you should know about how and why antipsychotics are inappropriately prescribed to people living with dementia in care facilities

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elderly man being given drugs

The more research I do into the inappropriate use of antipsychotics to address responsive behaviours in people living with dementia, the angrier I get.

I was deeply disturbed when I read this 2008 report produced by an all-party parliamentary group on dementia in the UK: “Always a last resort: inquiry into the prescription of antipsychotic drugs to people with dementia living in care homes.”

Here is an excerpt from the foreword by group chairperson Jeremy Wright MP:

In a care home setting, the management of dementia presents particular challenges. We should appreciate the pressures on those people who provide care, but we must not accept swift resort to inappropriate chemical restraint when better care is needed.

It has become clear that the overprescription of antipsychotic drugs to people with dementia in care homes is a huge problem. It may arise from inappropriate prescriptions, or from a prescription which is initially justified but which continues for too long, and it does significant harm.

It may damage physical well-being, compromise dignity and infringe human rights. It is systematic abuse of people with dementia in care homes. (Italics mine)

Here are seven key findings from the report’s summary:

1) Overprescribing antipsychotics is clearly a significant problem in many care homes. These drugs are prescribed as a response to the behavioural and psychological symptoms of dementia, experienced as a result not only of the condition, but also as a result of a wider and more complex set of problems external to the individual’s condition.

2) [The problems that lead to the inappropriate prescription of antipsychotics to people living with dementia in care facilities] include a lack of dementia care training for care home staff, which results in the staff not being able to support people with dementia, for example by providing person-centred care.

3) Inadequate leadership in care homes, a lack of support from external services (including inadequate monitoring and review of prescriptions), and the exclusion of family and friends from decision-making [are also problematic factors that lead to the inappropriate prescription of antipsychotics].

4) There are serious concerns that there is widespread inappropriate prescribing. For example, antipsychotics are being used for people with dementia who have mild behavioural symptoms and prescribing is often continued for long periods of time.

5) [The overprescription of antipsychotics occurs] despite the fact that antipsychotics have limited benefit for people with dementia, particularly when prescribed for long periods, and despite the serious side effects associated with their use.

6) [The side effects of antipsychotics] can be very harmful and can rob people with dementia of their quality of life. The widespread inappropriate prescribing of antipsychotic drugs is an unacceptable abuse of the human rights of people with dementia.

7) There are alternatives and solution to the use of antipsychotics, which some care homes have employed to good effect and which should be widely used. Many of these are small-scale, simple solutions, which could be implemented immediately, such as having an individually tailored care plan.

Read and/or download the full report here.

It’s time we overcame the barriers to stopping the use of antipsychotic medications in elderly people with dementia. Yesterday if not sooner.

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Copyright: barabasa / 123RF Stock Photo

11 Comments

  1. Pingback: 20 questions that help explain why people with dementia get agitated and physically aggressive

  2. Thanks for posting this Susan, My Mother has been forced on these drugs in the hospital. We desperately need strong laws in Canada and we need them now.

  3. My mom’s psychiatrist recently prescribed seroquel for its sedative properties. She tends to wake up several times a night and roam the house. The doctor did warn us that stroke risk would increase. I think any help with lessening mom’s agitation is welcome. validation has very inconsistent results in my opinion.

    • Thanks for your comment.

      I also wake up in the night. I am also restless. That doesn’t mean I should be prescribed a sedative. I think we sedate people for our own convenience, not necessarily because their behavior is inherently problematic.

      What nonpharmacological avenues did you try? You mention validation – did you try it? For how long? With what results? what else did you try?

      There is widespread agreement amongst geriatricians worldwide that antipsychotic medications should only be used as a last resort, after all other avenues have been explored. further, there is also agreement that if they are used, it should be at the lowest possible doses for the shortest possible time frames.

      There’s more on that here:

  4. My husband had Parkinson’s with mild dementia and Parkinson’s psychosis. I am disabled and was unable to continue care at home. Two nursing homes discharged him due to his behavior and the inability of Medicare to allow anti-psychotics. I found a home, requiring private pay which required 24 hour private aides and still would not allow anti psychotics. He was in unnecessary distress which could have been alleviated by mild use of antipsychotics. All insisted Medicare would not allow use. He died in far greater distress than was necessary. If, indeed these nursing homes were accurate. I am unable to comprehend their refusal or Medicare’s total resistance.

    • Judith,

      I’m so sorry for the loss of your husband and for the fact that he suffered unnecessarily.

      The irony is that research shows that often it’s the environment of the facility and the inability of the staff to effectively deal with people who live with dementia that causes problematic responsive behaviors. It’s also tragically ironic that your husband, who may have benefited from the judicious use of antipsychotics was denied them.

      I understand this is no solace to you, and that it must’ve been very painful to be helpless in the face of your husband’s distress. I know how that feels.

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