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.
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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