Members of the worldwide Alzheimer’s and dementia care community overwhelmingly recommend against using antipsychotic drugs as the first choice in addressing behavioural and psychological symptoms of dementia (BPSD) and aggression in dementia patients.
In fact, experts everywhere believe antipsychotic medication should only be used as a last resort after every non-pharmacological avenue of treatment has been exhausted.
The American Geriatrics Society says:
The Society further notes:
“People with dementia often exhibit aggression, resistance to care and other challenging or disruptive behaviors. In such instances, antipsychotic medicines are often prescribed, but they provide limited benefit and can cause serious harm, including stroke and premature death.
Use of these drugs should be limited to cases where non-pharmacologic measures have failed and patients pose an imminent threat to themselves or others. Identifying and addressing causes of behavior change can make drug treatment unnecessary.” (Italics mine.)
The Canadian Geriatrics Society says:
“…antipsychotics usually don’t reduce disruptive behaviour in older dementia patients.” (Italics mine.)
The side effects can be serious; they include drowsiness and confusion—which can reduce social contact and mental skills, and increase falls.
The Alzheimer’s Society of the United Kingdom says:
Instead of prescribing anti-psychotic drugs, health care professionals should begin by “fully assessing the person’s behaviour, health and current treatments, as well as understanding their history, interests, personality and culture to develop an individual care plan. The care plan should be designed to provide access to interventions tailored to the person’s preferences, skills and abilities.”
Finland’s current Care Guidelines say that for the treatment of memory disorders, antipsychotics should only be used as a short-term treatment for severe psychotic symptoms, agitation and aggression. (Italics mine.)
In June 2014, the Canadian Foundation for Healthcare Improvement announced:
“…[we] support healthcare organizations across Canada [in reducing]the inappropriate use of antipsychotic medications among patients with dementia.” (Italics mine.)
In February 2015, Health Canada issued a restriction on the dementia indication for risperidone; it states:
The indication for risperidone in dementia has been restricted to the short-term symptomatic management of aggression or psychotic symptoms in patients with severe dementia of the Alzheimer type unresponsive to non-pharmacological approaches and when there is a risk of harm to self or others. The indication no longer includes the treatment of other types of dementia such as vascular and mixed types of dementia. (Italics mine.)
In June 2015, the Ontario Drug Policy Network issued a report on antipsychotics and the elderly.
The report’s #1 recommendation is:
“…the ” implementation of programs to reduce the inappropriate use of antipsychotic drugs for elderly people with dementia.”
The comprehensive analysis was prepared by a group of experts from a diversity of disciplines. Their recommendations were based in part on this finding:
“…there were no significant differences in the improvement of total [Behavioural and Psychological Symptoms of Dementia] BPSD or be BPSD subscales for psychosis, aggression and agitation across atypical antipsychotic agents (namely: risperidone, quetiapine, olanzapine, aripiprazole) when compared to placebo among patients with dementia and BPSD.”
In other words, antipsychotic drugs (with a relatively small percentage of exceptions), don’t work in reducing responsive behaviours (BPSDs) in people living with dementia. The drugs–quetiapine in particular–are primarily used as sedatives.
Meanwhile, many physicians still prescribe antipsychotic medication for elderly people living with dementia. On average, about one in three residents in long-term care facilities in North America are given antipsychotics.
Why is that?
I’m looking for answers and blogging about this issue because I’ve seen the effects of these drugs first hand on people with dementia and I don’t want to be sedated when I get dementia myself. I want to engage life as fully as possible until the end.
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