Antipsychotic medication for dementia.

According to the Alzheimer’s Society there are currently 800,000 people with dementia in the UK. 80% of care home residents have either dementia or severe memory problems. Dementia is not a single condition but an umbrella term for a number of illnesses. It includes the relatively well known Alzheimer’s but encompasses many other conditions including frontal lobe dementia and dementia with Lewy bodies.

Dementia can affect individuals in a number of different ways but about 90% of people with dementia may experience aggression, agitation and psychosis (delusions and hallucinations). These symptoms can be immensely distressing for the individual and others. In a care home setting these difficulties may be magnified. A dementia sufferer with severe behavioural or psychological symptoms may cause distress and anxiety and be unsettling to other care home residents. It is perhaps, not surprising, that carers welcome treatments which promise to reduce or control these symptoms. GPs, perhaps unfamiliar with their new patients, may feel under pressure to act and prescribe medication.

Medical advances have resulted in new drugs eg Aricept which help to slow the progress of certain types of dementia. For others there is no effective treatment. The reality is that the medications typically prescribed to manage aggression and agitation may be antipsychotic drugs. These are drugs that are not designed (or in many cases licenced) to treat dementia symptoms. They are the drugs usually prescribed to treat people with mental health conditions such as schizophrenia.

In some (probably about 50% of care home residents) the medication can help to reduce the impact of the distressing symptoms. However in the other 50% these drugs do not work at all. For many dementia sufferers these medications will cause serious and disabling side effects. Research has shown that 2/3 of prescriptions for antipsychotic drugs are unnecessary or inappropriate. The implications of this for the NHS, for families and sufferers are profound.

Ultimately it will be the NHS that picks up the tab both for the medication and for the physical ill effects of over prescription e.g. falls, cardiac problems, strokes etc. The potential side effects of the medication cannot be overstated. Some carry a nine fold increase in the risk of stroke. Inappropriate antipsychotic medication is implicated in many deaths of care home residents every year. .

Prescription of antipsychotics may result in quiet, compliant care home residents but medication may prevent dementia sufferers from communicating other significant issues such as hunger or pain.. Families may find that their loved one has become distant, quiet, subdued and withdrawn – a shadow of their former selves. Most terribly of all, the dementia sufferer themselves will be denied an opportunity to live their remaining years with dignity. They will become a patient to be managed rather than an individual to be cherished and cared for.

There is an alternative. The reality is that many dementia sufferers who benefit little from anti-psychotic medication would benefit greatly from receiving person-centred care. The symptoms of restlessness, aggression and frustration can often be effectively tackled if the sufferer is treated with dignity and respect and if an effort is made to understand their history, lifestyle, culture and preferences. Even 10 minutes of simple one to one conversation on a daily basis can have a significant beneficial effect.

The Alzheimer’s Society is spearheading a campaign to prevent the unnecessary administration of anti-psychotic drugs to dementia sufferers. They offer excellent advice and guidance to families and carers and also health and social care professionals about alternatives to antipsychotic medication.

Whilst there is some evidence that campaigns have worked and that numbers of antipsychotic prescriptions are reducing, recent studies suggest that too many dementia sufferers are being prescribed too much medication for too long. As a society we are keen to comment and speculate about the future funding of care. We rightly condemn neglect of the elderly and vulnerable. Nevertheless we are apparently content to see tens of thousands of individuals prescribed medication that, at the very best, may not help them a great deal and, at the worst, may do them very real and terrible harm.