Concern over the possible overuse of medications in treating elderly people with dementia prompted the U.K. government to commission a study. The results of the study were published in England on November 12, 2009, and it says that overmedication is a common problem and that it leads to unnecessary deaths.
Dementia Treated with Drugs Intended for Schizophrenia
For the past 30 years, the National Health Service (NHS) has increasingly turned to the use of anti-psychotic medicines for the management of elderly patients who display troublesome behaviours.
The NHS asked Sube Banerjee, Professor of Mental Health and Aging, The Institute of Psychiatry, King’s College London to look into the issue. In his report, Dr. Banerjee writes: “These drugs appear to be used too often in dementia and, at their likely level of use, potential benefits are most probably outweighed by their risks overall. This is a problem across the world…”
He found that annually about 180,000 patients in hospitals, long-term care homes, and even in their own homes in the U.K. are given anti-psychotic medication as a way of controlling aggression. But, said Dr. Banerjee, the drug is unnecessary in 150,000 of the cases.
He concedes there are situations in which the medication is necessary, such as when the person is a risk to themselves or others. However, he cautions that anti-psychotic drugs should only be used for a maximum of three months.
Risks of Anti-psychotic Drugs
With only one in five patients deriving any benefit from the medication, Dr. Banerjee says the drugs are being over-prescribed.
Not just that, anti-psychotic drugs have harmful side-effects, particularly among the fragile elderly.
The reports states that the level of use “equates to an additional 1,620 cerebrovascular adverse events, around half of which may be severe, and to an additional 1,800 deaths per year on top of those that would be expected in this frail population.”
Care for Elderly Difficult
Managing patients with dementia is a real challenge. Typically, such people exhibit agitation, aggression, wandering, shouting, repeated questioning, and sleep disturbance. For people working in often understaffed long-term care homes, managing these problems is extremely difficult.
Dr. Banerjee found that, in his opinion, staff in these facilities too often jumped to using anti-psychotic drugs rather than trying non-pharmacological interventions first.
Recommendations for the Care of those with Dementia
Covering the study, BBC News health reporter Nick Triggle writes (November 12, 2009) that the U.K. government will act on Dr. Banerjee’s recommendation to reduce the prescribing of anti-psychotics. Triggle states that the government intends to:
- improve "access to other types of therapy, such as counselling;”
- improve “monitoring of prescribing practices;”
- help the families of dementia patients by “explaining what they can do if they are worried about drug use;”
- increase “specialist training in dementia for health and social care staff;” and,
- appoint “a new national director for dementia to oversee the measures.”
Better Care for the Elderly is Costly
Writing for communitycare.co.uk (November 12, 2009), Vern Pitt points out that implementing all the recommendations of the report “would require six extra full-time members of staff in community mental health teams for older people in the average” long-term care facility.
The price tag for this would in the region of £68 million ($119 million) a year in England. But Dr. Banerjee said a lot of this additional cost would be offset by a saving of £55 million ($96 million) that would come from the “cut in the use of anti-psychotics and reduced admissions to hospitals.”
An incalculable benefit would come from the more dignified and compassionate treatment of the elderly at the closing of their lives.
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