Friday, November 13, 2009
A government commissioned report has highlighted the practice of giving people with dementia antipsychotic drugs as a form of chemical restraint and says it is responsible for around 1,800 deaths a year
Up to two thirds of people with dementia who are given antipsychotic drugs as a form of chemical restraint don't need them, a new report has said. The practice of giving dementia sufferers drugs that are licensed to tackle schizophrenia is said to be "scandalous" and lead to around 1,800 deaths a year.
Campaigners have called for such over prescription of drugs to end and the Department of Health's plan is for prescriptions to be cut by two thirds in three years. This action follows an independent review by King's College London Professor Sube Banerjee which was commissioned by the Department of Health and showed that too many people with dementia were routinely prescribed antipsychotic drugs to treat aggression and agitation. This flies in the face of guidance from the National Institute of Health and Clinical Excellence (NICE).
The plan to tighten procedures up on drugs for people with dementia includes creating a new national clinical director for dementia, offering people with dementia and their carers access to psychological therapies to tackle the root cause of agitation and aggression, an audit to agree on definitive prescribing figures and clear local targets to cut antipsychotics use as a result of the audit.
There are also proposals for better regulation, closer collaboration with the General Medical Council (GMC) and royal colleges to make sure all health and social care staff have specialist training in dementia, and joint Department of Health /Alzheimer's Society guidance on what to do if a family member is given antipsychotics.
However, antipsychotics drugs are deemed by the medical profession to be appropriate for people with dementia in certain circumstances, such as when a person is a risk to themselves or others and where all other methods have been tried. But they should only be given them for a short time of say three months while a care plan is put in place, the report said. Banerjee estimated that about 36,000 of the 180,000 patients with dementia who are given these drugs get some benefit from them.
Care services minister Phil Hope commented: "It is unacceptable that antipsychotic drugs are routinely prescribed to people with dementia. More than half of people with dementia will experience agitation or aggression at some point, but NICE guidance is clear – antipsychotics should only be given when this is really necessary.
"Excellent examples of practice do exist, but our action plan will help make sure this is the norm, not the exception. Our new clinical director will provide strong leadership, supporting the NHS and social care to reduce antipsychotics use carefully and drive up quality."
He added: "We know there are situation where antipsychotic drug use is necessary – we're not calling for a ban, but we do want to see a significant reduction in use. We expect the findings and recommendations [of this report] to be taken into account by PCTs [Primary Care Trusts] and all other relevant organisations. Tackling the root of the problem is vital, which is why we are improving access to psychological therapies. We are also working with the Royal Colleges to ensure all health and social care professionals are able to care for people with dementia without routinely resorting to these drugs."
Banerjee said: "Antipsychotics are used too often in dementia; up to two thirds of the estimated 180,000 people with dementia receiving these are prescribed them unnecessarily. This review identifies the potential risks and benefits of these medications in dementia and presents actions that we can take to address this problem. In doing so we would provide international leadership in this complex clinical area as well as improving the quality of life and quality of care for people with dementia and their carers in England."
Neil Hunt, the chief executive of the Alzheimer's Society, called the report "long awaited" and welcome because it finally brought out into the open the scale of the problem within the NHS.
"The scandalous over prescription of antipsychotic drugs leads to an estimated 1,800 deaths a year," he said. "It must end."
Stressing that the government's action plan could not afford to fail, he went on: "Change will only be achieved with commitment from government, PCTs and health professionals and clear local targets. Today must mark a change in dementia care."
There are currently 700,000 people in the UK with dementia and this is expected to increase to a million in the next 10 years as the proportion of elderly people in the population rises.
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