Bruce Guthrie, Professor of Primary Care Medicine at Dundee, and a team including Dr Stella Clark from NHS Fife, carried out the study in response to long-term concerns expressed across the UK regarding the use of anti-psychotic and psychotropic drugs to manage behavioural and psychological disturbances in dementia.
An independent report carried out for the Department of Health in England last year recommended a significant reduction in the use of anti-psychotic treatments for people with dementia.
‘There have been significant concerns expressed for some time now regarding the use of these drugs to manage behavioural disturbance in people with dementia but there has been very little data gathered on just how common this kind of prescribing is,’ said Professor Guthrie.
‘What our study shows is that antipsychotic drugs are very commonly prescribed to people with dementia. These are drugs which are known to have relatively little benefit except in a small number of patients, but which can cause significant harm. They can bring on strokes and increase mortality rates – the report in England estimated the widespread use of these drugs was causing an additional 1800 deaths per year.’
The study additionally showed that people with dementia are also commonly being prescribed other sedative drugs including antidepressants and drugs like diazepam (valium).
The study looked at data from 315 GP practices across Scotland, containing records of over 270,000 elderly patients, representing around one third of the population. 10,000 of the elderly patients had been diagnosed as suffering from dementia.
Patients with dementia were shown to be twice as likely to be prescribed anti-depressants or other sedatives, but most strikingly were more than 17 times more likely to be prescribed anti-psychotics.
‘Although doctors are often trying to find the best way to manage symptoms which can be very disturbing to both patients and families, the use of anti-psychotics in this situation has only limited benefits and significant risks,’ said Professor Guthrie.
‘Despite that we see these drugs being very commonly used. At a minimum we would recommend that GPs do not prescribe anti-psychotics to people with dementia as a repeat prescription and should regularly review the need for continuing prescription.
‘More importantly, there needs to be investment in services to support alternative management strategies for people with dementia and to support families and other carers at home and professional carers in nursing homes so that the use of these drugs becomes more of a last resort.’
Dr Clark said the NHS in both Tayside and Fife has already started work with GPs and psychiatrists locally to review patients with dementia who may be receiving anti psychotic drugs.
The research has been published online in the journal Age and Ageing.
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