Prescribing of antipsychotic drugs for dementia at ‘concerning levels’ in Scotland, report claims
Report urges Government to reduce the inappropriate use of antipsychotics in dementia after finding 45% of patients were taking these drugs.
A Mental Welfare Commission report on the care of dementia patients in Scotland has raised grave concerns about inappropriate prescription of antipsychotic medicines.
Care records revealed that 84% of dementia patients were on at least one psychotropic medicine and 35% were taking three or more. This level of polypharmacy, without evidence of regular review, is concerning, said the report, Dignity and Respect: dementia continuing care visits.
Scotland’s minister for public health, Michael Matheson, said safe medication was a human right and the issue needed to be addressed.
More than 50% of patients were given anxiolytic medicines, mostly diazepam and lorazepam. In addition, 45% were taking antipsychotics, of which 33% were taking risperidone, 24% were taking quetiapine and 23% were taking haloperidol. Quetiapine is unlicensed and has little evidence to support its use in treating stress and distress, and haloperidol can cause significant side effects.
The report’s key recommendation is for the Scottish Government to develop a plan to reduce inappropriate prescribing of psychotropic medication in people with dementia. Matheson said the recommendation had been accepted and that action was under way.
Commenting on the report, Delia Bishara, consultant pharmacist in mental health and older adults at South London and Maudsley NHS Foundation Trust, says: “Use of antipsychotics in patients with dementia is associated with an increased risk of stroke and death.”.
Bishara refers to the 2009 Banerjee report, commissioned by the Department of Health, which estimated that at least 25% of dementia patients in the UK were on an antipsychotic, but that this could be as high as 50%. The Banerjee report recommended that prescribing should be reduced to a third of that level over three years.
“Since then there has been a national drive to reduce the rate of antipsychotic prescribing in patients with dementia,” Bishara says. “This latest report shows that nothing has changed in these continuing care units in Scotland”.
Another concern from the report was a lack of pharmacy involvement. Only 37% of dementia care units had regular pharmacy input beyond a top-up service and the report recommends that pharmacy should be a core part of the multidisciplinary team that conducts patient reviews at least annually.
Alex MacKinnon, the Royal Pharmaceutical Society director for Scotland, says that there has been repeated recommendations for formalised and consistent clinical pharmacy input into the care of dementia patients and the elderly, and yet this has clearly not yet been achieved as a part of a core service in Scotland.
MacKinnon calls on the Government and NHS in Scotland to commit to mandatory input from pharmacists to ensure that the ambition of high quality, safe, effective and person-centred care can be delivered.
The report acknowledged there had been progress in the care of dementia patients since the commission’s 2007 report, but said too many dementia units were failing to meet acceptable standards. In compiling the report, 52 NHS dementia care units were visited and 336 patients receiving care were met by the commission, which was set up by the Scottish Parliament to ensure that people with mental illness and learning disabilities receive lawful care, treatment and support.
Scotland health secretary, Alex Neil, called the report’s findings a “disgrace” and said that the Government would fully implement all 20 of its recommendations.
Citation: The Pharmaceutical Journal URI: 20065355
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