New approach to dementia antipsychotic medication

The short film, Antipsychotics & Dementia: Managing Medications, has been developed in response to recent research which has found that antipsychotic medication, which can have serious side effects, is used too frequently to manage behavioural and psychological symptoms of dementia.

Available on Alzheimer’s Australia’s Detect Early website, the resource has been developed by Alzheimer’s Australia NSW, in conjunction with Southern Cross Care (NSW & ACT) and the Dementia Collaborative Research Centre. It has also been supported by the Australian Medical Assocation (NSW).

Professor Henry Brodaty, Alzheimer’s Australia NSW medical advisor, says there are often a range of non pharmacological interventions that can and should be considered first when managing behavioural and psychological symptoms of dementia, such as pain therapy and person centred activity, before prescribing antipsychotic medication.

“In some cases, the use of antipsychotic medication is appropriate,” says Professor Brodaty, who is also the director of the Dementia Collaborative Research Centre.

“However, we know that in many cases, there are other, much more appropriate treatments that should be looked at first.

“For example, providing pain relief, tailoring personal care practices to the individual’s preferences, treating an underlying urinary infection, correcting problems with vision or hearing, playing favourite music or working with the family to engage the person in more meaningful and stimulating activities.”

An Alzheimer’s Australia report, released in March this year, found that about half of people in aged care facilities and up to 80% of those with dementia are receiving psychotropic medications. However, it also found that international data suggests that only 20% of people with dementia who are receiving antipsychotic medication get any clinical benefits from it.

The report, The Use of Restraints and Psychotropic Medications in People with Dementia, also finds that these medications can have a range of serious side effects, including increased risk of stroke, increased risk of mortality, a greater chance of falls, and increased confusion.

Southern Cross Care (NSW & ACT) chief executive, Paul McMahon, says the organisation had identified the need to better manage behaviours of people with dementia without the reliance on anti-psychotic medication.

“We also realised the need to educate our staff and health professionals, such as GPs, on eliminating high dependency on medication and improving outcomes for our residents with dementia.”

The Hon. John Watkins, Alzheimer’s Australia NSW chief executive, says the resource is a positive step in supporting GPs, pharmacists and other healthcare professionals working with people with dementia in care homes and in the community in how best to deal with behavioural and psychological symptoms of dementia.

“This really emphasises the importance of a partnership approach between the family of the person living with dementia, their treating doctor, their pharmacist and the care staff,” Mr Watkins says.

“It provides the evidence base for the review and de-prescribing of antipsychotic medications. The first line approach should always be to look and see if there are non-pharmacological approaches that may work better.”

Margaret Wood, daughter of a resident at Southern Cross Care (NSW & ACT), spoke of her experience of visiting her mother who has dementia.

“Mum was put on a drug which made her very sleepy and her speech garbled,” Mrs Wood says.

“She was also depressed and talked about wanting to die. When mum was taken off the medication, she began to improve. Her speech got better, and she was eating. She recognises us most of the time and she is bright and cheerful. It is so nice to visit her now.”