A new study has found that the number of antipsychotic drugs prescribed to people with dementia living in care homes hasn’t fallen, despite a national strategy calling for their use to be reviewed. It is a scandal that has to end now, says Mental Health Today editor Dan Parton.
A new study in BMJ Open reads depressingly and familiarly. It examined prescribing data between 2009 and 2012 from more than 600 dementia care homes across the country, concluding that there was no significant decline in antipsychotic prescribing rates over the 4-year period.
The overuse – and misuse – of antipsychotic drugs in dementia cares home has been a scandal for more than a decade now. Yet it still shows no sign of ending, despite government strategies, directives and – crucially – a wealth of evidence showing the detrimental effects the drugs can have on the people who take them.
But the fact that prescribing continues pretty much unabated shows how culturally ingrained it is in many care homes. It also shows how effective national directives are – or, more accurately, aren’t. Care home managers, frontline practitioners and medical professionals continue to collude in this approach because they know there will be no sanction for it.
The reasons why it is done are obvious – it makes things easier for care home staff. Dementia can make people become aggressive or agitated and they can experience delusions or hallucinations, which can be difficult and distressing to deal with. But those can also be symptoms of something else, such as pain or unmet need. Just giving them antipsychotics does not treat the underlying cause, it just treats the person as a problem.
One of the worst things about the apparently routine prescribing of antipsychotics is that it isn’t, in the majority of cases, clinically warranted. Antipsychotics can have a range of negative side effects, from making the recipient ‘zombified’ – that is, quiet and slow in movement – through to increased risk of stroke, falls or even death. This is well known to clinicians and care professionals alike.
What is also well known is best practice on how to care for and support people with dementia without resorting to drugs. Which is why this is so frustrating and such a tragedy – the evidence is out there and is being ignored – and people with dementia are paying the price.
While the government’s Dementia 2020 challenge has an aim of cutting antipsychotic prescriptions in care homes, I see no reason why that should be a success, for the same reasons the NDS failed. Just asking people nicely to stop doing it isn’t going to work: more robust action is needed to address this scandal.
What has to be remembered is that people with dementia are people first and foremost. The diagnosis is secondary. Treating people just as problems is dehumanising and only results in poor outcomes for the individual concerned.
The personalisation agenda has been around for the best part of a decade now, but practices like this still go against its aims. Even if their mental capacity is diminished, people should still be given the dignity and respect they deserve, and helped to live out their days as well as possible.
Yes, it can be difficult to care and support people with dementia – especially those experiencing the advanced stages of the condition – but that is no excuse for taking the easy option. As mentioned, the best practice is out there, and training is available to give workers the skills they require to give the necessary support.
However, the old problem of funding now rears its ugly head. Many care homes – public and private sector – are run on very tight margins, which can mean staff are not put onto training courses, which are expensive and can mean periods away from the home.
It is time for government intervention to put the onus on care homes to stop using antipsychotics when there is no clinical need – and to insist that commissioners are clear on that requirement in their contracts. Proper sanctions for not adhering to this, such as fines or closure, need to be put in place.
But the government should also open up funds for care homes to access so they can provide the training that frontline staff require to give the best possible care and support to people with dementia so they don’t have to resort to using the drugs in the first place.
But I doubt that this will happen. The situation has gone on so long that it indicates there is neither the political, professional or public will to change this to any great degree. Which means that people with dementia will experience a poor end to their lives and the scandal will continue.