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Care home dementia study finds failure to reduce antipsychotic prescribing

  • Research reveals no decrease despite ‘National Dementia Strategy’ guidance

Despite government guidelines there has been no reduction in the level of antipsychotic drugs prescribed to dementia patients.

The finding follows the government’s 2009 National Dementia Strategy (NDS), which recommended a review of the medication’s use in light of potential serious side effects.

The research was conducted by a group of academics including Dr David Owen from the University of Warwick and published in the medical journal BMJ Open.

The examined prescribing data between 2009 and 2012 from over 600 care homes2 across the country, concluding that there was no significant decline in antipsychotic prescribing rates over the four year period.

Dr Owen from the University of Warwick’s Institute for Employment Research said: “Antipsychotics were originally developed for use in patients with schizophrenia or psychosis, but our study shows that ‘off-label’ prescribing of these drugs to treat the behavioural and psychological symptoms of dementia is a common practice in care homes.”

The 2009 ‘Banerjee Report’4, commissioned by the Department of Health as part of the NDS, examined the use of antipsychotics for people with dementia, concluding that the drugs had a “substantial clinical risk” associated with them and that their overuse “must not be allowed to continue”.

However, researchers from the universities discovered that – although dosages were usually acceptable – prescribing levels did not reduce over the four years, and length of treatment was ‘excessive’ in over 77% of cases by 2012, up from 69.7% in 2009 (meaning it exceeded not only the recommended six week course, but also the maximum advised treatment length of 12 weeks).

Findings from the study also indicate that older first-generation antipsychotics (FGA) such as haloperidol and chlorpromazine are still being used extensively, with no measurable shift to safer second-generation antipsychotics (SGA) like risperidone – as recommended in the NDS.

According to the research, which was carried out by Coventry University; University of Warwick; Lancaster University; University of East Anglia; City, University of London; and technology company Invatech Health:

§ care homes in the highest prescribing 20% are more likely to be located in a deprived area5;

§ care homes in the lowest prescribing 20% are more likely to be served by a single GP practice, which could indicate that those homes benefit from a consistent message that is absent from homes served by multiple practices;

§ average annual expenditure on antipsychotics was £65.60 per care home resident (based on 2012 prices), which is less than 1% of the annual cost of a UK residential home place for a person with dementia6;

§ there was a six-fold variation between the geographical areas – in this case the areas covered by the former primary care trusts (PCT) – with the highest and lowest prescribing levels.

The study was led by Professor Ala Szczepura at Coventry University’s Centre for Technology Enabled Health Research, who said: “Care homes remain the forgotten sector in UK policy debate around the use of antipsychotics. This appears to be due to a lack of systematic monitoring of prescribing data in these settings. Our study has not only identified a failure of the National Dementia Strategy to produce a sustained decrease in use of antipsychotics, it’s also shown large regional variations and has found evidence indicating that their use is higher in care homes in deprived neighbourhoods.

22 September 2016

NOTES TO EDITORS

1 All-Party Parliamentary Group on Dementia (2008). Always a last resort. London: Alzheimer’s Society.

2 Prescribing patterns from 616 care homes (31,619 residents) were analysed.

3 ‘Off-label’ prescribing is legal in clinical settings. Risperidone is the only antipsychotic that can be prescribed ‘on-label’ in the UK for the treatment of the behavioural symptoms of dementia.

4 Department of Health (2009). The use of antipsychotic medication for people with dementia: Time for action. A report for the Minister of State for Care Services by Professor Sube Banerjee.

5 Deprived areas have been defined in this release as those amongst the 10 per cent most deprived in England according to the overall Index of Multiple Deprivation. SOURCE: Department for Communities and Local Government (2011). The English Indices of Deprivation 2010.

6 Joseph Rowntree Foundation (2008). Calculating the costs of efficient care homes.

7 Department of Health (2016). Challenge on dementia 2020: implementation plan. March 2016.

“Looking forward, the Prime Minister’s challenge on dementia 2020 aims to further slash inappropriate prescribing of antipsychotics by 67%, and reduce variation across the country7. It’s clear from our research that to achieve this in care homes, a significant change is required in prescription culture and management of vulnerable people with dementia.”

Contact:

Nicola Jones, Media Relations Manager

T: 07920531221

E: N dot Jones dot 1 at warwick dot ac dot uk