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Antipsychotic drug use by dementia patients may be underestimated
The scale of antipsychotic usage by dementia patients may be higher than previously estimated, posing a greater challenge to health care providers to reduce the number of deaths associated with the medication, according to recent study results. Approximately 1,800 annual deaths in the United Kingdom have been linked to their use, researchers said.
“The true scale of antipsychotic usage in dementia may be underestimated,” study researcher Ian Maidment, MRPharmS, MCMHP, said in a press release. “Usage may be up to 46% greater than official figures suggest.”
Maidment, a senior lecturer in clinical pharmacy at Aston University, and colleagues compared data collected from U.K. national registries, in which they identified dementia patients who were prescribed antipsychotic medication, with data they obtained from an intervention designed to reduce the frequency of antipsychotic prescriptions for dementia patients. Fifty-nine primary care practices were targeted by the intervention.
Results showed that 15.3% of patients with dementia received an antipsychotic vs. 10.5% in the national audit. However, the researchers noted that a significantly greater percentage of practices participated in the present study compared with the national audit. Dementia patients residing in assisted living facilities were almost 3.5 times more likely to receive an antipsychotic than those living in their own homes (P<.0001). The intervention was able to reduce antipsychotic prescriptions by 61.4%.
The most common type of antipsychotic prescribed to dementia patients was amisulpride (32.3%), followed by risperidone (Risperdal, Janssen; 23%).
The researchers said the intervention was successful on a small scale, but that further research is required to sufficiently reduce antipsychotic prescriptions on a national level. Based on these data, clinicians should also focus on dementia patients in assisted living facilities.
“Whilst the national audit is an important step, it presents a partial picture,” Maidment said. “If we rely on it, exclusively we are doing a disservice to people with dementia, their [caretakers] and their families.”
Disclosure: Maidment and study researchers Chris Fox and Anne Child have been consultants for pharmaceutical companies marketing psychotropics.
Perspective
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The BMC Psychiatry article by Child et al makes several thought-provoking points.
An increased incidence of deaths for dementia patients on antipsychotics is certainly concerning and not consistent with primum non nocere.
While 15.3% of dementia patients on their dementia registry were on low-dose antipsychotics, the actual number of patients may be greater, as the use of antipsychotics in dementia patients may be underestimated due to undiagnosed or underdiagnosed dementias and limited study participation. We do not necessarily know the true numbers of patients affected.
An interesting difference noted in the study was the 25.5% rate of antipsychotic treatment in dementia patients in care home residents compared with 7.3% of patients living at home. It may be that patients were institutionalized due to behavioral issues or perhaps due to the severity of the dementia. The increased rate of antipsychotic use in institutionalized dementia patients may also be related to the constraints of staffing and availability of behavioral interventions.
It is suggested in the article that the “person-centered approach” training for the care providers was an adequate and successful alternative to medication treatment for these patients. Providers must be more cognizant of antipsychotic use in our dementia patients and must find cost-effective alternatives for the difficult-to-treat dementia patients with behavioral issues.