More than 5000 dementia patients in Scotland are being prescribed controversial “chemical cosh” drugs that may be putting their lives at risk. Helen Puttick, Health Correspondent, Herald Scotland reports:
A major study has found that one in six sufferers are on antipsychotic medication, which can have a strong sedative effect and has also been shown to triple their risk of having a stroke.
There is a persistent fear among relatives and some experts that the drugs are used purely to keep patients subdued, particularly in nursing homes.
Henry Simmons, chief executive of charity Alzheimer Scotland, said the figures were a shocking indictment of the care given to people with dementia”.
He added: “We must bring an end to this horrific practice and to the lack of alternative, humane approaches to caring for this most vulnerable and disempowered group.”
Antipsychotic drugs are mainly intended to treat people with schizophrenia and similar mental illnesses. Dementia patients can suffer the symptoms they are designed to ease, such as aggression, agitation, sleep disturbance and delusions.
However, multiple studies have warned that elderly people with dementia are at risk from serious and life-threatening side-effects when treated with antipsychotics. A review commissioned by the department of health in England found they caused about 1800 deaths a year – 1% of the total number of dementia patients it estimated were on the treatment.
Professor Bruce Guthrie, an expert in primary care medicine at Dundee University, examined the rates of antipsychotic prescribing in 315 Scottish GP practices as part of official NHS research into the quality and safety of patient care.
He found 17% of patients with dementia were currently receiving an antipsychotic and 12% had been taking the same drug for more than six months.
Guthrie, whose findings are reported in the journal Age and Ageing, said the level of use was higher than he expected and concerning.
Trials, he said, showed the drugs only had a small impact on reducing disturbed behaviour in dementia patients and were clearly harmful.
However, he stressed he did not feel the drugs were prescribed maliciously but instead helped both family carers and care home staff to manage very difficult situations.
He said: “If family carers are at breaking point, if they cannot get support, or if professional carers are working in under-staffed conditions then I can understand why prescribing becomes something that is done because it is do-able.
“The real question is, if we are going to not use these drugs, is there going to be any investment in supporting carers – both relatives and professionals? We should not underestimate just how hard a job it is being a care assistant in a nursing home when there are a lot of older people with dementia.”
Guthrie’s research is based on data from 2007, but he said there was no evidence levels of prescribing had changed.
The Westminster review said four out of five dementia sufferers given antipsychotics should not be taking the drugs and a target was set in England to reduce use by two-thirds in three years. Scotland has a new dementia strategy that says the drugs should only be given as a last resort.
There are 71,000 people in Scotland with dementia, according to Scottish Government figures, and the number is expected to double in the next 25 years. The criteria used by Dundee University to determine which patients in their sample had dementia were very specific and the study therefore underestimates the number of sufferers.
Ranald Mair, chief executive of Scottish Care, which represents care service providers, admitted there had been over-use of psychoactive drugs among dementia patients, but stressed that doctors rather than care home staff prescribed the medication.
Mair said: “The issues that are being identified by the Dundee study have been well identified and we are in the process of addressing those. We are further on than we were.
“We do have a published strategy from the Scottish Government. We do have acknowledgment of the issues and there are attempts to improve practice around this issue.”
‘She was comatose when on the drug’
CASE STUDY:
When Iris McIntyre returned from holiday she found her 86-year-old mother, Marion, had been prescribed a new drug.
She decided to research details of the antipsychotic medication on the internet and was immediately concerned.
Numerous different studies have warned the drugs carry health risks, including strokes and heart problems.
She was worried her mother, who has angina, had not been given an ECG to check her heart before she started taking the treatment.
It was, she said, a community psychiatric doctor – rather than her usual GP, whom she holds in high regard – who had written the prescription.
Iris said: “I have campaigned for weeks and weeks to get my mother off it.”
Originally from Lanark, Marion was a land girl who started her own milk business when she was 21 in Partick.
During the last two years her health has declined, and she was diagnosed with dementia in November last year.
Iris, a businesswoman, strived to look after her mother, who she describes as a kind and loving person, staying with her several days a week and taking her on holidays.
But she has also suffered ill health and took a break while Marion entered respite care.
It was then, she said, that her mother was put on the drug.
Iris, who lives in Auchterarder, said: “I felt it made her very sleepy and her behaviour was odd. When I took her out in the car she used to be quite alert. When she was on the drug, she was comatose, sound asleep.”
Her mother is no longer on the treatment, but Iris is concerned drugs are used to keep people with dementia sedated.
The facts about antipsychotics
Antipsychotic drugs are mainly used to treat conditions such as schizophrenia, addressing a range of symptoms including agitation, severe anxiety and violent behaviour.
They work by increasing or reducing the effects of natural chemicals in the brain, which regulate mood, behaviour and sleeping patterns.
The Medicines and Healthcare products Regulatory Agency, the government agency responsible for ensuring medicines work and are acceptably safe, says elderly people with dementia are at risk from serious side effects when treated with antipsychotics.
Only one type, risperidone, is licensed for treatment of dementia-related behavioural disturbances in the UK.
Nevertheless the medicines are used to treat patients with dementia who are being looked after by relatives, hospitals and care homes.
