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Anti-psychotic drugs in dementia care and Medication in extra Care Housing

Antipsychotic prescribing in care homes before and after launch of a national dementia strategy

This study was produced jointly by five universities and drawn from prescribing data taken from more than 600 care homes across the UK between 2009 and 2012. It comes six months after the Prime Minister’s Challenge on Dementia 2020 targeted a 67% overall reduction in inappropriate prescription of antipsychotic drugs by 2019.

The research paper found no sustained reduction in antipsychotic prescriptions - used to regulate behavioural and psychological symptoms and also known as the ‘chemical cosh’ - to such patients in the four years following the government’s 2009 National Dementia Strategy. A report commissioned that year by the Department of Health as part of the Strategy recommended a review of their use, because of potential serious side effects - including death.

The report describes inappropriate antipsychotic prescription as a marker of poor care, and contrasts well-developed protections against physical restraint and deprivation of liberty with far sketchier ones when it comes to ‘chemical restraint’. As well as noting the overall persistence of antipsychotic drugs, it finds:

 

  • That older, less safe drugs are still being used extensively, rather than second-generation medications recommended by the NDS
  • That ‘excessive’ periods of prescription (lasting more than 12 weeks) rose from 69.7% of treatment courses in 2009 to 77% in 2012
  • That care homes in the highest-prescribing 20% were more likely to be in deprived areas
  • That care homes in the lowest-prescribing 20% were more likely to be served by a single GP.

The authors added that:

  • There needs to be a discussion about how to support care workers and clinical staff with training - they stated that “Some patients’ behaviour may be to do with pain they can’t articulate, not dementia, so can be treated with an analgesic instead.”
  • The frequent practice of patients staying with their individual GPs, rather than identifying one surgery to look after a care home, makes implementing a consistent prescribing policy across homes very difficult and should be looked at.

Medication in extra care housing

This factsheet is aimed at practitioners, commissioners, care service managers and housing managers in extra care housing. It highlights examples of practice, outlines areas for consideration by provider, sets out key lessons learned and provides a list of useful frequently asked questions.

The following practice areas are covered in the factsheet:

  • Safe Storage
  • Obtaining Medicines
  • Administration of Medicines
  • Monitoring and Record Keeping
  • Disposal of Medicines
  • Over-the-counter (OTC) and Homely Remedies
  • Side Effects and Contra-indications
  • Medicines Adherence Support
  • Consent and Choice
  • Staff Training