Alzheimer’s Australia report shows misuse of psychotropic medications in people with dementia
First published 26 March 2014, I felt this was worthy of blogging about again as a reminder to us all, as only yesterday heard from a clinician in aged care it was ok to use them.
Up to 80% of people with dementia and nearly half of people in residential aged care facilities are receiving psychotropic medications that in some cases are inappropriately prescribed, a report released today by Alzheimer’s Australia has revealed.
The report, The Use of Restraint and Psychotropic Medication in People with Dementia, provides an evidence-based review of the prevalence of the use of restraint, and the potential negative consequences and legal issues surrounding the use of psychotropic medication and physical restraints in people with dementia.
Ita Buttrose, who was then the National President of Alzheimer’s Australia, said that the report raises concerns that in many cases psychotropic medications and physical restraints are the first line of response to the challenging behavioural and psychological symptoms of dementia (BPSD).
“International data suggests that only 1 in 5 people with dementia receive any clinical benefit from these medications,” Ms Buttrose said.
“We must ensure that the basic rights of a person with dementia are respected. Clinical guidelines indicate that psychosocial approaches should be considered first, including person-centred care and recreational therapies,” Ms Buttrose said.
The key points of the report at a glance:
• The prevalence of physical restraint in aged care facilities varies and evidence suggests prevalence ranges from 12–49%.
• Physical restraints can have a range of adverse psychological and physical effects. Research has shown that overall physical restraints do not prevent falls and may in some cases cause death.
• There are some situations in which it may be appropriate to use physical restraint for a short period of time, but clinical guidelines indicate that physical restraints should always be an intervention of last resort.
• There are a wide range of environmental, strength-promoting, surveillance and activity-based alternatives to using restraints.
• It is best practice to ensure that consultation takes place with the carer and/or legal representative prior to the decision to apply restraint. In an emergency situation this may not be possible immediately but should be done as soon as possible. Jurisdictional variations in guardianship legislation govern the roles of proxy decision-makers in giving consent to restraint on behalf of people unable to give informed consent themselves.
• About half of people in residential aged care facilities and up to 80% of those with dementia are receiving psychotropic medications, although this varies between facilities. There is evidence to suggest that in some cases these medications have been prescribed inappropriately.
• BPSD although variable in severity are common and affect almost all people with dementia sometime during their illness. They have a range of physical, environmental and psychosocial causes.
• The evidence supporting the effectiveness of psychotropic medications in treating BPSD is modest at best, with some support for atypical antipsychotics. International data suggests that up to 20% of people with dementia who receive antipsychotic medications derive some benefit from the treatment.
• Psychotropics have a range of serious side effects and are associated with increased mortality for people with dementia.
• Psychotropics are best used where there is severe and complex risk of harm, when symptoms are psychotic in nature, when psychosocial interventions have been exhausted or when there are comorbid pre-existing mental health conditions.
• Experts recommend that psychotropic medications be used for a limited period only, with regular review regarding possible discontinuation at least three-monthly.
• Expert consensus guidelines recommend the use of multidisciplinary, individualised psycho-social approaches as a first line approach to behavioural symptoms of dementia. There are a range of psychosocial and caregiver interventions that have evidence-based support. Best practice for BPSD treatment is comprehensive, individualised assessment in order to provide person-centred care, with family and professional caregiver education and support.
• Informed consent for use of psychotropic medications should be obtained from the person themselves where possible. Alternatively, if the person is unable to give informed consent, then consent should be obtained from a substitute decision-maker.
Key recommendations are also available in the report.