Rethinking antipsychotics and dementia

3 minute read

Weaning dementia patients off anti-psychotic drugs is unlikely to create mayhem, research shows


Anti-psychotics have next to no effect on symptoms such as aggression and agitation in most dementia patients, according to an Australian study.

A research team at the University of NSW found no significant change in the behaviour of 75% of patients in residential-care facilities whose antipsychotic medication was ceased.

Professor Henry Brodaty, Scientia Professor of Ageing and Mental Health at UNSW, said the results underlined a need for more focus on non-pharmacological strategies for managing agitated patients, and a shift towards more “person-centred” care.

“Certainly, the recommendation has been for some time that where people are on anti-psychotics for behavioural symptoms of dementia, they should be gradually reduced after about three months to see if they are still necessary, with the aim of trying to stop them,” Professor Brodaty said.

He said at least a quarter of patients in residential aged care were on anti-psychotic medications, which were associated with higher mortality and faster cognitive decline as well as side-effects such as parkinsonism and urinary incontinence.

The Halting Antipsychotic Use In Long Term Care (HALT) Project, conducted by the university’s Dementia Collaborative Research Centre, involved 139 patients at 24 residential-care facilities. The patients were assessed a month before ceasing the medications and reassessed after three, six and 12 months.

Most had been prescribed the medication after admission to long-term care, despite not having a primary psychotic illness or severe neuropsychiatric symptoms.

“What we’ve found is that about 90% come off their anti-psychotics, and about one-quarter are re-prescribed, presumably because their symptoms reverted.  But for three-quarters, they did not,” Professor Brodaty said.

“We looked at their behaviours and there was no change. They had the same levels of agitation, aggression, delusion, hallucinations – a lot of these things persisted, but the anti psychotic wasn’t doing anything for them.”

The HALT project relied on a “nurse champion” at each facility who identified patients for the study and helped train other care staff in alternative strategies for handling challenging behaviour.

Staff were asked to consider the cause of the behaviour in each patient, and tailor interventions to their needs. Depending on the person, this could involve the use of distraction, taking patients out to exercise, engaging them in music and activities, or a change of schedule.

Professor Brodaty said the results indicated a need for more education of care staff, who often pressured GPs to sedate noisy or unruly patients. This added to the problem of polypharmacy in aged-care settings.

“Often GPs are put upon by the nurses. They say, Mrs Smith is running into people’s rooms, she’s calling out, you have to do something, can’t you give her something?”

Although the study found most dementia patients could do without anti-psychotics, a percentage needed anti-psychotics because their behaviour posed a danger to themselves and others, he said.

Dr Richard Bills, a Victorian GP with an interest in aged-care, said he was cheered by the findings.

“They should empower GPs, that they are unlikely to create too much mayhem by weaning patients off anti-psychotics,” he said.

Professor Brodaty is presenting the research findings at the Alzheimer’s Association International Conference (AAIC) 2016 in Toronto, Canada, this week.

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