Attitudes against drug use in dementia care harden
LONDON: Non-drug treatments for people with dementia in nursing homes deliver significantly better outcomes for improved quality of life than pharmacological interventions, a world-first dementia study reveals.
Yet up to 48 per cent of the more than 100,000 aged-care residents living with dementia in Australia are being prescribed anti-psychotic drugs, despite them being considered a treatment of last resort, the report says.
More than half of those prescriptions have been found to be potentially inappropriate, raising questions about whether they are a form of “chemical restraint”.
The world’s largest population-based study of dementia behaviour looked at almost 6000 Australians living with dementia across 2000 nursing homes, finding almost all behaviours and psychological symptoms of dementia could be helped by non-pharmacological treatments.
The residents deal with symptoms such as agitation, aggression, anxiety, delusions, hallucinations and disinhibition.
Interventions such as cognitive stimulation, activity planning and encouraging reminiscence, occupational therapy, aromatherapy and music therapy delivered substantially better results than pharmaceuticals, the study found.
Using an internationally accepted measure of dementia behaviours known as Neuropsychiatric Inventory, it found non-pharmacological interventions reduced NPI scores by between 61 and 74 per cent, and were side-effect free.
Anti-psychotic medications reduced NPI scores by an average 8 per cent.
The study, Evaluating the Clinical Impact of National Dementia Behaviour Support Programs on Neuropsychiatric Outcomes in Australia, will be published in the Frontiers in Psychiatry journal this week.
“Non-pharmaceutical treatments for nursing home residents with dementia have been recommended for years, but this study shows that the impact of those interventions dwarfs that of antipsychotics,” associate professor Stephen Macfarlane, head of clinical services at Dementia Support Australia and the report’s lead author, said.
“It is real evidence of what should get traction in the future in terms of treatment options, but the majority of aged-care residents with dementia are still prescribed antipsychotics.
“They are being wildly overprescribed.
“Estimates are that only 10 per cent of this prescribing is appropriate,” Dr Macfarlane said.
“It is often the case there is a lack of efficacy and high rates of adverse effects, including falls, sedation and death.”
He said the main reasons aged-care residents weren’t provided with appropriate non-pharmacological therapies were a lack of investment in care staff and a lack of understanding of dementia by medical professionals.
“Aged-care staff are stretched at the best of times and they are under-trained for the complexities of offering these therapies, even if they have the time, which they don’t,” Dr Macfarlane said.
“Doctors are taught very little about dementia while they study, and GPs do no extra training in the field. Doctors are generally called on to prescribe, so that’s what they tend to do.”
Mike Baird, chief executive of aged-care provider HammondCare, said the study was a “game changer” for how dementia should be treated in residential aged-care services.
“The evidence is in that for the overwhelming number of people living with dementia … the best approach is tailored psychosocial care strategies,” he said.
