Care group halves antipsychotic drug use within three months

Within three months a care home group has halved the number of antipsychotics drugs for its dementia residents and reduced drugs use by a third for residents who have more general challenging behaviours.

The new trial led by an Admiral Nurse working at Colten Care has put more emphasis on non-pharmaceutical interventions, which the care group believe could potentially “save thousands of lives” if applied nationally.

In their approach they have employed ‘psychosocial’ interventions in place of antipsychotic drugs for those who displayed challenging behaviours, reserving medication for areas of care, such as palliative care, where is has been seen to be most effective.

‘Here’s a tablet that will help’

Across their group of 20 homes clinicians at Colten Care sought to use alternative first-line responses for distress, anxiety, aggression, apathy, nausea, low moods “or other complex behaviour that carers can find challenging”.

Admiral nurse Kay Gibson, who led the initiative, said: “The results have been truly spectacular”. She went on to say: “By taking a non-pharmacological approach, we have cut the use of antipsychotics by half in our dementia-specific settings and by a third across the whole group.

“Nationally, the number of antipsychotic prescriptions that could be reduced with appropriate support will obviously vary by setting but, based on our experience, alternative approaches can make a big difference and potentially save thousands of lives.”

At the beginning of a 3-month trial, 64 residents were being routinely prescribed antipsychotics among nearly 260 people living in five dementia-specific care settings. Now, exactly half are receiving the drugs.

For those with a variety of conditions across all 20 homes there were 97 residents using the medicines, and now there are only 65.

The trial started with observations before a framework could be established, as Ms Gibson explains. She said: “I initially worked with colleagues to check the evidence base for intervention, clinical supervision and monitoring of nurses, and devised a short observational inspection framework.

“Instead of saying ‘here’s a tablet that will help’, we have put much more store on personal interaction, activities, talking and working one-to-one with the resident to encourage feelings of wellbeing and purpose.”

Psychosocial therapies on offer include the input of a dedicated music and arts partner who stimulates residents’ creativity and imagination through singing, playing music, drama, poetry, storytelling, dance and active listening.

1,800 deaths a year through misuse of antipsychotics

There are 850,000 people with dementia in the UK, with numbers set to rise to over 1 million by 2025, according to the Alzheimer’s Society.

Despite widely known risk factors, around 180,000 people in England with dementia are treated with antipsychotics every year; use at this level is thought to equate up to an additional 1,800 deaths a year, according to the findings of Colten Care.

A recent study by Exeter University, Kings College London and Oxford Health found that additional dementia training for care home staff increased social interaction for residents; it also stipulated that reviewing the use of antipsychotics could reduce resident mortality by an estimated 36 per cent, saving up to 20,000 lives a year.

According to the study report, which was published in PLOS Medicine in February of this year: “Agitation is a common, challenging symptom affecting large numbers of people with dementia and impacting on quality of life. There is an urgent need for evidence-based, cost-effective psychosocial interventions to improve these outcomes, particularly in the absence of safe, effective pharmacological therapies.”

Dr Sara Imarisio, Head of Research at Alzheimer’s Research UK explained: “People with dementia can experience severe agitation that can be distressing for those living with the condition as well as carers and loved ones. There is a lack of safe and effective treatments for the behavioural symptoms of dementia and a desperate need for new ways to help those affected.

“Just like any one of us, people with dementia benefit from social engagement and this study highlights how approaches to dementia care that include a social element can have a positive effect on quality of life and help to limit symptoms like agitation.

Audit and review

Review of ongoing medication has been a large part of the initiative. Many residents can be taken off of unnecessary drugs over time just by being reviewed regularly to see if their conditions have changed. As Ms Gibson explains: “Even though an antipsychotic may have been necessary at a particular time, if treatment is not reviewed appropriately then someone could remain on an antipsychotic prescription for a long time.”

She continues: “This can be problematic as someone living with dementia might only receive therapeutic benefit in treating or managing these symptoms for a limited period and even worse, go on to experience potentially harmful side effects.

“I’m really proud that through our auditing, monitoring and alternative approaches, we have safely reduced the use of antipsychotic medicines in our homes.”

Ms Gibson is to present her findings to Dementia UK’s annual Admiral Nurse Forum at Nottingham University, 17-18 September 2018.

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