Half of dementia residents take antipsychotics, considered risky and ineffective

Embargoed until: Publicly released: 2021-06-25 00:00

New Zealand

Unsplash / Christina Victoria Craft

Almost half of 271 older people in long-term dementia care are on antipsychotic medication - and more than one in five are prescribed a sedative - finds a New Zealand study from the Waikato. It also reveals the dosage wasn’t reviewed often enough to meet guidelines. These practices go against the research evidence, which shows both antipsychotics and sedatives have low effectiveness - and raise risks - in dementia. The authors say the high use is concerning, and more regular prescribing reviews, and upskilling of staff, is needed.

News release

From: New Zealand Medical Association (NZMA)

Key Points

· The prescription of antipsychotics in the general New Zealand population aged 65+ years has continued to increase in the last decade and remains high in aged residential care.

· Despite the increasing evidence around the relatively poor efficacy and increased risks associated with antipsychotic and sedative prescription in individuals with dementia, this study shows the use of these medications in dementia care and psychogeriatric facilities remain high, with 48.2% of residents in this study currently prescribed an antipsychotic and 22.1% prescribed a sedative.

· Furthermore, less than 20% of those prescribed an antipsychotic or a sedative had the most recent dose change occur within the 12 weeks recommended by guidelines, with over 30% of those prescribed an antipsychotic and 48% of those prescribed a sedative not having their dose adjusted for over a year.

· With clear evidence of the risks of antipsychotics in dementia, the proportion of residents prescribed an antipsychotic or sedative in this study, in conjunction with the prolonged duration of prescription, is cause for concern and needs addressing."

Summary

This study aimed to quantify the use of antipsychotic and sedative medications in residents with dementia in long-term care facilities in the Waikato and identify factors associated with the prescription of these medications. Despite the increasing evidence around the relatively poor efficacy and increased risks associated with antipsychotic and sedative prescription in individuals with dementia, this study shows the use of these medications in dementia care and psychogeriatric facilities remains high, with 48.2% of residents in this study currently prescribed an antipsychotic and 22.1% prescribed a sedative. Furthermore, less than 20% of those prescribed an antipsychotic or a sedative had the most recent dose change occur within the 12 weeks recommended by guidelines, with over 30% of those prescribed an antipsychotic and 48% of those prescribed a sedative not having their dose adjusted for over a year. With clear evidence of the risks of antipsychotics in dementia, the proportion of residents prescribed an antipsychotic or sedative in this study, in conjunction with the prolonged duration of prescription, is cause for concern and needs addressing.

Journal/
conference: New Zealand Medical Journal

Organisation/s: University of Auckland, Waikato District Health Board

Funder: This research was funded by a summer studentship research grant from the Waikato Clinical School, University of Auckland. The authors would like to thank the participating aged residential care facilities for their involvement.

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