An analysis of studies that involved more than 23,000 people with dementia has found that sufferers do better without drugs.
The study authors, led by geriatrician Jennifer Watt, from St Michael’s Hospital and the University of Toronto in Canada, concluded that outdoor activities and massage were more effective in treating aggression and agitation in dementia sufferers.
They have called on policymakers to prioritise non-drug treatments for the behavioural and psychological symptoms of dementia.
The study comes in the wake of a presentation to the Royal Commission into Aged Care Quality and Safety that claimed antipsychotic drugs were overprescribed in nursing homes.
Chief medical officer Professor Brendan Murphy said doctors were under pressure from staff with real or perceived workload issues to prescribe drugs for agitated residents.
Dementia affects 50 million people worldwide with up to 75 per cent experiencing so-called neuropsychiatric symptoms, including aggressive behaviour, agitation and anxiety, according to scientific journal Cosmos.
Such symptoms generally lead to sufferers being placed into care at an earlier age as at-home carers struggle to cope.
Despite the fact that drugs such as antidepressants and antipsychotics can increase the risk of falls, broken bones and death, the authors noted that they continued to be prescribed at high rates.
Dr Watt said a lack of reliable data on the merits of drug and non-drug treatments for neuropsychiatric symptoms had hindered informed decision-making about treatment options and that head-to-head randomised controlled trials were required.
To fill the knowledge gap, Dr Watt’s team trawled a raft of databases to collect information for a multi-study analysis.
They reviewed 163 studies covering 23,143 people with dementia of at least moderate severity. The mean age of sufferers was over 70, with 65 per cent living in care.
For sufferers with aggression, the authors found that getting outdoors might be exactly what the doctor ordered, that “outdoor activities” – including gardening – were more effective than anti-psychotic medication in treating physical aggression, Cosmos reports.
They also found that massage and touch therapy were better than medicated treatments.
The authors believe the success of non-drug treatments could lie in the simple fact that aggression and agitation are not random manifestations of dementia, but signal an issue requiring attention.
“Non-pharmacologic interventions may be efficacious because behaviour has meaning, which needs to be uncovered through multidisciplinary assessments and care that addresses underlying needs,” they write.
The authors say more research is needed to clarify the relative cost-effectiveness of drug and non-drug treatments for dementia sufferers experiencing aggression and agitation.
However, they are adamant that carers must consider prioritising non-pharmacologic over pharmacologic interventions for aggression and agitation, given the potential harms associated with certain pharmacologic interventions.
Have you been a carer for a dementia sufferer? Was aggression an issue?
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