Antipsychotics are leading to the premature deaths of as many patients with dementia as those helped by the prescribed drugs, a senior geriatrician says.
Renewing a call for antipsychotics to be avoided as the first treatment for behavioural and psychological symptoms of dementia, President of the Australian and New Zealand Society for Geriatric Medicine (ANZSGM), Associate Professor Eddy Strivens, told YourLifeChoices the drugs were of little value to patients not suffering psychosis.
The drugs, which are strong tranquilisers, were designed to treat people with schizophrenia and bipolar disorder who largely experienced hallucinations or delusions.
Dementia patients displaying agitation or aggression may be reacting to an unmet need rather than showing symptoms of psychosis, Prof Strivens said.
“The ANZSGM wants to stimulate the conversation around reducing the use of antipsychotics because there is evidence linking them with a risk of increased morbidity,” he said.
“Often, a patient with dementia may be reacting to something in their physical environment and this is mistaken for psychotic behaviour.
“The patient may merely be precipitated by hunger, thirst, bright lights, constipation or side-effects of other medications.
“In some people, confusion can arise from having a salt or electrolyte imbalance in their blood, as is sometimes seen with diabetics or patients with thyroid problems.”
Prof Strivens believes that before antipsychotics are prescribed, a thorough assessment of the patient ought to be conducted by their GP or specialist.
“They need to look at the behaviour and decide whether it is a consequence of an unmet need,” he said.
“Then they can go about designing an alternative treatment involving person-centred care.”
Figures showing that prescriptions of antipsychotics had grown almost 360 per cent in the 24 years to 2016 have drawn criticism that Australian doctors are over-medicating patients with the strong sedatives.
“We believe they don’t work well and practitioners ought to consider non-drug interventions first,” Prof Strivens said.
Referencing a UK report by Professor Sube Banerjee, of London’s King’s College, he said that national leadership was required to begin rolling back the use of the drugs in nursing homes.
Restricting the use of anti-psychotics is one of a five-plank manifesto called Evolve that the ANZSGM supports.
According to the document: “People with dementia may exhibit aggression, resistance to care and other challenging or disruptive behaviours. In such instances, the modest effectiveness of atypical antipsychotics may be offset by the higher risks for adverse events and mortality. Non-pharmacological interventions can be an effective substitute for antipsychotic medications. Use of these drugs should therefore be limited to cases where non-pharmacologic measures have failed and patients pose an imminent threat to themselves or others.”
Do you think that prescribing antipsychotics to dementia patients can solve their behavioural issues? Who benefits most from these sedative drugs: the patients or their carers? Do you think prescribing antipsychotics should be more tightly regulated?
More than a decade after warnings were issued about doctors inappropriately dosing dementia patients with strong sedatives, it is astounding that they need to be reminded to stop this abhorrent practice, again.
Lately, the Australian and New Zealand Society for Geriatric Medicine (ANZSGM) has had to issue another alert that anti-psychotic drugs can precipitate the deaths of patients with dementia. When will practitioners supposedly caring for frail, elderly patients stop this abuse?
These patients are likely to be in residential care or hospitals. The peak body advocating for best-practice care of these patients is alarmed at the rampant prescription of antipsychotics. And we should worry, too, because there, but for the grace of God go all of us, at some future point.
Antipsychotics help patients with bipolar or schizophrenic disorders. The drugs ameliorate the downside of their delusionary thoughts. But if you do not suffer these psychological illnesses, then those medications will not ease your suffering. They may quell certain behaviours – agitation, aggression – but they will do nothing to address the underlying cause of distress, according to various studies. Some of those studies even suggest that they will pre-empt death, if a patient is misdiagnosed and improperly medicated.
Sadly, the unmet needs of patients with dementia are in many cases being ignored for the sake of the convenience of their carers and medical practitioners. Patients are being drugged into a pliable, stupefied state so that they can be “managed” more easily.
According to the ANZSGM, what practitioners ought to be doing is more closely examining why these patients are troubled. Prominent geriatricians are suggesting that these patients are expressing a frustration about their physical environments or uncontrollable bodily functions.
The organisation is pleading with those who care for frail, elderly patients to more closely examine the needs of this vulnerable cohort. They want to see better assessments, more non-drug therapies, treatments that focus on psychological remedies, and improved attention to the very personal needs of this growing demographic.
And let’s face it … more of us are going to end up in that category as modern medicine keeps some of our vital functions working while others deteriorate.
What our society needs is a more incisive look at how to manage dementia patients without stripping them of their last remaining cognitive abilities, and precipitating their deaths through the prescription of dangerous tranquilisers.
I’m calling out the Minister for Aged Care, Ken Wyatt, to do something meaningful with his responsibility towards elderly Australians. If he fails to address this growing problem, future generations may judge his ministry as responsible for the early demise of thousands of people.
What are you going to do, Mr Wyatt? Are you going to ban the automatic prescription of strong tranquilisers for patients with dementia? Are you going to mandate better assessment of how to meet the needs of the growing number of patients suffering from dementia? Tell us, Minister. Because if you call yourself the Minister for Aged Care, you better be doing something constructive for the vulnerable people you have been charged to advocate for.
(article updated 25/01/18 10.30am)