True scale of anti-psychotic usage in dementia may be under-estimated

The scale of the challenge to reduce the use of anti-psychotic drugs by people with dementia may be under-estimated, according to researchers from Aston University and the University of East Anglia, working with NHS Kent and Medway. There is a key public health challenge to reduce the prescribing of anti-psychotic drugs to people with dementia as they are thought to be associated with up to 1,800 deaths a year.

Ian Maidment, corresponding author and a Senior Lecturer in Clinical Pharmacy from Aston University has worked in medication management in dementia for 20 years states: 'The true scale of anti-psychotic usage in dementia may be under-estimated. Usage may be up to 46% greater than official figures suggest.'

The researchers compared the results of the government's National Dementia and Anti-Psychotic Prescribing Audit with research, led by Anne Child, an experienced senior clinical pharmacist for NHS Kent and Medway cluster of primary care trusts (PCTs). They found that 15.3% of people with dementia received an anti-psychotic, compared to the national audit, which found 10.5%. However, only 48.9 per cent of GP practices across the country participated in the national audit compared with 98.3 per cent of practices in Medway which took part in the detailed local study.

The Medway project, carried out from January to December 2011, and analysed by researchers from Aston University and the University of East Anglia, identified that

·People with dementia living in care homes were nearly 3.5 times more likely to receive a low-dose anti-psychotic than people living at home (25.5 per cent compared to 7.3 per cent)

· It was possible to reduce or withdraw low-dose anti-psychotics for more than 60 per cent of patients with dementia (43 out of 70) whose medication was initiated by their GP.

 · Clinical trials need to be commissioned as a matter of urgency to confirm the effectiveness of pharmacist medication reviews.

The paper, which appears in the BioMed Central's open access journal BMC Psychiatry, also sets out the detailed process undertaken before and during withdrawal of anti-psychotics from patients.

Anne Child, primary author, who is now Head of Pharmaceutical Care at Avante Care and Support said: 'We have demonstrated that a multi-disciplinary approach to dementia care, involving a pharmacy-led medication review, GPs, and care homes, can produce a positive outcome for patients, in one region of the country. More work is now needed.'

Dr Chris Fox, co-author, from UEA's Norwich Medical School said: 'Another issue with the national audit is it fails to report the usage of the drug lorazepam, which is sometimes used instead of anti-psychotics. It is potentially equally dangerous. Until we capture the true level of usage of all these drugs we cannot truly understand the issue.'

Ian Maidment added: 'Whilst the national audit is an important first step, it presents a partial picture. If we rely on it, exclusively we are doing a disservice to people with dementia, their carers and their families.'