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Call for training on non-drug approaches to managing behaviour


Australia’s dementia peak body is calling for anti-psychotics to only be used as a last resort to manage dementia-related behaviours and training for aged care staff on alternatives to chemical restraint.

Dementia Australia has made five policy recommendations in a companion paper to new Australian Institute of Health and Welfare (AIHW) research it funded on dispensing patterns for anti-dementia medications.

The AIHW found that in 2016-17 almost a quarter of the 58,500 people on anti-dementia medications were also given an anti-psychotic (24 per cent) for the management of behavioural symptoms such as psychotic symptoms and aggression.

Most of those dispensed both types of medications were supplied the anti-psychotic Risperidone at least once (62 per cent) followed by Quetiapine (27 per cent), Olanzapine (15 per cent) and Haloperidol (11 per cent).

Anti-psychotics may have side effects such as dizziness, unsteadiness, sedation and symptoms similar to Parkinson’s disease such as shakiness, shuffling gait and stiffness, the report highlights.

Dementia Australia’s paper Medication use by people living with dementia recommends anti-psychotics only be used as a last resort.

Dementia Australia CEO Maree McCabe said the research demonstrated further evidence of inappropriate prescription of medications for people with dementia.

Maree McCabe

“Our focus must be on the delivery of the best possible care and quality of life at every stage of dementia,” Ms McCabe said.

“The use of anti-psychotic medications in the majority of instances is contrary to achieving these outcomes.

“There are many non-pharmacological interventions that must be considered as first line options when some of the challenging symptoms of dementia may present,” she said.

The paper recommends all staff working in aged care facilities receive high-quality training in dementia care with a focus on alternatives to chemical restraint to minimise the inappropriate and unnecessary use of anti-psychotic medications.

A new aged care regulation that came into effect on 1 July aims to limit the use of all restraints in aged care, however, many say it is the wrong apporach.

Public and consumer advocates, researchers and health profressionals from around the country raised human rights concerns over the regulation at a Parliamentary Joint Committee on Human Rights hearing in Sydney last week.

The say more needs to be done to prevent restraints and some are calling for working towards banning restraints altogether (read more here).

Polypharmacy

The AIHW research also found that more than three-quarters of people on anti-dementia medications were also provided cardiovascular system medications (77 per cent).

The next most common medications were those for the alimentary tract and metabolism (64 per cent) and anti-infectives for systemic use (62 per cent).

Dementia Australia said this was further evidence demonstrating the extent of polypharmacy in people with dementia and an increased risk of adverse effects.

It said a holistic approach to medication management was needed to ensure regular reviews were conducted.

Dementia Australia also recommends a review of anti-dementia medication usage patterns, regular multi-stakeholder medication reviews for people with dementia and a medication review following events such as falls or hospitalisations.

Read Dementia Australia’s paper here and the AIHW research here.

Dementia Australia released another paper last week in response to AIHW reasearch on hospital care for peopel with dementia it also funded, which you can read about here about here.

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