Aged care providers and clinical teams need to ensure the prescribing of antipsychotics to people with dementia includes a plan to discontinue the drugs, a dementia expert tells Australian Ageing Agenda.

Dementia Centre director Associate Professor Colm Cunningham and Dementia Centre head of clinical services Associate Professor Stephen Macfarlane co-authored an article published on Monday calling for routine deprescribing plans for people with dementia on antipsychotics.

The article published in the Australian Prescriber aims to reduce the use of antipsychotic medications, and for those who are in charge of care, to help with their decision making.

Associate Professor Cunningham said antipsychotics were often used inappropriately with this cohort.

Colm Cunningham

“It’s being used as a frontline approach to behaviours and psychological symptoms and dementia, yet antipsychotic drugs are not actually meant to be the first primary approach,” Associate Professor Cunningham told AAA.

He said research showed that up to 44 per cent of Australia’s aged care residents were on antipsychotic drugs despite estimates that only 10 per cent of this prescribing was appropriate.

Associate Professor Cunningham said if a person from the public went to the doctor with an issue, it would be a process of administering a medication, reviewing the impact and deciding what the next step is.

“With antipsychotics, people often go on it before being moved into residential care because things are changing and when they move into care, they are increased further and often not reviewed. Yet they wouldn’t do that for the general population,” he said.

Associate Professor Cunningham said deprescribing plans were important to better manage and limit the use of antipsychotics as well as to provide an opportunity to try non-drug strategies.

The aged care provider’s clinical lead, general practitioner and specialist psychogeriatrian should all be involved in planning and implementing deprescribing plans, he said.

He said antipsychotics do not treat some of the condition behind the prescription and most behaviours stop within several months regardless of the prescription of antipsychotics.

Step-by-step support

The article includes a deprescribing algorithm to support clinical teams to review a resident’s antipsychotic use and make an informed decision about whether to stop, continue or monitor.

“The importance of the algorithm is thinking about how we’re assessing, not responding to a one-off event,” Associate Professor Cunningham said.

There is a strong expectation for aged care providers in Australia to demonstrate they are using deprescribing plans, but that should not be the sole reason they are using them, he said.

“The primary reason should be in tailored personalised care and it should always be something that they are regularly reviewing,” Associate Professor Cunningham said.

“Antipsychotic use in Australia is too high. And we have to work together at reducing it and when using it.”

The Dementia Centre is releasing a podcast on Thursday, which includes Associate Professor Macfarlane talking about the key issues related to antipsychotic medications and people with dementia.

Access the Limiting antipsychotic drugs in dementia article here.

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1 Comment

  1. I think one of the biggest issues in aged care is because there are no appropriate nurse to resident ratios some nurses think it is appropriate to get a resident drugged up so that they are much more easily controlled. It’s not ethical!

    i also think they forget that elderly people are still people so if they are wondering put them on the toilet because chances are they simply want to find the toilet. Do this before they slip in their own urine. Give them food, drink and if necessary pain relief and try and find something to keep them distracted before asking a Doctor to prescribe something for a supposing wandering and difficult resident.

    Doctors too must ask staff, if they have honestly tried all this and really there should be some appropriate paperwork to prompt nurses to do all these things, before a Registered Nurse approaches a Doctor to ask them to prescribe something to settle down a resident.

    No elderly person should be drugged unncessarily.

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