The use of antidepressants in the treatment of depression in people with dementia is ineffective, while those with mild to moderate behavioural and psychological symptoms of dementia (BPSD) should not usually be prescribed antipsychotics due to the increased risk of adverse events, according to Australia’s first clinical guidelines on dementia.

The first evidence-based guidelines to be officially endorsed, which provide 109 recommendations for health and aged care staff, will be launched by the Minister for Aged Care Sussan Ley today.

The guidelines highlighted the importance of “comprehensive role-appropriate dementia-specific training for health and aged care professionals” and re-affirmed the importance of individual care plans based on an understanding of the person with dementia gained by thorough assessment.

Aged care staff should identify, monitor and address environmental, physical health and psychosocial factors that can cause distressing BPSD, the guidelines stated.

People with dementia who develop BPSD should usually be treated using “non-pharmacological approaches in the first instance,” it said. Non-drug treatments that have some evidence to support their use, such as music therapy, are listed in the guidelines.

“People with Alzheimer’s disease, vascular dementia or mixed dementias with mild-to-moderate BPSD should not usually be prescribed antipsychotic medications because of the increased risk of cerebrovascular adverse events and death,” they stated.

The guidelines reaffirmed that care for people with advanced dementia should be based on a palliative approach and involve a palliative care service if indicated.

The guidelines, developed within the Cognitive Decline Partnership Centre (CDPC), were produced as part of the government’s Boosting Dementia Research Initiative.

Blueprint for training, approaches

Associate Professor Craig Whitehead, who was lead investigator of the guidelines’ development for the CDPC, told Australian Ageing Agenda that the fact there was now such a high-level position on the importance of staff training meant the aged care sector could examine its training regimes and match those against what the evidence showed was effective.

One surprising outcome was the lack of evidence for the use of antidepressants for the treatment of depression in people with dementia, Associate Professor Whitehead said.

“There are several very large studies that show they’re ineffective,” he said.

Given antidepressants were commonly prescribed in residential aged care, the guidelines’ recommendations were significant as “these drugs are not risk free.”

Conversely, there was some evidence for both carer interventions and staff interventions to help at a psychological level yet these were not as freely available or publicly funded, whereas prescriptions for antidepressants were supported through the MBS. “That was a really interesting conundrum,” he said.

Discussing the guidelines’ implementation, Associate Professor Whitehead said the CDPC was working with Alzheimer’s Australia, aged care partners and consumers to identify which recommendations should be focused on for the next phase of implementing them into practice.

The guidelines are available to read here

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  1. Is diazepam included in these drugs? I am convinced that my mother’s death was exacerbated by the use of diazepam to control her behaviour in a care home. The immediate effect was slurred speech, a changed gait and unbalanced. I was shocked that they used these and didn’t seem to care about the impact. After a month she had some sort of ‘brain event’ which I think was a stroke and she died within three weeks.

  2. Administrators and bean-counters please take note!

    The presence of skilled staff (and plenty of them) is the foundation for ethical care. Time to reevaluate the practices of under-staffing and hiring cheap. Your current M.O. is the antithesis of what our elderly require.

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