Drugs for elderly: More than one in 10 residents of nursing homes and long-stay units for the elderly are receiving inappropriate medication to deal with the symptoms of dementia, new research has found.
The study of 345 residents living in extended-care units in the west of Ireland found that of the 80 patients prescribed regular anti-psychotic medication, some 41 (51 per cent) were receiving the drugs inappropriately.
Residents living in private nursing homes were more likely to receive inappropriate anti-psychotic medication than those residing in public facilities.
Anti-psychotic drugs, also known as major tranquillisers, are primarily used to treat schizophrenia, severe depression, bipolar disorder and other causes of psychotic behaviour. Using the drugs to treat restlessness, wandering and the intermittent aggression found in some patients with dementia is considered inappropriate.
Anti-psychotic medications are relatively ineffective in managing problem behaviours in dementia. And in terms of side effects, they are known to increase the risk of stroke in a patient group already at risk of cardiovascular problems.
Dr Jean Murphy, a GP registrar with the Western General Practice Training Programme; Dr Shaun O' Keeffe, consultant geriatrician at Merlin Park Hospital, Galway; and Dr Liam Glynn of the department of general practice, National University of Ireland, Galway, collected prescribing data from three public and four private extended-care units over a three-month period last year.
They found no difference in the frequency of dementia or in the use of anti-psychotic drugs between residents of public and private units.
But when the researchers applied US guidelines to detect the inappropriate use of anti-psychotic drugs, they found that 41 of the 345 patients received unsuitable medication for the treatment of dementia.
Among the reasons given for using anti-psychotic drugs inappropriately were restlessness, patients being prone to wandering, and intermittent aggression from patients.
Other questionable uses of the major tranquillisers, which include the drugs haloperidol, respiridone and olanzapine, were in patients who were calling out, shouting or spitting.
Asked if legislation similar to that introduced in the US was now needed to tackle the problem, Dr Murphy said: "I feel guidelines would be more helpful than legislation. If guidelines were put in place to advise doctors on how to approach and manage this difficult patient group, I believe they would be welcomed by all who work in the area."
The authors also called for increased access to specialist geriatric and psychogeriatric services. "I feel increased input from psychogeriatric specialists would help to decrease inappropriate prescriptions. They could advise on alternative medications or if an alternative diagnosis, like depression, should be considered," said Dr Murphy.
"Anti-depressants or a short course of benzodiazepines could be considered as alternatives to prescribing anti-psychotic medication [in people with dementia]. Behavioural interventions such as relaxation therapy or meditation may also be helpful."
Behavioural problems are common among patients with dementia. Almost two-thirds of those with the condition have one or more neuropsychiatric symptom, including apathy, depression, irritability, agitation and delusions.