Trial halts sedation of dementia patients

Australian researchers have successfully decreased the use of antipsychotics among a trial group of dementia patients in NSW nursing homes.

Witnessing a person gradually lose themselves to dementia is very distressing and when their behaviour becomes erratic and often aggressive many are treated with antipsychotic medication.

Sedating dementia patients with antipsychotics to control troubling behaviours is not always necessary and causes serious side effects, many experts in the field argue.

Worried about the "systemic sedation" of dementia patients within Australian nursing homes, a team of researchers from the University of New South Wales developed a new project to halt the use of antipsychotics in long term care.

Early results, presented at the Alzheimer's Association International Conference (AAIC) 2016 in Toronto on Monday, have been encouraging, according to Professor Henry Brodaty.

The Halting Antipsychotic use in Long Term Care (HALT) Project successfully eliminated regular antipsychotic medication from the treatment plan in 75 per cent of study participants after six months, said Prof Brodaty.

A patient follow up will be held at 12 months.

De-prescription was achieved through training nurses, dubbed 'Nurse Champions', in person-centered approaches to managing behavioural and psychological symptoms of dementia (BPSD).

Out of the 140 residents involved in the trial from across 243 nursing homes, cessation of antipsychotics was achieved in 90 per cent of the patients.

Of those, 25 per cent went back on the drugs afterwards, suggesting that 75 per cent didn't need them.

Prof Brodaty says the early findings point to the inappropriate use of antipsychotics.

"There's no point of de-prescribing if behaviours of concern re-emerge and in fact we found no difference in the level of behaviours after de-prescribing the anti-psychotics," said Prof Brodaty.

Antipsychotics are known to cause sedation and increase mortality. Other side effects include increased risk of fall, constipation and stroke.

There are still a proportion of people with dementia that do benefit from medication but before reaching for the prescription pad as a "knee-jerk" reaction, alternatives strategies should be looked at first, Prof Brodaty said.

The fact is, he said, there could be a number of reasons why a person with dementia starts yelling or becomes aggressive and the key is to find out what the behaviour is communicating.

It may be that a male patient with dementia is upset that the person taking him into the shower every day is a woman and they would prefer a man to do it, and vice versa.

Or it could simply be that their spouse has gone on holiday and they're upset because there's no one visiting them.

According to The Royal Australian & New Zealand College of Pyschiatrists, psychotropic medications can help relieve anxiety, depression, psychosis, agitation and aggression in patients with dementia.

It recommends clinicians weigh the advantages and disadvantages of various treatments and acknowledges that achieving this balance is often difficult.

Source AAP

Stay up to date with SBS NEWS

  • App
  • Subscribe
  • Follow
  • Listen
  • Watch