Currently in the UK there are 700,000 sufferers of dementia, a number estimated to double in the next 30 years.
Concerns have been raised about the high rates of use of antipsychotics to control psychological and behavioural disturbances associated with dementia. Prof Banerjee estimates that 180,000 people are being treated per year with these drugs (which were originally developed to mitigate the psychotic symptoms associated with schizophrenia), but that only 20 per cent of these people receive ‘some benefit’ from taking them. The report states that antipsychotics are responsible for an estimated 1,800 deaths per year among those suffering dementia. Banerjee recommends that their use is reduced to one third of current levels within three years.
The overuse of these medications is attributed in the report to the ‘cumulative failure’ to deal with the challenges posed by some of the behavioural symptoms of these illnesses. Banerjee claims that ‘for the large majority, it appears that current systems deliver a largely antipsychotic based response’ whereas these should be a sparingly used and minor part of a holistic care package.
Professor Banerjee’s recommendations to bring the rates of antipsychotic use down dramatically include the following:
- A National Director for Dementia should lead and oversee audits in each PCT area of current use of antipsychotics followed by the publication of specific local goals for reductions;
- Medical directors in each NHS organisation should ensure they have the clinical governance mechanisms in place to review their level of risk and to ensure good practice is carried out;
- PCTs should invest in ‘extra capacity’ in specialist older people’s mental health services to provide in-reach dementia advice and training to care homes and GP surgeries;
- A national vocational qualification in dementia care (non-pharmacological management) should be introduced for care home staff;
- GPs and older people’s mental health services should use the local audit data to devise a combined approach to reducing the rates of antipsychotic prescription.
At the same time, the Alzheimer’s Society has published a report on the quality of care for people with dementia in general hospital settings (of which they occupy around 25 per cent of the beds), with recommendations for improving the quality of their care as well as system efficiency overall.
To download the report visit the Alzheimers Society website.