We slashed their antipsychotics and this happened…

A care home intervention to reduce the ‘chemical cosh’ boosts staff satisfaction, improves quality of life and saves money. Surely not?

There are 800,000 people with dementia in the UK, a third live in care homes. Dementia can generate behaviours such as agitation, aggression, wandering, shouting, repeated questioning, sleep disturbances, depression and psychosis which can challenge carers and residents.

Such behaviours are all too often the trigger for prescribing antipsychotic drugs, originally designed to treat schizophrenia. Dubbed ‘the chemical cosh’, they can reduce aggression, but also increase the risk of stroke, falls and death.

It is estimated that 2/3 current UK prescriptions of antipsychotics for people with dementia are inappropriate!

1,000 people with dementia on an antipsychotic x 12 weeks = 10 deaths + 18 cerebrovascular events + 58–94 gait disturbance

With Department of Health funds we set up a project to change this. We targeted care homes (where antipsychotics prescribing is prevalent) across Coventry and Warwickshire. Each care home received a two-session nurse-based training course on managing behaviour that challenges. Our well attended training package, also included a video depicting examples (good and bad) dementia care methods.

We identified residents who were inappropriately placed on antipsychotics, and with supervision plus input from a pharmacist, stopped the prescriptions gradually. By eight weeks, 75% were successfully withdrawn off antipsychotics, with no recurrence in challenging behaviour. Analysis shows that with greater primary care involvement, even more cases for withdrawal could have been identified.

Staff training, which involved all levels, junior and senior, was well received.

At 13%, antipsychotics prescribing rates in our area were lower than the 20% national average. Moreover, we demonstrated that our ‘simple’ intervention could reduce prescribing rates broadly within the Department of Health’s aspiration.

In fact, new data suggests that this is a constant trend in our locality and in 5 years Coventry clinicians slashed new prescriptions of antipsychotics for people with dementia from 11% to 1.5%

We estimate that using the same intervention across Coventry and Warwickshire would

  1. get 285 people with dementia off antipsychotics in a year
  2. prevent 2-3 strokes and 2-3 deaths
  3. be cost-effective.

We estimated that this preventative approach would generate in our locality £80,000 direct savings and £240,000 quality of life improvements benefits per annum.

Perhaps Coventry & Warwickshire is a step closer to becoming a dementia-friendly locality

Who said you cannot deliver much better healthcare for much less.




Advancing European healthcare policies for people living with dementia and their carers

As a member of ALCOVE’s executive board, it gives me great pleasure to announce the arrival of a new and far-reaching joint action project, co-financed by the European Commission.

The last 50 years in Europe have seen an increase in life expectancy, as well as a corresponding surge in diseases linked to ageing, particularly dementia. Given the high prevalence, cost, and profound impact on society of Alzheimer’s disease and other dementias, the European Union has accorded dementia a high public health priority.

ALCOVE brings together 30 partners from 19 EU Member States to improve our knowledge and information exchange on dementia and its consequences, and to preserve health, quality of life, autonomy, and dignity of people living with dementia and their carers in EU member states.

ALCOVE’s main objectives are to:

  • establish a European network of healthcare institutions
  • inform and advise policymakers, healthcare professionals, caregivers, and citizens through convergent recommendations
  • reduce the risks associated with psychotropic drug use, particularly antipsychotics.

ALCOVE aims to improve data on dementia prevalence; access to early dementia diagnosis; care for those living with dementia, especially those with behavioural and psychological symptoms; and the rights of people with dementia, particularly with respect to advance declarations of will. A Toolkit to reduce Antipsychotics will also form part of the project.

In conducting this work, ALCOVE draws on previous European studies, and existing networks.

England’s task includes making recommendations to improve early diagnosis, very topical. don’t you think?

I look forward to collaborating with Professor Dawn Brooker and her team (Association for Dementia Studies, Worcester University) to deliver this timely piece of work.

For more about progress visit http://www.alcove-project.eu/

ALCOVE will report its findings in Paris in the Spring of 2013 so watch this space.