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Harmful antipsychotics prescribing jumped 50 per cent in dementia care homes during pandemic

Harmful antipsychotics prescribing jumped 50 per cent in dementia care homes during pandemic

Prescribing of potentially harmful antipsychotics to people with dementia has increased by more than 50 per cent on average in care homes during the pandemic, new research has found.

Covid-19 presented unprecedented challenges for care homes, where around 70 per cent of residents have dementia. Levels of illness and lockdowns had major impacts on both staff and residents. Issues such as access to PPE, staffing levels, isolation, and caring for residents in lockdown conditions were just some of the challenges facing care homes.

Now, as covid levels in the UK are high, new research led by the University of Exeter and King’s College London, presented this week at the Alzheimer’s Association International Conference in San Diego, compared antipsychotic prescribing for people in dementia in UK care homes, comparing current prescribing and pre pandemic prescription rates. Overall, the number of people with dementia receiving these prescriptions had soared from 18 per cent to 28 per cent since 2018, with prescription rates of over 50 per cent in a third of care homes.

Antipsychotic drugs are used to treat some of the more distressing behavioural and psychological symptoms of dementia, such as agitation and psychotic episodes. Antipsychotics have only very limited, short-term benefits in treating psychiatric symptoms in people with dementia but significantly increase the risk of serious side effects, including stroke,  accelerated decline, and death.

The research data compares current prescribing rates from the COVID-19 iWHELD study with pre pandemic data from a similar care home cohort study with over 700 residents evaluated in each study.

Professor Clive Ballard, at the University of Exeter, was part of a national campaign to reduce antipsychotic prescribing by 50 per cent in 2009. He said: “Covid-19 put tremendous pressure on care homes, and the majority of them must be applauded for maintaining relatively low antipsychotic prescribing levels amid incredibly difficult circumstances. However, there were very significant rises in antipsychotic prescribing in one third of care homes and we urgently need to find ways to prioritise support to prevent people with dementia being exposed to significant harms.”

Joanne McDermid, Co-PI, at the King's College London, said, "We've been hearing from care staff in our COVID-19 iWHELD study the power of building community and supportive networks in care home settings is helping to address these challenges."

iWHELD is funded by UK Research and Innovation and Alzheimer’s Society. 

Dr Richard Oakley, Associate Director of Research at Alzheimer’s Society, said: “This study shows the shocking and dangerous scale of the use of antipsychotic drugs to treat people with dementia in care homes. 

 “Alzheimer’s Society has been campaigning for a move away from the model of ‘medicate first’ and funded research into alternatives to antipsychotic prescriptions, focused on putting people living with dementia at the centre of their own care. This drug-free, tailored care can help avoid the loss of lives associated with the harmful side effects of antipsychotic medications.”

The conference presentation is entitled ‘Antipsychotic prescriptions and neuropsychiatric symptoms (NPS) in NH residents with dementia: a comparison of Pre and during Covid pandemic’.

Date: 4 August 2022

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