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Antipsychotic misuse

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‘Scandalous abuse’ of the elderly prescribed antipsychotics in hospital exposed

Tens of thousands of vulnerable dementia patients are being prescribed ‘chemical cosh’ drugs in hospital wards in a ‘scandalous abuse’ of the elderly, ten leading health organizations have said in a letter to The Daily Telegraph

Three quarters of nurses have seen people with dementia in general wards in hospital prescribed antipsychotic drugs that are known to double the risk of death and triple the risk of a stroke in these patients, research has shown.

It is the first time the scale of the abuse in hospital wards is exposed, following warnings that 100,000 dementia patients in care homes are prescribed the drugs leading to the deaths of 23,000 a year.

Ten leading charities, carers groups and experts have written to The Daily Telegraph saying: “We cannot stand by while this scandalous abuse of vulnerable citizens continues.”
Neil Hunt, Chief Executive of Alzheimer’s Society said: “The massive over prescription of antipsychotics to people with dementia is an abuse of human rights, causing serious side effects and increasing risk of death. These powerful drugs should only be used in a small number of cases. The Government must take action to ensure that these drugs are only ever used as a last resort.”
They have called on the government to publish its long-overdue review of the use of antipsychotics which ministers promised would be out in May of this year.

Rebecca Wood, Chief Executive of the Alzheimer’s Research Trust, said: “While the Department of Health prevaricates, thousands of people are being put at risk through the misuse of antipsychotics.”
Antipsychotics have a sedative effect and are not licensed for use in dementia but are prescribed when patients become agitated or difficult and often then are left on them for long periods.

A survey by the Alzheimer’s Society of over 1,000 nurses and nurse managers working on general wards in hospitals found more than three quarters said antipsychotics were used always or sometimes and one quarter said that the drugs were used inappropriately.
Mr Hunt said the numbers of patients prescribed the drugs in hospital is likely to be in the order of tens of thousands.

The letter to The Daily Telegraph reads: “100,000 people with dementia in care homes are being inappropriately prescribed a damaging chemical cosh of antipsychotic drugs and new research suggests that there is a significant problem in hospitals too.
“Antipsychotics should only ever be a last resort. This over prescription is abuse and it must stop.

“The government must urgently publish its plans to tackle the overuse of antipsychotics. These plans must deliver better support for people with dementia and those working with them as well as cracking down on inappropriate prescribing practice.
“We need to make good care the norm and move away from resorting to dangerous drugs which can increase confusion and the risk of premature death. We must all work together to improve dementia care.
“We cannot stand by while this scandalous abuse of vulnerable citizens continues.”
It is signed by Neil Hunt, Chief Executive, Alzheimer’s Society; Rebecca Wood, Chief Executive, Alzheimer’s Research Trust; Jeremy Wright MP, Chair, All Party Parliamentary Group on Dementia; Tim Hammond, Managing Director, Barchester Healthcare; Andrew Harrop, Head of Policy Policy, Age Concern and Help the Aged; Martin Green, Chief Executive, English Community Care Association; Imelda Redmond, Chief Executive, Carers UK; David Rogers, Chair Local Government Association Community Wellbeing Board; Stephen Burke, Chief Executive, Counsel and Care; Karen Jennings, Head of Health, UNISON; and Des Kelly, Director, National Care Forum.

Earlier this year, a study published in Lancet Neurology found that antipsychotic drugs double risk of death for many patients if used over a three year period. A second study, using the records of six million people, published by the British Medical Journal online found antipsychotics tripled the risk of stroke in dementia patients.

Around 100,000 people with dementia are routinely prescribed antipsychotics in UK care homes. This could mean 23,500 people dying prematurely, according to a 2008 report by Paul Burstow MP.
Ms Wood added: “After so many delays, the government must take swift and decisive action.
“Alzheimer’s Research Trust scientists at the Institute of Psychiatry are investigating alternative safer means of reducing agitation among dementia patients. We must urgently develop safe and effective treatments for people with dementia.
“By breaking its promise to take prompt action on the misuse of antipsychotic drugs the government is failing the most vulnerable people in our society.”

The review is yet to be published.
Dr Dave Anderson, chairman of the Royal College of Psychiatrists’ Faculty of Old Age Psychiatry, said: “This is symptomatic of a health and care system ill designed for people with dementia, yet, 30 per cent to 40 per cent of older people admitted to a general hospital will suffer from dementia.
“The staff in general hospitals need access to dementia training and advice from a specialist liaison mental health team for older people if we are to eradicate this problem.”
A spokesman for The Royal Pharmaceutical Society of Great Britain said: “Pharmacists recognise that once treatment with an antipsychotic has started it will often be continued when a patient is admitted to hospital, and that it is not surprising that hospital nurses also see an overuse of the medicines.
“The role of our profession is to oversee the appropriate use of medicine.”
“People with dementia should only be offered antipsychotics if they are severely distressed or there is an immediate risk of harm to the person or others.”
Adapted from The Telegraph 07/10/09