Project Lead: Michael Dennis, Swansea University
There are around 700,000 people in the UK with dementia. According to Alzheimer’s UK, 90% of people with dementia experience behavioural and psychological symptoms- such as agitation, aggression, delusions and hallucinations. People with dementia who experience these symptoms are often, and inappropriately, prescribed antipsychotic drugs (a range of medications used for types of mental distress or disorders).
Over recent years there has been growing evidence in the increased risk of death associated with antipsychotic use in older people with dementia. Although this concern combined with limited evidence of efficacy has informed guidelines restricting antipsychotic prescription in the elderly, the use of antipsychotics remains common.
Previous studies have looked at short-term outcomes, select populations, and were restricted to examining death and stroke risk. This study looked back and examined the electronic records for a large population-base of older people living with dementia.
The research used linked routine data (allowing the cross checking and study of various patient reports and health care events) and examined the relationship between antipsychotic medication and serious harmful outcomes.
This study looked at the influence of exposure to antipsychotic medication on acute cardiac events (sudden or reduced blood flow to the heart), venous thromboembolism (the formation of blood clots in the veins), strokes, hip fractures, and all-causes of death.
A total 9674 people were identified of whom 3735 were exposed to antipsychotic medication.
An increased risk of a venous thromboembolic episodes, strokes and hip fractures were associated with antipsychotic use. However, there was no long-term increased death in people exposed to antipsychotic medication.
The increase in adverse medical events supports guidelines restricting antipsychotic use in this population.
Inappropriate use of antipsychotic drugs is extremely harmful. This study shows that there is a clear increased risk of adverse medical outcomes, in particular venous thromboembolism, stroke and hip fracture in older people living with dementia who are exposed to antipsychotic medications.
Reducing the use of antipsychotic drugs for people with dementia is a key element of the Dementia Plan for Wales and a national priority in England.
The risks highlighted in this study support recommendations restricting non-emergency antipsychotic medication use in people with dementia to those with psychosis or severe aggression when other non-pharmacological treatment plans have failed.
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