This week saw the publication of results from the National Dementia & Antipsychotic Prescribing Audit 2012. The report, available in pdf format covers the period from 2006 to 2011. The report notes a decrease in the numbers and percentage of people with dementia in England receiving a prescription of antipsychotic medication between 2006 and 2011.
The report drew on data from patient records held at GP practices across England. 3,850 GP practices (representing 45.7% of all GP practices in England) participated in the audit, and patient records relating to 196,695 unique patients with a diagnosis of dementia were included in the analysis. Of these, 130,340 records relating to people who were alive and registered on a GP practice system at the time of the audit. It is estimated that approximately 750,000 people in the UK live with dementia. A report in 2009 argued that people with dementia were being over-prescribed antipsychotic medication, and that these medications were causing harm. It was estimated that antipsychotic medications were responsible for an additional 1,800 deaths and 1,620 cerebrovascular adverse events (e.g. stroke) in people with dementia each year.
The key findings from the audit of antipsychotic prescribing in dementia were:
- Over the last 5 years there has been a decrease of 10.25% in the prescription of antipsychotic medication (from 17.05% in 2006 to 6.8% in 2011).
- There has been a 51.8% reduction from 2008 – 2011 in the number of people with dementia receiving a prescription of an antipsychotic medication.
These findings are clearly very encouraging. They demonstrate that raising the profile of the potential adverse effects of antipsychotic medication has contributed to a significant reduction in the number of these prescriptions being issued by GP practices. As the Alzheimer’s Society have said, this is a “momentous achievement”. These statistics, do not, however provide an entirely complete picture, and so it would be premature to declare victory in the battle against the over-prescription of antipsychotic medication to people with dementia. The statistics only cover prescriptions from GPs, so do not include prescriptions in specialist services, community health teams or inpatient prescriptions in general hospitals. From our dementia project research, participants told us that antipsychotic drugs were often prescribed at crisis moments, or in general hospitals, as well as by GPs. These other routes to prescription must be included if there is to be a comprehensive understanding of prescribing practices.
The report also highlighted significant variation in prescription rates across the UK, with much higher prescription rates in the North West and in Yorkshire and Humber than in London or the North East. This provides further evidence of the contemporary ‘postcode lottery’ in dementia care. More work needs to be done to ensure that the availability of support and treatment for people with dementia does not depend on where they live.
Finally, the report demonstrated a small increase in two aspects of antipsychotic prescriptions for people with dementia. Firstly, there were increases between 2006 in prescription rates in the age categories of 45-54, 55-64 and 65-74 years (whereas prescriptions to people aged over 75 fell). Second, there was an 8.8% increase in the prescription of Risperdal (risperidone), the only antipsychotic medication with an MHRA license for the treatment of people with dementia.
Whilst the move to more licensed (and less ‘off-label’) prescription of these medications is to be applauded, they also highlight that the reduction is because of the proven dangers of antipsychotic use in elderly people with dementia. Less research has been done exploring the effects of antipsychotics in younger people with dementia (who often have diagnoses of the rarer types of dementia). Further clinical research needs to be carried out to explore the effects of antipsychotics on cognitive functioning in people with dementia, as well as the potential for cerebrovascular adverse events. It can only be hoped that this reduction in off-label prescription will encourage research into safe and effective treatments to help people with dementia and their carers to cope with the complex and challenging behavioural and psychological symptoms of dementia.