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Painkillers ‘may ease agitation’ in dementia patients

As reported by BBC New today

Many dementia patients being prescribed “chemical cosh” antipsychotic drugs could be better treated with simple painkillers, research says.

The British and Norwegian study, published on the BMJ website, found painkillers significantly cut agitation in dementia patients.

Agitation, a common dementia symptom, is often treated with antipsychotic drugs, which have risky side effects.

The Alzheimer’s Society wants doctors to consider other types of treatment.

Experts say that each year about 150,000 patients in the UK are unnecessarily prescribed antipsychotics, which have a powerful sedative effect, and can worsen dementia symptoms, and increase the risk of stroke or even death.

They are often given to patients whose dementia makes them aggressive or agitated.

But researchers from Kings College, London, and Norway speculated that the behaviour may sometimes be caused by pain, which patients were unable to express in other ways.

They studied 352 patients with moderate or severe dementia in nursing homes in Norway.

Half were given painkillers with every meal, the rest continued with their usual treatments.

Supervised treatment ‘key’

After eight weeks, there was a 17% reduction in agitation symptoms in the group being given painkillers – a greater improvement than would have been expected from treatment with antipsychotics.

The researchers concluded that if patient’s pain was properly managed, doctors could reduce the number of prescriptions for antipsychotic drugs.

Click to play

Prof Clive Ballard, Alzheimer’s Society: “Simple painkillers… had a a very, very substantial impact”

Professor Clive Ballard, one of the report authors and director of research at the Alzheimer’s Society, said the finding was significant.

“At the moment, pain is very under-treated in people with dementia, because it’s very hard to recognise,” he said.

“I think this could make a substantial difference to people’s lives – it could help them live much better with dementia.”

However, he said painkillers should only be given to patients under the supervision of a doctor.

The Alzheimer’s Society is issuing new guidance calling on doctors to think much harder before prescribing antipsychotics, and to look at prescribing pain medication instead.

The National Care Association said the study highlighted some of the complexities of dementia.

“Pain in itself is debilitating, so to identify it as the route cause of agitation and aggressive behaviour is a major breakthrough which will enable us to support people appropriately,” said its chairman, Nadra Ahmed.

A government programme to reduce the inappropriate prescription of antipsychotic drugs is already under way in England.

The care services minister Paul Burstow welcomed the study.

“It should act as a further call for GPs to carefully examine the reason why those with dementia display agitated behaviour, rather than immediately resorting to antipsychotic medication,” he said.

No need for ‘chemical cosh’ at Rose Lodge

We were audited today by our local psychiatric consultant for our use of anti-psychotic medication, as part of a general audit of dementia care homes in the area. It is wonderful to see that this topic is being given the active attention that it deserves.

Originally invented for conditions such as schizophrenia, for many years now some care homes and hospitals have made extensive use of such medication as a “chemical cosh” for people with dementia. This means people are on purpose kept very subdued (“dozy” or even “zombie-like”) and so they are much less capable of interacting with the people around them. It makes for an environment which is “easy to manage” but has a detrimental effect on the wellbeing of the residents, including side effects such as dribbling and loss of balance causing falls.

Our policy is to keep such medication to an absolute minimum and for short periods only. Rather than resort to anti-psychotic medication we believe that by providing a therapeutic physical and social environment, we can improve our resident’s wellbeing and that this substantially reduces the need for anti-psychotic medication. You will find many stories on this site about how we provide such an environment at Rose Lodge.

The consultant confirmed that we are doing very well in keeping such medication to a minimum.

We recently admitted a gentleman from another care home who was prescribed such an anti-psychotic medicine, causing drowsiness, dribbling, and reduced sociability. When we discussed this with his wife, she told us that the care home had assured her that he was not prescribed any anti-psychotic medicines and that the dribbling was a symptom of the dementia (It is not!).  As we do with all new residents that take such medication, we talked with the family and the GP and promptly took this gentleman off his anti-psychotic medication and within days he started to ‘come alive’ and stopped dribbling, much to the delight of his family.

If you are concerned that this kind of thing may be happening to your loved one then do consult the GP who should be able to give you accurate information, and also discuss options for reducing or removing such medication. But be aware that your loved one may not be in an environment where this is possible as it does require a completely different approach to providing dementia care. Hospitals are notorious for not providing such an environment and some care homes are no better.

Minimising anti-psychotic medication is not an easy option. But we strongly believe that the increased well-being of our residents fully justifies taking this approach.

There is a great factsheet from the Alzheimer’s society about the use of anti-psychotic medication including a list of the ones that are in common use. You can find it here:

http://www.alzheimers.org.uk/factsheet/408