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Over 42,000 dementia patients on antipsychotics, show first data

More than 42,000 dementia patients were prescribed with anti-psychotic medication over a six week period this autumn, according to new figures released by NHS Digital.

It is the first time that anti-psychotic medication prescription data have been released.

It revealed that 42,991 people (9.4%) out of the 458,461 on the dementia register in England were given the medication in the six weeks to November.

GPs in the Midlands and East of England recorded the highest number, with 15,309 patients out of the 143,114 on the dementia register getting anti-psychotic medicine prescriptions.

NHS Digital also revealed that recorded prevalence has increased from 0.77 the previous year to 0.78 in November, with one in 128 people diagnosed with the condition.

The data included information from 7,185 practices.

It said that there are an estimated 645,783 people in England with dementia and 68% of them have a recorded diagnosis.

NHS Ashford CCG recorded the lowest number of prescriptions, with 27 cases, out of 955 patients on the register.

The highest number were prescribed by NHS Northern, Eastern and Western Devon CCG where 893 patients from the 8,404 on the dementia register received the medication.

No ethnicity details were recorded for nearly three quarters of patients.

NHS Digital is also recording the number of patients with and without psychosis who have been prescribed the anti-psychotic medication. This data is available on request.

Doctors delivered 37,684 assessments in October 2017 and arranged 282,573 care plans.

Readers' comments (7)

  • This is terrible.

    Just this week I have been lectured by those leading Dementia policies in the UK that we are "empowering" our older generation.

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  • Is this really such a bad thing? These drugs have been unfairly demonised by NICE because of their risks but the reality is that those with advanced dementia have palliative needs that we are simply not recognising. It can't be very nice to be chronically agitated, shouting, wandering around at night and lacking a sleep wake cycle. Its often unsafe and distressing for patients, fellow residents and also carers. Even the best EMI homes struggle with all this and many are sub-par. The reality is that low dose antipsychotics are often effective for a wide range of these symptoms. Evidence for other 'trendy' behaviour based intervention is woolly at best. Perhaps it's time to recognise the terminal nature of dementia and relax the dogma around the use of antipsychotics antil something better comes along?

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  • Dear Mutley,
    I believe this is a bad thing because these drugs are being overprescribed in place of hands on care. There is also robust evidence that antipyschotics can increase morbidity and mortality.

    The Dementia Tsar wrote a "Change paper" in the BMJ a few years back so he shares my view as does Professor Sube Banerjee who reviewed such prescribing some years back.

    I agree that there is a place for antipsychotics in the short term and for those whose distress does not respond to other approaches. I prescribe antipsychotics in my job.

    Apart from Risperidone, which has a 6 week licence for BPSD in Alzheimer's type dementia all other drugs are OFF label.

    I would contend that your terminal and palliative generalisation does not reflect the fact that in the last decade a drive for earlier and earlier diagnosis has widened the "net". I have always argued for a timely approach to dementia diagnosis.

    When I became a Consultant in Psychiatry for Older Adults in 2001 my trainer handed me a package the size of a phone directory: "This is the future" he said. The package was on BPSD (Behavioural and Psychological Symptoms of Dementia)and, though I did not realise it then, was the product of the Pharmaceutical Industry.

    15 years on and we have "Over 42,000 dementia patients on antipsychotics". The situation is just the same in Scotland.

    Yes, my trainer was right when he said in 2001 that "this is the future".

    Realistic medicine this is not.

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  • UtterFool

    I’d take the opinions of clinicians physically removed from the day to day provision of the care for these patients with a pinch of salt. Spend a month working as an HCA dispensing personal toileting level care and then you’d have my ear. Otherwise the advice is of obvious interest but doesn’t represent the full picture - this might be inconvenient but is unfortunately reality

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  • ...and can we have data on the cut in dementia services in the same period?

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  • The sincere expressions of clinical difficulty and professional distress amongst doctors managing those with dementia are almost palpable.
    The demands placed upon those caring for patients with dementia must be fully acknowledged.

    There is a profound prescribing dilemma in that many of the serious toxicities of all antipsychotics are almost indistinguishable from the progressive irreversible intellectual impairment which defines the pathophysiology of dementia.

    Most evidently; - The behavioural and psychological toxicities of antipsychotics.

    It is the generally accepted viewpoint that psychotropic drugs may be more toxic in the presence of underlying organic brain disease.

    This increases the risk of antipsychotic induced akathisia, aggression and violence which cause immense suffering in the now toxic as well as dementing patient.
    The suffering in those who try to care for them is exacerbated.

    The next danger is now antipsychotic dose elevation and psychotropic drug augmentation with potential for further life-threatening adverse drug reactions.

    This is truly a medical "Catch-22" and those attempting to address the situation are surely to be respected.

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  • Dear All,
    And there are approx 20,000 nursing homes in England, so thats on average 2 patients per home. Thats pretty good and quite the opposite to the widespread use of the chemical cosh some would believe GPs are supposedly using.
    Regards
    Paul C

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