What, if not antipsychotics?
The DH insists an antipsychotic prescription isn’t ‘quality care’ for dementia, but cops out of suggesting alternatives, says Copperfield
The DH insists an antipsychotic prescription isn't ‘quality care' for dementia, but cops out of suggesting alternatives, says Copperfield
Hey, whaddya know? The drugs do work after all! NICE says that drugs for dementia actually do stuff and they do it so well that we can now give them to patients who might actually remember to take them.
Which just leaves the ones who won't. The poor bastards who end up aimlessly wandering around the twilight units in the granny stackers. For lack of anything more effective, they'll still get their daily ration of unlicensed atypical antipsychotic.
The Department of Health insists that there is a need to reduce the number of antipsychotic drugs used to treat the elderly. The logic to justify this belief is unclear. Any alternative strategy they have in place to manage the challenging behaviour of patients with dementia remains a mystery.
One thing is certain – there is no connection between the anticipated reduction in the number of prescriptions and the fact that they currently cost the NHS around £275m a year. No sir.
High-volume prescribers are going to be named and shamed. GP consortia and PCTs will be held to account and asked to show how they are providing ‘quality care' for people with dementia. Quality care along the following lines, perhaps…
‘Doris is becoming increasingly restless and has started to wander. Last night she got very agitated and scratched one of the staff nurse's arms when she tried to take her back to her room.'
A problem indeed, as a fingernail wound to the forearm can keep even the most dedicated night nurse away from work for several weeks, once you factor in debriefing and post-traumatic stress counselling.
‘Could you possibly prescribe something to settle her at night?'
‘I'm afraid not, but here are some helpful hints from an excellent "Coping with Alzheimer's sufferers' behaviour problems" website. Why not adjust your own anxiety level? Offer her a seat in a comfortable chair that she will find it hard to get out of – a bean bag is ideal. Redirect the pacing or restless behaviour into purposeful activity.'
Or, in other words, give less of a toss, imprison her in soft furnishings and if all else fails, tie a mop to her arse.
‘If she does go missing, begin your search by checking potentially hazardous areas in and around the building such as high balconies or deep stairwells before extending the search to include local bus shelters, stretches of open water and roadside ditches.'
Go on, I dare you. In real life we all know what happens next. Under pressure from the nursing-home manager and Doris's family, who have no idea where she learned language like that and who recoil at the sight and smell of Grandma's latest dirty protest, you'll call in the psychogeriatrician, who'll write the first prescription for the sedative that you'll immediately put onto her repeat-medicine chart.
And why not? We don't leave young schizophrenics to deal with their terrifying hallucinations untreated – when did allowing elderly women to suffer become socially acceptable?
Treatment might result in Doris's fatal stroke occurring in 2014 rather than 2016. It might increase the risk of next winter's chest infection being her last. And it might just relieve some of the distress she feels every time she has a moment's insight into the unremitting hell she's living through.
'Sick Notes' by Dr Tony Copperfield is out now, available from Monday Books.Click here for more from Copperfield Copperfield