Families of people with dementia urged to participate in monitoring their treatment
14 April 2014
Following the release of a Senate Committee report on the care of Australians living with dementia, NPS MedicineWise is urging the families of people with dementia to play a part in monitoring treatment of their loved one, especially if the person with dementia has been prescribed antipsychotics to manage some of the behavioural or psychological problems associated with the condition.
The Senate Committee recommended that the use of antipsychotic medication should be reviewed by the prescribing doctor after the first three months to assess the ongoing need, and that health professionals undertake longer consultations with a patient and at least one family member or carer where the patient has presented with dementia.
NPS MedicineWise CEO Dr Lynn Weekes says that antipsychotic medicines are sometimes prescribed for people suffering behavioural or psychological problems associated with dementia, but that studies show using these medicines for longer than necessary, especially in the elderly, can lead to serious side effects that can be life-threatening.
“Many people who have dementia do have behavioural and psychological problems associated with this condition, such as wandering, calling out, aggression and depression,” says Dr Weekes.
“Unlike chronic mental illnesses, these problems tend to fluctuate and be short-lived, so long term treatment with an antipsychotic medicine is unlikely to be needed. In addition, some of these behaviours won’t be alleviated by antipsychotics but may result in side effects such as drowsiness, tremors or falls.
“People with dementia who stay on antipsychotic medicines longer than necessary can end up experiencing serious side effects without any real benefits. This can place people with dementia at increased risk of cardiovascular problems, infections and even death.”
Families and carers of people with dementia are encouraged to discuss the benefits and risks of treatment, as well as treatment goals, with the doctor. They can also report any signs of side effects in the person they are caring for, such as dizziness, abnormal bodily movements and constipation.
NPS MedicineWise educational programs over the past several years have encouraged health professionals — and carers of people with dementia — to use non-drug approaches first when treating behavioural and psychological problems associated with dementia. Treatment with prescription medicines, such as antipsychotics, should only be considered if non-drug approaches are unsuccessful.
“Behavioural and psychological problems associated with dementia are not always caused by the dementia itself, but can be caused by other underlying problems such as urinary tract infections, constipation, pain or hearing loss. It’s important to rule out these causes first before starting any treatments,” says Dr Weekes.
If treatments are required, we recommend trying non-drug therapies first such as muscle relaxation therapy, personalised music, video or audio tapes of family members and changing bathing routines. These all have a low risk of harm compared with antipsychotic medicines and may provide a better response. An antipsychotic medicine should only be used if psychotic symptoms, aggression or agitation are causing severe distress or are a risk of harm to the person with dementia or to others. Once a person is prescribed a medicine, a doctor should regularly review the need for the treatment to determine when it can be stopped.
For more information about preventing medicine problems in older people, visit www.nps.org.au/olderandwiser
For more information on prescription, over-the-counter and complementary medicines (herbal, ‘natural’, vitamins and minerals) from a health professional, call NPS Medicines Line on 1300 MEDICINE (1300 633 424) . Hours of operation are Monday–Friday 9am–5pm AEST (excluding public holidays).
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