Get the biggest stories sent straight to your inbox Sign up for regular updates and breaking news from WalesOnline Thank you for subscribing We have more newsletters Show me See our privacy notice Invalid Email

Antipsychotic medicines are being prescribed “inappropriately” to people with dementia in care homes across Wales, a major Assembly report has concluded.

The Health, Social Care and Sport Committee was told antipsychotics were increasingly being used to “manage” challenging behaviour of people with dementia .

Their report found that these drugs were often given out as a first option rather than a last resort – despite them carrying an increased risk of heart attacks and strokes for patients.

Studies estimate that there are at least 1,800 extra deaths each year among people with dementia as a result of their taking antipsychotics.

Dr Dai Lloyd AM, chairman of the committee, said there was also “considerable concern” over the lack of data and records which made it difficult to build up a national picture of prevalence.

He said: “We are not suggesting that antipsychotics should never be prescribed for people with dementia; it is the appropriateness of their prescription that is under question.

“Given the increased risk of heart attack or stroke associated with their use in people with dementia, we are very concerned that in many cases they appear to be an option of first choice rather than a last resort, when people who are living with dementia are demonstrating challenging behaviours.

“Unnecessarily medicating vulnerable people in care is a profound human rights issue which must be addressed.”

In 2009, a report by Professor Sube Banerjee on the use of antipsychotic medication for people with dementia found that antipsychotics appeared to be used too often, with any potential benefits outweighing the risks.

“It is extremely worrying that nearly 10 years after the publication of Professor Banerjee’s report there still remain significant concerns about the inappropriate use of antipsychotics in care home settings,” added Dr Lloyd.

Bikram Choudhary, director of the Welsh-based care home group SilverCrest, said the company homes offer a "non-pharmacological" approach towards its residents with dementia, instead favouring behavioural management techniques.

He said: "We take an holistic approach, exploring our residents’ personalities, their family history, their occupation and interests. This really helps us to build up an understanding of them as individuals, and how this impacts on their behaviour.

"Our ethos is to adopt a more positive social interaction approach and this has been very successful.

"We found for example that one or two of our residents were consistently more active in the evenings and lethargic in the mornings.

"When we looked into their backgrounds we discovered that they had worked night shifts for the majority of their lives, and so we changed the way we interacted with them.

"We have also introduced alternative non-pharmacological solutions across our care homes, such as providing sensory rooms, coffee shops, a bar and even a post office where residents can pop in and pick up some snacks and interact with our staff.



"We believe it is vital that we create as familiar an environment as possible, which focuses on lifestyle so that residents can participate in cleaning, gardening projects and continuing with activities they used to enjoy before their dementia diagnosis.”

The Assembly's Health, Social Care and Sport Committee has called on the Welsh Government to ensure that all health boards are collecting and publishing standardised data on the use of antipsychotic medication in care homes and report back to it on progress within 12 months.

It also wants to make sure all health boards are fully compliant with NICE guidelines on dementia, which advise against the use of any antipsychotics unless the dementia patient is severely distressed or there is an immediate risk of harm to themselves or others.

“A person living with dementia presenting challenging behaviour often has an unmet need which they may be unable to communicate,” added Dr Lloyd.

“As such, we believe it is vitally important to look at the person as a whole in order to understand what may be causing a particular behaviour.

“We know that there are various good practice checklists that could be used by staff in care homes to identify the possible causes behind an individual’s behaviour.

“Yet we were told that antipsychotics are being used as a default position in care homes and some hospital wards, when people with dementia are difficult to deal with.

“We believe cultural and systemic changes are needed to ensure antipsychotic medications are prescribed appropriately.”

In response, a Welsh Government spokesperson said: “The use of antipsychotic medicines should be in accordance with NICE guidelines, reserved for challenging behaviour of dementia only where the benefits outweigh the risk, and when non-pharmacological approaches have been unsuccessful.

“In February we published our Dementia Action Plan, which acknowledges the need for careful audit and monitoring of such prescriptions. We welcome the Assembly Committee’s report and will now take time to consider its findings.”

Nigel Downes, Royal College of Nursing Wales Associate Director (Professional Practice), said: "Nurses have a key role in providing high quality care.

"Patients with dementia have specific and complex needs, and those with dementia in a care home are likely to require greater levels of care than other patients in similar settings.

"Therefore, this can only be achieved when the workforce is properly resourced, staffing numbers are correct and staff receiving the correct level of training; especially in relation to dementia-care training.

"The RCN agrees that every person with dementia, presenting challenging behaviour, receive a person-centred care assessment.

"Following this assessment, the correct treatment should follow based on their individual needs.

"Care homes should also ensure that they are able to offer a range of treatment options for people with dementia, including evidence based psychological therapies where appropriate.”