19. Medication

MedicationAntipsychotic medication
In workbook 2 antipsychotic medication was discussed. There has been much focus on how and when antipsychotic medication for people with dementia is used. Several studies have highlighted concern and indicated significant risks relating to their use.

There have been many non pharmacological interventions described throughout this workbook. You will remember that anti psychotic medication should be considered only once all other non pharmacological interventions have been considered. (refer to NICE Guideline at www.nice.org.uk/guidance/TA217)

In 2009 an independent clinical review of the use of anti-psychotic drugs was published (Banerjee 2009). Several recommendations came from this report including:

Recommendation 7: There is a need to develop a curriculum for the development of appropriate skills for care home staff in the non-pharmacological treatment of behavioural disorder in dementia, including the deployment of specific therapies with positive impact.

Further learning

  • Professor Sube Banerjee. (2009) The use of antipsychotic medication for people with dementia: Time for action. A report for the Minister of State for Care Services. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_108303
Task: Watch the YouTube video http://dementia.dh.gov.uk/call-to-action-on-the-use-of-antipsychotic-drugs/ of Professor Alistair Burns discussing ‘The right prescription – Call to action on the use of antipsychotic drugs’ and make notes in your workbook on the key points.

STAR Initiative
The STAR initiative was developed by Cornwall and Isles of Scilly Primary Care Trust, Royal Cornwall Hospitals NHS Trust and Cornwall Care in 2010. It was developed in response national and local recognition of the overuse of medications prescribed to people with dementia and the impact that these drugs may have on physical health and quality of life.

It provides an educational toolkit aimed at reducing the use of inappropriate medication in people with dementia. Within this information there are practical observation tools and a ‘3 monthly’ checklist to review, monitor and reduce the prescribing of medication

Further learning

Acetylcholinesterase (AchE) Medication and Memantine
These medications do not ‘cure’ dementia but in certain cases can help to slow down the rate of progression of the illness.

In March 2011 a review and re-appraisal of donepezil, galantamine, rivastigmine and memantine for the treatment of Alzheimer’s disease resulted in a change in NICE guidance. Specifically:

  • Donepezil, galantamine and rivastigmine are recommended as options for managing mild as well as moderate Alzheimer’s disease, and
  • Memantine is recommended as an option for managing moderate Alzheimer’s disease for people who cannot take donepezil, galantamine or rivastigmine and as an option for the later stages of Alzheimer’s disease
Task: Watch the video ‘Minimising the use of restraint in care homes for older people: creative approaches’ http://www.scie.org.uk/socialcaretv/video-player.asp?guid=BCE0A383-9D9E-45BD-8593-E9C4FE6318ED and write notes in your workbook on the ideas given by the people on the video of alternatives to use of medication.

Further learning

Task: In your notebook list 10 key learning points from completing the workbook which are meaningful to you and your workplace, which you will take with you into your practice.

Further learning resources «