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	TX: 12.11.09 - Anti-psychotic drugs and dementia PRESENTER: WINIFRED ROBINSON

	Downloaded from www.bbc.co.uk/radio4 THE ATTACHED TRANSCRIPT WAS TYPED FROM A RECORDING AND NOT COPIED FROM AN ORIGINAL SCRIPT. BECAUSE OF THE RISK OF MISHEARING AND THE DIFFICULTY IN SOME CASES OF IDENTIFYING INDIVIDUAL SPEAKERS, THE 麻豆约拍 CANNOT VOUCH FOR ITS COMPLETE ACCURACY. ROBINSON Well the government today acknowledged that two-thirds of the elderly people in England, who are prescribed anti-psychotic drugs for dementia, derive no benefit from them at all. They're usually given as a sedative to people who are anxious, agitated or aggressive. A series of ways of trying to cut back on the prescription of anti-psychotics was outlined at a news conference this morning by the care minister Phil Hope and Henrietta Harrison was there. Henrietta: HARRISON Yes Winifred. Well the report confirmed concerns about the effects of anti-psychotic drugs that actually go back years. The review found that the medication is used far too often and of that 180 people with dementia on anti-psychotic medicine only 36,000 saw a benefit. ROBINSON So it's a 180,000 and only 36,000 of them benefited? HARRISON Absolutely yeah. So the report went on to say there's clear evidence that anti-psychotics are currently being used when other approaches could be more effective to deal with anxiety and behavioural problems. The negative effects of the drugs include shaking and stiffness, an acceleration of mental decline and as this report confirmed, an increased risk of strokes, an increased risk of death. Sube Banerjee is the author's report. BANERJEE About 1% of individuals may die from taking these medications on top of the normal mortality that is associated in dementia. And that equates to about 1800 people in the UK. HARRISON Why are anti-psychotic drugs so widely used? BANERJEE Because that's what's happened over the last 30 years. They're used because those that prescribe them and the settings in which they're prescribed don't have ready access to the non-pharmacological ways of treating these behavioural disturbances. It's only been recently that we've started to understand just what the risks are. And the focus of the report is to deal with the fact that we have essentially a problem that has taken 30 years to grow of dementia moving from being a very uncommon thing to being a very common thing. Thirty years ago if we went into care homes perhaps 20% of people would have dementia, now it's more like 80 or 90%. So we've gone from it being the exception to the norm, what hasn't changed are people's skills and the ability to deploy good quality non-pharmacological treatments. HARRISON The report does recommend in some cases that anti-psychotic drugs are used for people with dementia, say to help them stay at home with their relatives or if they become a danger to themselves or others but that treatment should be closely monitored. Now this report has been a long time coming, research in 2006 found that the drugs do more harm than good and an all parliamentary group last year called for an end to the widespread use of the drugs. Neil Hunt is the chief executive of the Alzheimer's Society. HUNT Oh yeah much too long, much too long but very welcome nonetheless, it's a really big event and it's very important that it happened. HARRISON Care homes have not been coping, now there is a report encouraging less use of anti-psychotic drugs but there's no extra money, so why all of a sudden will care homes be able to cope? HUNT We have got a lack of investment overall in the care system, so we don't necessarily share the department's view that it can all be done by improved management. Nonetheless there are really good cause for hope here that we do see situations where the leadership in certain care homes have produced innovations in terms of design, in terms of how the place is laid out, the freedom and choice that are given to residents, the training given to staff and so forth, now yes it costs some money but actually the commitment from leadership to focus on the needs of the people is a really key and decisive factor here. You don't need tons of money to really fundamentally change people's approach to this care. HARRISON The government accepted the recommendations, which include that the use of anti-psychotic drugs be reduced by two-thirds in the next three years; that they appoint a new clinical director for dementia; that carers have a better understanding of psychological therapies; that there's better training and that an audit is set up of prescription figures. ROBINSON Henrietta Harrison thank you. Well I spoke to the care minister Phil Hope just a little bit earlier and I asked him why an audit of current prescribing is needed. HOPE Professor Banerjee has helpfully mapped out some estimates based on reliable and robust data that he as a scientist has identified but we need to know the actual facts - the hard numbers on the ground. So we want every primary care trust to carry out an audit of the actual use of anti-psychotic drugs and then to set targets for the next three years to bring down a significant reduction. And the new national clinical director for dementia that I'm appointing will be responsible for working with those primary care trusts to ensure they carry out that audit, set these targets and then achieve those targets over the next three years. ROBINSON You've spelled out the guidelines as they currently stand for the use of these drugs for dementia, that they should only be used when everything else has been tried and then only for three months but that is such a far cry from what's happening now. Even three years do you think that a significant change like that can be achieved over that timescale? HOPE I think we have to achieve a significant change over the next three years. The NICE guidance is very clear that these drugs should be used only when somebody's severely distressed or when a person is at risk to themselves or others and when other methods have been tried. That is not what is happening at the moment. But I've been to care homes, I went to one only this week, where I saw a reduction in the use of these anti-psychotic drugs by 62% and that was because this care home was working closely with community mental health team specialists, with the general practitioner who prescribes the drugs and of course training their own staff to find alternative ways and means of looking after and reducing the agitation and the anxiety and the challenging behaviour, there's often the reason why these drugs get prescribed in the first place. I know it can be done. ROBINSON You've promised better access to psychological therapies but no more money. HOPE Well there is extra money going into the roll out of our psychological therapies programme, rising to £173 million in the year 2010 ... ROBINSON But that's a general programme. HOPE Indeed it is and we believe that people with dementia should have access to that general programme. But let me say there is a huge amount of money being spent on providing care for people with dementia in their own homes, through domiciliary care workers or in care homes through care assistance. The question is whether we can train and develop new ways of working for these people with existing resources to do things differently in the way that they carry out their care which means that GPs do not have to rely on these drugs to deal with a person's challenging behaviour. I have seen it work in practise so I know it can be done. If it can be done in one care home with existing resources it can be done in every care home. ROBINSON Well it certainly isn't done everywhere and what should people listening who have relatives taking these drugs do if they are unhappy with the effects that they are witnessing? HOPE Well the first thing I want to say to people is please don't panic, it may be, as the report shows, that some people are being rightly prescribed these drugs. But what they should do is perhaps go and talk to the person making the prescription - their GP or the specialist consultant if that's the case - and if they're not sure - if they're still anxious about the answers they're getting to those questions and want a second opinion I'm working with the Alzheimer's Society to provide some guidance for family members on what to do if a member of their family is being prescribed with these drugs and they might want to contact the Alzheimer's Society for further support. So we do believe that family members should be involved when decisions of these kinds about these drugs are being taken by GPs. ROBINSON The care minister Phil Hope. Back to the Transcripts homepage Back to the You and Yours homepage The 麻豆约拍 is not responsible for external websites

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