Antipsychotic drugs are widely used for purposes other than the treatment of psychosis – in aged and extended care facilities this often means that this group of drugs is used to manage behavioral and psychological symptoms of dementia, even though there is now a body of knowledge that identifies the problems with this approach. A previous study – Halting Antipsychotic Use in Long‐Term Care (HALT) – achieved deprescribing of antipsychotics, about 1 in 5 participants had antipsychotics re-prescribed (or never reached a dose of zero). A recent study investigated reasons for re-prescription of antipsychotic medication and factors associated with ongoing antipsychotic use, relating to care staff requests and perceived behavioral changes.
The people found to make the largest contribution to re-prescribing were nurses (63.2%), followed by family members (39.5%), GPs (23.7%), specialists (13.2%), and hospital staff (10.5%). There were multiple drivers for antipsychotic use in 46.2% of participants, principally involving Increased agitated and aggressive behaviour. The authors rightly identify that the previous intervention alone was not enough to prevent antipsychotics from re-appearing on the drug charts of people living with dementia in the aged care setting. What is less clear is the extent to which the heavily advocated non-pharmacological approaches that are suggested as strategies to deal with behavioral and psychological symptoms of dementia in aged care are actually sufficient to deal with the issue. This matter is complex and warrants more study, and an open-minded view of the challenges involved.