Call for Less Antipsychotics in Residential Care (CLeAR)

CLeAR is a voluntary quality improvement initiative initiated by the BC Patient Safety and Quality Council designed to support interested teams from all residential care facilities in BC in their efforts to address the behavioural and psychological symptoms of dementia (BPSD) and reduce inappropriate use of antipsychotics.

See their "Call to Action" and information about joining here: http://bcpsqc.ca/clinical-improvement/clear/a-different-approach/

The Use of Selected Psychotropic Drugs Among Seniors on Public Drug Programs in Canada, 2001 to 2010

Published by the Canadian Institute for Health Information, this analysis focuses on antipsychotic drug use by seniors (aged 65 or older) associated with a heightened risk of falls in seniors.

https://secure.cihi.ca/free_products/psychotropic_AIB_2012_en.pdf

A review of the use of antipsychotic drugs in British Columbia residential care facilities (2011)

This report documents the process and findings of a review of issues associated with the prescription of antipsychotic medications for elderly residents of residential care facilities in British Columbia.

The Ministry of Health undertook the review at the direction of the Minister of Health, in response to public concerns including a complaint raised by a family whose mother was in residential care in the Fraser Valley.

The review occurred from April to June of 2011. Its Terms of Reference were to examine the extent of antipsychotic drug use in provincial residential care facilities, to review existing protocols for treatment of dementia symptoms, including use of consents to care, and to determine whether further actions are required to ensure the health, safety and dignity of elderly residents with dementia.

http://wpp01.msss.gouv.qc.ca/appl/K30/K30Redirection.asp?doc=p&id=3494

Geripods

The GeriPod broadcast series is offered for interdisciplinary practicing clinicians, students and others involved in primary care and aging.

These free podcasts are developed by the New Jersey Institute for Successful Aging through its federally-funded New Jersey Geriatric Education Center and are available as a subscription or as individual episodes at no charge from iTunes University.

Topics include:

• Use of antipsychotics
• Depression
• Management of behavior problems

To access the series go to:
http://njisa.umdnj.edu/education/geripods/index2.html

Toxic Medicine: What You Should Know to Fight the Misuse of Psychoactive Drugs in California Nursing Homes

On February 23, 2010, the California Advocates for Nursing Home Reform (CANHR) released a new guidebook on psychoactive drugs as the first stage of CANHR's 2010 Campaign to End Inappropriate Drugging of California Nursing Home Residents.

The guidebook, designed for families or advocates of nursing home residents, provides basic information on psychoactive drugs in nursing homes, including their use and side effects.

The guide also reviews the applicable California legislation on informed consent and provides practical tips for nursing home residents or their family members to prevent misuse of psychoactive drugs.

http://www.canhr.org/reports/2010/Toxic_Medicine.pdf

The Use of Antipsychotics for People with Dementia: Time for Action

This report, commissioned by the UK Department of Health, is an extensive review of the use of antipsychotics, and examines the evidence base, their use in other countries, and the views of all stakeholders: clinicians, carers, managers, people with dementia, etc.

The review makes the positive finding that there are clear actions that can be taken to address the issue. It states that there are some simple actions which need to be avoided, such as prohibition or wholesale cessation of these medications and recommends a measured, planned approach in order not to compromise patient safety, causing considerable harm and leading to a paradoxical increase in distress for people with dementia and their carers.

http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_108302.pdf

Report on the prescribing of anti-psychotic drugs to people with dementia

In recognition of widespread concern about the over-prescription of anti-psychotic drugs, and as part of the priority being given to improving care for people with dementia, Sube Banerjee was asked to undertake an independent clinical review of the use of anti-psychotic drugs.

These reports contain the results of his review and the Department of Health (England) response to his findings.

Banerjee report:
http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_108302.pdf

Department of Health response:
http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_108363.pdf

Antipsychotic Use in Seniors: An Analysis Focusing on Drug Claims, 2001 to 2007

Published on July 9, 2009 from the Canadian Institute of Health Information.

This publication looked at more than one million seniors on public drug programs in six provinces with the goal of identifying trends in the claims for antipsychotics in people age 65 or older. The provinces were Alberta, Saskatchewan, Manitoba, New Brunswick, Nova Scotia and Prince Edward Island. Based on claims in these provinces, total drug program expenditures on antipsychotics were almost $17.6 million in 2006–2007, accounting for 2.0% of the total drug program expenditures in that year.

Antipsychotics were primarily developed for the treatment of schizophrenia and bipolar disorder, but they are increasingly being used to treat the behavioural and psychological symptoms associated with dementia in seniors, such as delusion, aggression and agitation. These symptoms affect more than half of patients with Alzheimer’s disease and related dementia and can result in harm to both patients and their caregivers. There are two classes of antipsychotics: typical and atypical. Among these two classes, there has been a continued shift to the use of newer atypical agents.
To download, to to:
http://tiny.cc/PbxCd

Assessment Report on Conventional Antipsychotics

Released by the European Medicines Agency (EMEA) on November 20, 2008, this report was generated by a request from the UK to the EMEA's Committee for Medicinal Products for Human Use (CHMP)xamine the safety of antipsychotic medicines, particularly when used in elderly people with dementia.

The Committee for Medicinal Products for Human Use (CHMP) addresses the following issues in the report:

1) strength of evidence to suggest that conventional antipsychotics are associated with excess mortality when used with elderly people with dementia

2) strength of evidence to suggest that conventional antipsychotics are associated with a greater risk of mortiality when compared with atypical antipsychotics

3) whether or not the risk can/should be extrapolated to those conventional antipsycotics not included in the studies

4) the need to conduct further studies

http://www.emea.europa.eu/pdfs/human/opiniongen/Conventional_%20Antipsychotics_Article5.3-Appendix1-CHMPAR.pdf

Always a Last Resort: reducing antipsychotic use

Up to 105,000 people with dementia are given the drugs inappropriately, according to expert predictions in the new UK All-Party Parliamentary Group (APPG) on Dementia report, 'Always A Last Resort', published today.

Antipsychotics continue to be a first resort for dealing with challenging behaviour in people with dementia, such as aggression or agitation, despite causing devastating side effects, doubling risk of death and costing the UK over £60 million a year.

'Always a Last Resort' identifies 5 vital steps to reduce antipsychotic use and reveals there is currently no audit or regulation of the issue. It urges the Government to use its new National Dementia Strategy to address the problem and the National Institute for Health and Clinical Excellence to conduct a thorough review.

http://www.alzheimers.org.uk/downloads/ALZ_Society_APPG.pdf