More knowledge can drive back the use of psychopharmaceuticals in dementia

The new Care and Involuntary Treatment Act, that may take effect in 2015, requires a different role of the care providers in dealing with problematic behavior in dementia. The use of medication may no longer be considered matter-of-fact. As a result, it will be necessary to use alternative methods in treating problematic behavior in dementia.

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And so there is a greater need for knowledge of the available options and their use. As it is, studies on my part show that care professionals are not fully equipped to apply these alternative treatment methods. The study, as my final assignment of the TIAS Master of Health Administration, examined the course of action of care professionals in using anti-psychotics for problematic behavior in dementia. I am meanwhile involved in a national project (financed by HWS) by order of Vilans that is to drive back the use of psychopharmaceuticals in both the care for the elderly as well as the care for the handicapped.

The use of anti-psychotics in dementia should occur as little as possible – except for the treatment of psychosis. Known side-effects of anti-psychotics include a decrease in cognitive functions, an increased risk of a stroke, the loss of initiative and activity and an increased risk of fall incidents. More than one-third of the clients suffering from dementia in Dutch nursing homes are prescribed psychopharmaceuticals for a prolonged period.

There have been recent initiatives to reduce the use of anti-psychotics in dementia patients. This alternative approach is aimed at activating the client and the initial results are very promising. The treatment policy of the Stadzicht location of the Laurens Foundation in Rotterdam is an example of this. It decided that dementia patients were essentially no longer to be treated with anti-psychotics. This step involves a change in culture, for both the care professionals concerned as well as for the family. The study shows that both parties are generally of the opinion that the use of anti-psychotics has an irreplaceable role in limiting the degree of unrest. It is found in practice, however, that the renewed approach of Laurens yields visible results and that the use of medication can be pushed back.

Unfortunately, driving back the use of psychopharmaceuticals in dementia is not an item on the agenda throughout the Netherlands. The reason for this is the fact that a change of this kind is not easy. Doctors, care providers, family members, care agencies, the pharmaceutical sector and the Health Care Inspectorate (IGZ) all have their own opinion of what is desirable. Taking steps in the right direction requires a combination of acquiring knowledge of the alternative possibilities, realizing a cultural change within the team of professionals and warranting the progress for the family and the external stakeholders.

Vilans is to organize a kick-off meeting with the prominent stakeholders in October. This invitational conference will be the green light for a project that is to lead to sufficient interest in the Netherlands in pushing back the use of psychopharmaceuticals in dementia and in the care for the handicapped. In addition, a practical collection of alternatives is to be compiled in the months to come, which provides an explanation of the possible courses of action for problematic behavior. But it won't stop at that. With the introduction of pilots at care organizations that concern the cultural change and the use of alternatives, this project will lead to a change in opinions on the use of psychopharmaceuticals.

Anne-Mieke Krijgsman den Ouden MSc. works as an independent advisor and coach via WestOost Inc. and works for various care organizations in the Netherlands and North-America. Her expertise is mainly in the field of strategy, operational management and professionals. With her nursing background, she has a more than average interest for the care of dementia patients.