Dementia care: anti-psychotics a "last resort"

With about $20 million a year spent on anti-dementia medications and almost 95,000 people with dementia hospitalised, more needs to be done to provide quality health care, advocates say.

It follows the release of two Australian Institute of Health and Welfare (AIHW) reports.

The institute said dementia was a major cause of ill health and death in Australia, affecting up to 436,000 Australians in 2018 and causing more than 13,700 deaths in 2017.

Its Hospital care for people with dementia 2016-17 report found there were 94,800 admissions to hospital of people with at least one diagnosis of dementia.

“Nine in 10 (92%) hospitalisations involved at least one overnight stay, with an average length of stay of 13 days,” AIHW spokesman Richard Juckes said.

Dementia was recorded as the principal diagnosis in about one in five (22%) hospitalisations. For the other 78% of hospitalisations, dementia was recorded as an additional diagnosis.

Most patients hospitalised with dementia had an average of eight additional health conditions, commonly related to the urinary system (42%) and type 2 diabetes (24%).

Where dementia was an additional diagnosis, the most common principal diagnosis was related to injury (21%), and more than one in three (36%) of these were for a leg fracture.

Juckes said one in three (33%) hospitalisations were for unspecified dementia and one in four (27%) were for Alzheimer’s disease, the most common form of dementia.

One in two (48%) hospitalisations ended with the patient going home, about one in three (29%) with the patient continuing care in hospital, about one in five (17%) ended in a new admission to residential aged care and 6% ended with the patient dying in hospital.

The institute’s Dispensing patterns for anti-dementia medications 2016-17 report examined dispensing patterns for four anti-dementia medications and the associated costs to people and the government.

“These four prescription medications were dispensed a total of 546,000 times in 2016–17, at a cost of $20 million,” Juckes said.

“Donepezil accounted for 65% of all anti-dementia medications dispensed, followed by Galantamine (15%), Rivastigmine (12%) and Memantine (8%).

“About 80% of anti-dementia medications were prescribed by general practitioners and 42% by other medical specialists because people could be prescribed by more than one prescriber.”

Dementia Australia CEO Maree McCabe said the AIHW reports reinforced that more needed to be done to provide quality care for people living with dementia.

“With the number of people living with dementia expected to increase to an estimated 1.1 million by 2058, this data reinforces for us that we must act now to improve medication management and support for people living with dementia in hospital environments,” she said.

A Dementia Australia paper, Medication use by people living with dementia, made recommendations including that anti-psychotics were used as a last resort and quality training in dementia care was provided for all staff working in hospitals.

“Our focus must be on the delivery of the best possible care and quality of life at every stage of dementia,” McCabe said.

“The use of anti-psychotic medications in the majority of instances is contrary to achieving these outcomes.

“There are many non-pharmacological interventions that must be considered as first-line options when some of the challenging symptoms of dementia may present.”

A second Dementia Australia paper, Hospital care for people living with dementia, included recommendations that the physical environment of hospitals adhered to dementia-friendly design principles and that hospitals provided mandatory staff training in dementia.

“It is only through a collaborative approach to dementia care in hospitals, which centres on the involvement of people living with dementia, their families and carers, that we can ensure quality of life and limit unnecessary and dangerous situations,” McCabe said.

Image credit: ©stock.adobe.com/au/Bulat