A new study has warned of the potentially harmful effects of dementia patients taking off-label antipsychotic medications, particularly for those living in home or community-based residencies.

Researchers from the Department of Geriatrics and Gerontology at Rowan University School of Osteopathic Medicine, found that the mortality rate was 1.6 times higher in those with dementia who were taking off-label antipsychotics compared to those who were not.

A problem outside of care homes

While antipsychotic medications are now rarely used in care homes due to the increased awareness of their negative effects through various educational campaigns, they are still widely used by those with dementia in more private settings, such as at home.

This is often the result of families being unable to cope with a loved one exhibiting behavioural and psychological problems, often referred to in medical terms as BPSD.

BPSD usually occurs in the middle and late stages of dementia, and causes people to exhibit aggressive or psychotic behaviours and interpret their surroundings differently, which can make caring for someone with the condition difficult.

Rise in antipsychotic drugs

What also causes problems for carers is they see no other alternative but to turn to off-label antipsychotic drugs, unaware that there are other options available.

Author of the study, Rengena Chan-Ting, D.O., says that the rise in antipsychotic medication use outside of care homes is also due to physicians being limited in what they can prescribe to help:

“Physicians are often limited in the medication treatments that are available for a patient suffering from behavioural and psychological symptoms of dementia, especially for a community dwelling patient,” he said.

“It’s not unreasonable for them to try antipsychotic medications, with caveats. However, older patients are especially vulnerable to the adverse effects of these medications, which greatly increase their risk of death.”

Currently 37% of spending on antipsychotic medication goes towards off-label use.

More promising alternatives

The dangers of off-label antipsychotic medications are what encouraged Regena Chan-Ting and her researchers to look into alternatives to help combat behavioural and psychological problems in people with dementia.

They found that interventions that do not use drugs, such as stimulation in the form of sensory therapy for dementia, were viable alternatives.

“There is a growing body of evidence that non-drug approaches can be more effective than antipsychotics, which benefit only 20-30 percent of patients,” said Chan-Ting.

Non-invasive techniques

She also suggested that other non-invasive techniques, such as cognitive and emotional therapy and various calming techniques can help quell behavioural and psychological problems, without the need for drugs.

Reminiscence therapy, which encourages those with dementia to think back on experiences from their past with the use of prompts, such as newspaper clippings or photographs, has been found to also be beneficial.

“I recommend physicians partner with the patient and caregivers to find the best combination of approaches, involving the patient, and team involved, in decision making to the fullest extent possible,” said Chan-Ting.