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Alternatives to the chemical cosh

7 November 2011
By Bob Erens

There is wide concern about anti-psychotic drugs being prescribed far too readily for patients with dementia, particularly in care homes. The so-called ‘chemical cosh’ has been blamed by government-commissioned research for the premature deaths of 1,800 people a year.

And the side-effects on an estimated 180,000 UK dementia sufferers can be profound, including social withdrawal, accelerated cognitive decline as well as dizziness and unsteadiness that can lead to falls.

That’s why the Care Services Minister, Paul Burstow, wants a dramatic two-thirds reduction in prescription levels. But what can be offered instead for patients with dementia who may wander or become agitated or aggressive?

The Department of Health has asked PIRU to look at alternatives to these antipsychotic drugs. There are lots of potential options including massage, music therapy, light therapy, physical activity and exercise interventions, cognitive training interventions, better behaviour management therapy as well as specific training and education for care givers.

The big question is what works, in what circumstances and for which patients? We hope to come up with some answers and also identify the research gaps so that these drugs are used only as the last resort.

PIRU is bringing speed and expertise to reviewing a vast swathe of existing research (there are already over 30 literature reviews of more than 400 research papers). We should be able to nail down what is known and what requires further study. We have excellent partners at the EPPI-Centre, Institute of Education and at Collaborations for Leadership in Applied Health Research and Care: Cambridgeshire and Peterborough (CLAHRC CP).

The PIRU investment will be money well-spent if, at the end of our project, we can make a real difference to vulnerable people’s lives and help turn Paul Burstow’s laudable policy ambition into a practical reality. Our work could give doctors, nursing staff and carers the confidence to employ better treatments that enhance dignity and well-being during the twilight years of life.

Bob Erens is Deputy Director of PIRU