In 2013, the Irish National Audit of Dementia found that 29% of a sample of people with known dementia (identified through national hospital discharge data) were receiving antipsychotic medication prior to acute hospitalisation (compared to 9.4% in England and Wales). Of these, 41% were discharged on higher doses of an antipsychotic, while 12% of patients not prescribed an antipsychotic before admission were discharged with a new regular prescription. Concerningly, the indication for the new antipsychotic medication was only documented in 78% of cases. Assessments for treatable underlying causes of non-cognitive symptoms were poorly performed – ruling out delirium (45%), or pain (76%), assessing mood (26%), and seeking information from family about distress-provoking factors (3%) or calming actions (2%).
A National Clinical Guideline was launched in December 2019 to guide the appropriate use of psychotropic medication for non-cognitive symptoms in a person with dementia (in any setting). This is complemented by a clinical algorithm for clinical staff and a “patient and family information leaflet” for a person living with dementia or caring for a person with dementia, or the general public.
A sister guidance document on non-pharmacological interventions is also available.
There is also a specific psychotropic self-audit tool for use in acute hospitals, along with a user manual (to be available from Spring 2020).