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Olanzapine and risperidone prescriptions for people with dementia in care

Consultant Psychiatrist and Honorary Lecturer (Leicester University), Mental Health Services for Older People, Elderly Services Centre, Rotorua Hospital, Private Bag 3023, Rotorua, New Zealand

Paul Bradley

Research Assistant, Leicester University, Department of Health Sciences, Leicester General Hospital, UK

James Lindesay

Professor of Psychiatry for the Elderly, Leicester University, Department of Health Sciences, Leicester General Hospital, UK

Declaration of interest

None.

AIMS AND METHOD

To determine what has happened to care home residents with dementia who were on risperidone or olanzapine prior to the Committee on the Safety of Medicines (CSM) guidance, and to compare with a previous audit of the practice within a community mental health team (CMHT) for older people. Residents with dementia were identified from 10 randomly selected care homes in Leicestershire, and prescriptions before and 9 months after the CSM guidance were assessed. Carers were interviewed to determine who was reviewing residents and how often a review occurred.

RESULTS

In total, 330 residents’ medication charts were assessed; 164 (50%) had documentation which identified them as having a dementia; 75 of these residents with dementia (46%) were on an antipsychotic at some time during the audit period. Before CSM advice 69% (37 out of 54) of the antipsychotics prescribed to residents with dementia were either risperidone or olanzapine; this reduced to 39% (19 out of 49) after the CSM advice. Out of those who continued on risperidone or olanzapine, the majority were under GP care only (15 out of 19) and overwhelmingly seen on an as-required basis and infrequently. In two-thirds of cases the prescriptions for antipsychotics were for behavioural and psychological symptoms of dementia. Compared with the CMHT for older people, primary care was less successful at withdrawing risperidone or olanzapine.

CLINICAL IMPLICATIONS

Further research is needed to clarify what approach would be most acceptable and cost-effective to assist British GPs in the management of this patient population.