New research indicates that individuals living with dementia are being treated with potent antipsychotic medications for periods exceeding recommended guidelines.
The study further suggests that prescribed doses are often higher than advised, and the practice of stopping and then restarting these drugs is “common”.
While antipsychotics can help manage the behavioural and psychological symptoms of dementia, the National Institute of Health and Care Excellence (Nice) advises their use only for severe agitation or distress, and strictly under specialist supervision.
Analysis by experts from University College London (UCL) looked at data from 9,819 people living with dementia aged between 60 and 85, who received their first antipsychotic prescription between 2000 and 2023.
The study found initial treatments lasted seven months, exceeding the Nice guidance of one to three months.
The analysis also showed almost one in five (18%) patients were given an initial prescription higher than the minimum effective dose.
Researchers said the findings, published in the Lancet Psychiatry, “highlight a persistent gap between clinical guidelines and real-world prescribing of antipsychotics in people living with dementia, underscoring the need for interventions that prioritise safety and person-centred dementia care”.
Dr Juan Carlos Bazo-Alvarez, of UCL’s department of primary care and population health, added: “Looking at about two decades of primary care data, we found that many people with dementia remain on antipsychotics longer than guidance recommends, and that stopping and restarting treatment is common.
“These insights from routine records can help clinicians make safer, more person-centred decisions about prescribing and reviewing medication.”
Of those who started on a moderate/high dose, some 519 (29 per cent) had a moderate/high dose in all quarters of the first year of treatment.
Among patients who stopped the drugs, more than half (56 per cent) restarted medication later.
Professor Irene Petersen, of UCL’s department of primary care and population health, added: “Our research highlights that there is a substantial gap between clinical guidelines and what is happening in practice.
“Perhaps it is time we re-evaluate the guidelines once again.”