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Scotland's National Dementia Strategy: One Year On Report


6. Better response to behaviours that staff and carers find challenging

6.1 The strategy aims to ensure that people with dementia receive care that is appropriate to their needs at all times and in all care settings and which recognises and protects their rights and dignity, including safeguarding rights to safe and appropriate care; maximising their involvement and say in how care and treatment is designed and delivered as far as possible; and help people retain existing capabilities and skills as far as possible.

6.2 When developing the strategy through 2009 it was clear that these principles were key to improving care and treatment when managing behaviour that challenges - in particular when prescribing psychoactive medication. The Mental Welfare Commission published Remember I'm Still Me in 2009, which told us that people in care homes were often receiving impersonal care and that, as part of that culture, there was an overuse of such medication; and the strategy included an expert working group tasked with looking at this area of care in all care settings.

6.3 As part of improving care and treatment in this area the strategy makes a commitment to a reduction of the use of psychoactive medication during 2011 (and a further reduction for future years). This commitment is designed to help drive wider changes such as involving those with dementia and their carers in promoting positive care in order to help behavioural issues from arising; always exploring therapeutic approaches as the first alternative in intervening in such circumstances; always regarding the use of psychoactives as the last treatment option and complying fully with the law in assessing someone's capacity to consent to treatment ; and always reviewing prescribing at regular intervals to assess its continued appropriateness.

6.4 In preparing the framing of the initial commitment on reducing prescribing this year, we have commissioned a specialist academic baseline assessment on the current use of psychoactive medication for those with a diagnosis of dementia. It is tasked with looking specifically at the prescribing of antipsychotics and other psychoactive drugs to people over the age of 65 with dementia over the last decade - compared to such prescribing to over-65s without dementia. This also includes assessing any evidence of changes in prescribing practice in response to regulatory warnings; and, importantly, the duration of such prescribing in each case.

6.5 Clinical decision-making in individual cases is of course taken by the relevant professional, and there are cases when the prescribing of psychoactive medication is appropriate and the best treatment option at that particular time, particularly when psychotic symptoms manifest themselves in behaviour which cannot be managed without medication. We know for example that such drugs may be helpful for some in relieving symptoms such as agitation, delusions or hallucinations, and, although there are risks, where the prescribing of psychoactive medication is appropriate, clinical decision-making will always need to weigh any risk against the risks around not prescribing.