But health experts are warning the drugs can carry serious risks, particularly in elderly people, and should not become a substitute for understanding what is triggering someone’s behaviour.
Scottish NHS guidance warns psychotropic medicines used in care homes can be linked to “avoidable drug related harms” including falls, fractures, strokes, cognitive decline and death.
And guidance from NHS Glasgow and Clyde guidance warns: “The use of inappropriate psychotropic medicines in care home residents is associated with poorer outcomes.”
The Care Inspectorate has now launched a new dementia toolkit designed to help carers identify alternatives before medication is considered.
The regulator said that cares for people with dementia are being “encouraged this Dementia Action Week to visit a new website and app offering “simple but effective hints and tips to reduce stress and distress without the need for medication”
The latest Care Inspectorate review into psychoactive medicines in Scottish care homes in warned of a “continued high psychoactive medication burden” among elderly residents during the pandemic.
In its analysis of 943 residents across 58 Scottish care homes, more than two-thirds were prescribed at least one psychoactive drug. Nearly one in five residents were on regular antipsychotic medication, while almost half were prescribed antidepressants.
Scotland’s care regulator has urged staff looking after people with dementia to turn to simple everyday solutions instead of medication where possible — amid continuing concern
The watchdog found in its 2023 study that 66.4% of residents were taking at least one regular psychoactive medicine, with 28% on two or more. The analysis concluded that “the levels of prescribing of psychoactive medicines for older people in care homes remains high”.
The review found average prescribing rates in the homes studied were 46.1% for antidepressants, 18.8% for antipsychotics and eight per cent for anti-anxiety drugs.
It also found 45% of residents prescribed regular antipsychotics saw no changes at all to those medicines over a 10-month period. A similar pattern was found for anti-anxiety drugs, where 44% of residents had no medication changes during the same timeframe.
The briefing states that antipsychotics “should be used at the lowest effective dose and for the shortest possible time” and that residents “should be reassessed regularly” to determine whether they still need the medication.
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Inspectors also noted concerns raised during and after the Covid pandemic about the “potential misuse of medication to sedate and/or control behaviour” while caring for vulnerable residents.
The review highlighted examples of “person-centred non-pharmacological approaches” used in some homes to manage “stress and distress”. These included using “interactive cats” to calm residents and “not wearing staff uniforms as this was found to trigger stress”.
The Care Inspectorate said the new toolkit had been developed over two years with frontline staff and advisers, with funding from the Scottish Government. It is hosted on NHS Scotland’s Right Decision Service website and app.
Jackie Irvine, chief executive of the Care Inspectorate, said: “It is well documented that medication can be used to manage incidences of stress and distress.
“The resources we have launched today point care services and those caring for people with dementia to a range of [alternative] strategies which can be used to benefit people living with dementia by helping to reduce stress and distress.
She added that the examples in the toolkit showed how understanding a person’s environment and individual experiences could make a major difference.
Scottish Government figures estimate around 90,000 people in Scotland are living with dementia.
The guide reflects wider pressure across health and social care services to reduce reliance on antipsychotics and sedatives in dementia care wherever possible.
Scots NHS guidance states that non-drug approaches should be explored before psychotropic medication is used to manage distress or behavioural changes linked to dementia.
It says carers and clinicians should consider factors such as pain, dehydration, infection, noise, fear, confusion or environmental triggers before resorting to medication.
Current NHS Greater Glasgow and Clyde guidance says: “An inclusive collaborative approach to medication review is more effective at minimising the use of inappropriate psychotropic medicines.”
The guidance also warns: “Older people are more susceptible to antidepressant associated adverse effects such as falls”, as well as “agitation” and “confusion”.
On anti-anxiety medication, it states: “Benzodiazepines can have serious side effects in older people, including drowsiness, confusion and risk of falls.”
The NHS guidance adds: “Non-pharmacological interventions should be considered” and says psychotropic medication should form part of a “holistic person centred care package”.
It also states: “Residents with dementia should have regular medication reviews” and says reviews can help identify medicines “which may no longer be appropriate”. A Care Inspectorate online toolkit, launched during Dementia Action Week which launches today (Monday), contains more than 30 videos, audio clips and practical guides showing how small changes to a person’s surroundings or care can sometimes prevent distress escalating.
Cheryl Henderson, education and dementia coordinator at Elder Homes, which operates two care homes in Edinburgh, said the Care Inspectorate resources could improve quality of life for both residents and staff.
She said: “These resources will help enhance people’s quality of life, not just those living with dementia but also those who support them.
“As there is such a wide range of videos and podcasts in one place, this ensures there is a broad range of subjects covered.”
One animation in the resource tells the story of a woman called Mary whose patterned curtains cast moving shadows in the evening, leaving her terrified because of changes in visual perception caused by dementia. Staff only resolved the issue after changing the curtains.
Another example shared by the watchdog involved a care home resident becoming upset during personal care because staff towering over them caused distress. The Care Inspectorate said switching to carers of a similar height led to the resident becoming “happier”, eating more and seeing “a reduction in psychoactive medication use”.