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 Europe Struggles With High Antipsychotic Rates, Study Finds

Nearly two out every five European elders who suffer from dementia are being given antipsychotic drugs, a new study has found.
Scanning the case records of 791 seniors in eight European countries, researchers at the RightTimePlaceCare Consortium found that more than 37 percent had been given prescriptions for antipsychotics. The prevalence varied wildly—from nearly 12 percent in Sweden to 54 percent in Spain—but the overall use of antipsychotic medicines in Europe was actually higher than in the United States (about 33 percent).
Provider advocates and regulators here in the states have set lofty goals to help get those with dementia off antipsychotics; the RightTimePlaceCare study demonstrates that the problem of off-label antipsychotics is a global one.
The RightTimePlaceCare study was published in the latest issue of JAMDA, the Journal of the American Medical Directors Association.
It’s not clear why Europe has such high rates, or such high variance of rates. But corresponding author Maria Soto, a gerontologist at Toulouse University Hospital in France, speculates that antipsychotic rates are high in Germany (47 percent), Estonia (nearly 48 percent), and Spain because those countries lack a national policy on antipsychotic reduction.
The study also found that the odds of having residents on antipsychotics decreased precipitously in those care centers that featured dementia-specific wards.
That finding, which may be the first of its kind, “could have clinical implications because the major mission of these units is the management of [neuropsychiatric symptoms] with a nonpharmacological approach, such as the environment, and to reduce psychotropic prescription,” Soto writes.
“There is evidence to support the effectiveness of psychosocial interventions for reducing [antipsychotic] medication in care home residents, and all consensus guidelines propose the nonpharmacological treatment as first line treatment,” Soto concludes.
Closer to home, some advocates saw the European study as confirmation that American providers were right to target antipsychotic use in their quality initiatives.
“Long term care centers have been dedicated to safely reducing the use of these medications and focusing more on person-centered care,” says Steven Chies, a Minnesota provider. “Having specific dementia care units and staff trained on dementia care has helped make our significant progress possible. We hope other countries can look to the U.S. as an example of how we can improve dementia care.”
Bill Myers is Provider’s senior editor. Email him at wmyers@providermagazine.com. Follow him on Twitter, @ProviderMyers.
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