Other therapies beat drugs for agitation and aggression
Antipsychotic drugs are commonly prescribed to people with dementia but music and massage can be at leat as effective in treating the agitation and aggression of dementia.
There’s been ongoing concern in Australian aged care facilities about chemical restraint with antipyschotic drugs to manage the behavioural symptoms of agitation and aggression in dementia. These drugs come with significant risks such as increased risk of fractures, falls and early death.
In the past decade, the rate of prescription of antipsychotics among older Australians has fallen but not by much. Recent evidence has focused on what alternatives to these drugs are available – so called non-pharmacologic treatments.
In this review of the evidence of non-pharmacologic treatments and how they compare with drugs, Canadian researchers collected a number of studies that looked at both types of treatment. They found 163 in all. Some used treatments like massage and touch therapy (using simple massage to calm and soothe a patient), music therapy (playing music to a patient that they enjoy or may have enjoyed as a younger person) and multidisciplinary care (the use of multiple health professionals, like nurses and physiotherapists, to monitor and anticipate the needs of patients).
Music therapy and massage beat drugs for agitation and aggression
Massage, touch and music therapy all performed better than drug treatments in managing dementia symptoms, while recreational therapy (physical activity, going outside) while having benefits, didn’t do as well.
One thing the researchers didn’t analyse was the cost of these treatments – but they say that they don’t have to be expensive. Indeed, loading up songs on a music player or a five-minute massage or hand-holding session with a loved one or someone you look after, can provide the therapy and even be done at home.
The other piece of the puzzle when it comes to reducing antipsychotic prescription is education of health professionals who work in aged care.
The evidence suggests many of them don’t realise just how high their prescription rate is and something as simple as showing how they compare to other facilities can help drive drug use down.
Last Reviewed: 04/08/2020
© Norman Swan Medical Communications.
For reference: Watt, et al (2019). Comparative Efficacy of Interventions for Aggressive and Agitated Behaviors in Dementia: A Systematic Review and Network Meta-analysis. Annals of Internal Medicine doi: 10.7326/M19-0993.
Certain drugs increase risk of dementia
The anticholinergic class of drugs, commonly prescribed to older people, may be linked to an increased risk of dementia when used often and in a strong formulation.
Depression in older people
Older people may be particularly prone to depression because of the increased likelihood that they will be experiencing stressful life events.
When someone experiences psychosis they are unable to distinguish what is real. Symptoms include confused thinking, delusions and hallucinations.
The best treatment for psychotic illness usually includes a combination of antipsychotic medication, psychological therapy and community support.
Alzheimer's disease is the most common form of dementia. Find out all you need to know, including what causes it and whether it can be prevented.