While dementia can occur in any family, a new study recently published in the journal Clinical Epidemiology suggests that significant racial differences exist in terms of quality of care that dementia patients receive. A team of researchers at University College London analysed data from 53,718 people across the UK who had a dementia diagnosis, and 1,648,889 people without dementia, drawing from The Health Improvement Network primary care database and collected between 2014 and 2016. Based on their findings, Asian people with dementia were 14% less likely than white patients to be prescribed anti-dementia drugs when they were potentially beneficial, and received them for an average of 15 fewer days per year. Also, when compared to White groups, Asian and Black individuals with dementia were no more likely to be prescribed antipsychotic drugs, but those that had were prescribed them for 17 and 27 days/year more, respectively.
Although anti-dementia drugs - cholinesterase inhibitors or memantine - are the only class of medication available for treating early symptoms of dementia such as memory or other cognitive declines, other medications such as antipsychotics are often prescribed to treat some of the associated behavioural and psychological symptoms. The use of antipsychotic drugs in dementia patients remains controversial in many cases given that they can be overused as a means of "calming down" and making them more manageable. Socioeconomic factors may also come into play in facilities with insufficient staffing or care provided.
In discussing the new study findings, lead researcher Patricia Cooper expressed concern over the racial disparities in dementia care and the overuse of antipsychotic medication. "Rates of antipsychotic prescribing in all ethnic groups exceeded recommendations for treating the often very distressing behavioural and psychological symptoms of dementia, such as agitation or challenging behaviours, which are the most common reasons antipsychotic drugs are prescribed to people living with dementia," she said. "While there has been a very sharp reduction in antipsychotic prescribing in the UK over the past 10 years, these figures suggest there is still work to do to ensure that people with dementia only receive potentially harmful antipsychotic drugs if there are no acceptable alternatives."
Co-author Dr Mary Elizabeth Jones (UCL Institute of Epidemiology & Health Care) has also weighed in on the dangers of overprescribing antipsychotic medication. "While we have yet to find out whether taking antipsychotic drugs for a few weeks more increases the associated risks, which can include falls, cognitive decline, strokes and even death, it's a potentially significant inequality which we should take seriously, " she said. " More work may need to be done to ensure that guidelines are being consistently met, and that dementia services are culturally competent."
While previous studies looking at American and Australian dementia patients have also found disparities in drug treatment for minority ethnic groups, this is the first time the issue has been investigated in a large UK study. It also highlights the need for greater vigilance on the part of family members to avoid the dangers associated with overmedication and to make sure that their loved ones with dementia are getting the best possible care.
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