– What lies at the bottom is a desire to help, but there is too little knowledge about the side effects and alternatives to this medicine. That’s according to Professor and Head of Research Geir Selbæk at the National Center for Aging and Health. The latest study from 47 Norwegian nursing homes shows that 19 per cent of dementia patients received antipsychotics. This medicine can be used in an emergency when there is a need to calm down dementia patients with psychoses or strong restlessness, but then all other measures must be tried first. – Far too much of this type of drug is used without the indication for its use being considered well enough. This does not only apply to nursing home residents, but it applies to the elderly in general, says Selbæk. news has told that two women with dementia at Namso’s health center only became more crooked and crooked over the course of a few months, after being given antipsychotics. This side effect of the medication is not equally known to all doctors, according to the senior doctor at the National Competence Service for Movement Disorders. Research manager Geir Selbæk at the National Center for Aging and Health believes that too many elderly people are given antipsychotics. Photo: Aleksandr Nedbaev Concerned Both random samples and the study from 47 nursing homes show that the use of antipsychotics is persistent over time for some. – The worst thing is that some patients with dementia are left on the medicine for a long time, without the benefits and side effects having been assessed well enough, says the head of research. Antipsychotics can only be used short-term for a few weeks, according to national guidelines. In Norway, only Ripserdal is approved for use in dementia patients with Alzheimer’s. Other types of antipsychotics are also used, but then doctors must justify the choice in the patient record. These are antipsychotics Traditionally used in psychiatry against disorders such as schizophrenia and bipolar disorder. Examples of such tablets are Seroquel, Risperdal and Haldol. Dampening effect on the central nervous system by, among other things, reducing delusions, psychoses and hallucinations. In Norway, only Risperdal/risperidone of the current atypical antipsychotic drugs has an approved indication for the short-term treatment of psychotic symptoms and aggression in moderate to severe Alzheimer’s dementia (up to six weeks). Other types of tablets of this medicinal antipsychotic are also used, outside the approved indication. Doctors must then use it at their own risk, and justify the choice in the patient record. Source: Directorate of Health, Joint Catalogue. Changed posture Senior doctor Kenn Freddy Pedersen at the National Competence Service for Movement Disorders in Stavanger hopes that as little as possible of this type of tablet is used for elderly people with dementia. – Some doctors with little experience probably do not know that changes in posture over a relatively short time can be due to side effects of antipsychotics, he says. Both women at Namso’s health center received Risperdal for six and ten months in a row. In the description of the medicine in the Joint Catalogue, it is stated that a crooked back (dystonia) is a common side effect, which can affect up to one in ten people who receive the tablets. The head doctor says that some elderly people can get a crooked back due to wear and tear in the neck – and spinal column, but then it happens over many years. A crooked back is not part of dementia, he says. – If there is a relatively rapid change in posture or movement pattern, then all warning lights should light up, he says. Senior doctor Kenn Freddy Pedersen at the National Competence Service for Movement Disorders says that all warning lights must be on if a patient changes rapidly after receiving a drug. Photo: Kaj Hjertenes Skewness that doesn’t go away The head doctor says that the crooked back will go away if you stop taking the medicine, but that doesn’t always happen. – What is perhaps less well known is that these symptoms can last a very long time after stopping treatment (months to years), and in some cases be irreversible, says the senior doctor. A woman at Namso’s health center still has a severe fracture in her neck more than a year after she stopped taking antipsychotics. Treatment with Botox has not helped. – Older people, and especially those with dementia, are more vulnerable to side effects than those who are younger and mentally fitter, says senior doctor Kenn Freddy Pedersen. HAS STOPPED THE TABLETS: One year after she stopped taking antipsychotics, the woman is still as crooked. Photo: Private Asking for a national overview There is no national overview that shows the use of medicine in nursing homes. Professor and senior researcher Hege Salvesen Blix at the Institute of Public Health says it is possible to create simple solutions to get a comprehensive overview of drug use in nursing homes. – The data is already there, but it is not collected in one place. It can help us see if there are large, local differences. We can use this to give feedback to those who prescribe medicine in nursing homes, says Blix. She thinks it is sad that they lack an overview of the use of medicine for the most fragile patients, who are most exposed to side effects. Blix receives support from the head of research at the National Center for Aging and Health, Geir Selbæk. He says this is very important. – I hope it will be taken seriously. There is far too much variation from nursing home to nursing home in how good the knowledge and culture are to use alternative measures, instead of medicine, Selbæk. Everyone who lives in a nursing home is entitled to a medication review at least once a year. No less than 42 per cent have not had this in the past year. Calling for better medicine routines Geir Selbæk believes that many people are confused about the rather serious anxiety symptoms that people with dementia can experience. – For someone who has very serious problems, severe anxiety or psychosis, it can mean a lot to them to suppress it, he says. Nevertheless, careful monitoring of side effects and effect of the medicine is needed, he says. – I think you can have better routines for that. You must also have a better culture to be able to consider other measures, before taking the step of using the medicine, says Geir Selbæk. There were 39,305 patients in nursing homes in 2021, and eight out of ten were patients with dementia. More people get dementia It is estimated that 101,188 people had dementia in Norway in 2020, the fourth round of the Trøndelag Health Survey (Hunt4) showed. In Norway, it is expected that the number of people with dementia will rise to almost 237,000 in 2050. Around 84 per cent of almost 40,000 elderly people living in Norwegian nursing homes are patients with dementia. The number of old age and nursing home places has decreased from 40,708 in 2015 to 39,305 in 2021. Source: National Competence Center for Aging and Health Hope doctors gain more knowledge A husband from Namsos did not understand anything when his wife in her early 60s became more and more crooked. She was given antipsychotics for ten months and eventually could not lift her head. – It is just sad if some doctors’ lack of knowledge has caused my wife great suffering for many months, he says to news. He thought the dementia disease had escalated. He is asked to tell his story. He intends to do that during a national conference in geriatric and nursing home medicine in Trondheim in March. He has taken many pictures and videos of his wife. – I can’t rewind time, but I hope doctors gain more knowledge, says the husband. He believes that medicine is given in good faith, and that many people do not know enough about the alarming side effects, such as crooked backs and damage to the motor skills of the nervous system in the upper body. Now he and two other husbands have complained to the State Administrator, after their wives received antipsychotics for many months at Namso’s health center last year. Two suffered crooked backs, while one suffered open wounds on the face. Hey, you! Do you have thoughts about the case you’ve read, or tips for something we should look into more closely? Please contact!
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– Not all doctors know that a crooked back is a side effect of antipsychotics – news Trøndelag
