Dispensing of antipsychotics to people with dementia
People with dementia may experience changed behaviours, such as aggression, agitation and delusions, commonly known as behavioural and psychological symptoms of dementia (BPSD). To manage these symptoms, non-pharmacological interventions are recommended, but medical professionals may prescribe antipsychotic medicines to people with dementia with BPSD as a last resort. However, inappropriate prescribing of antipsychotic medicines is a major problem among people living in residential aged care and a key issue raised in the Royal Commission into Aged Care Quality and Safety (Royal Commission 2021) (see Box 8.2 for more information). Risperidone is the only antipsychotic that is currently listed on the PBS for BPSD.
In 2019–20, antipsychotic medications (which are part of the psycholeptics group) were dispensed to about one-fifth (21%) of the 64,600 people who had scripts dispensed for dementia-specific medication (Figure 8.8). This includes all antipsychotic medications and not just Risperidone.
Around 56% or 7,700 of the people dispensed antipsychotic medications were women. The proportion of people within each age group who were prescribed scripts for antipsychotics decreased slightly with increasing age. The average age of people dispensed antipsychotic medications was 80 for men and 81 for women – the same age as men and women who were dispensed scripts for dementia-specific medication (age 80 for men and 81 for women).
In each age group, men were relatively more likely to be dispensed scripts for antipsychotics at least once than women (Figure 8.8a). However, as more women have dementia, overall more women were dispensed antipsychotic medication than men.
Antipsychotics were more likely to be dispensed to people who were also taking Memantine (35% of people on Memantine) compared with other dementia-specific medicines (27% of people on Rivastigmine, 20% of people on Galantamine and 19% of people on Donepezil) (Figure 8.8b). This probably reflects the fact that Memantine is prescribed for moderately severe to severe Alzheimer’s disease, whereas the other 3 dementia-specific medications are prescribed for mild Alzheimer’s disease.
Although Risperidone is the only antipsychotic listed on the PBS for BPSD, scripts for other antipsychotic medications were dispensed to people with dementia. Around 39% of people with scripts dispensed for antipsychotic medication and dementia-specific medication were supplied Risperidone, followed by Quetiapine (29%) and Olanzapine (24%) (Table S8.11).
Figure 8.8: People who were dispensed dementia-specific medications in 2019–20: percentage who were dispensed antipsychotic medication (a) by age and sex and (b) by dementia-specific medication