Antipsychotics and other medications dispensed to people with dementia
What other medications were dispensed to people who were dispensed scripts for dementia-specific medications?
As people living with dementia often have other co-existing conditions, they are likely to be prescribed a range of other medicines. The most common type of medications dispensed to people who were dispensed dementia-specific medications in 2023–24 were for the cardiovascular system (dispensed at least once to 80% of men and 78% of women). This was followed by nervous system medications (73% of men and 77% of women) and, alimentary tract and metabolism medications (64% of men and 63% of women) (Table S8.8).
Dispensing of antipsychotics to people living with dementia
Psychoanaleptics are one of the most common subgroup of other medications dispensed to people who were dispensed dementia-specific medications (53% of people, Table S8.9). These medications are used to treat depression and other neurological and mental disorders, and include antipsychotic medications.
People living 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 concern for older people and a key issue raised in the Royal Commission into Aged Care Quality and Safety (Royal Commission 2021) (see Antipsychotic medication for people with dementia and inappropriate prescribing of antipsychotics). Risperidone is the only antipsychotic that is currently listed on the Pharmaceutical Benefits Scheme (PBS) for BPSD.
In 2023–24:
- Antipsychotic medications (which are part of the psycholeptics group) were dispensed to about 1 in 5 (20%) of the 77,500 people who had been dispensed dementia-specific medications. This includes all antipsychotic medications and not just Risperidone.
- Around 55% or 8,700 of the people dispensed antipsychotic medications were women. Older people were less likely to be dispensed antipsychotic medications on average – decreasing from 24% of people aged 30–64 to 20% of people aged 85 and over.
- In each age group, men were more likely to be dispensed scripts for antipsychotics at least once than women (Figure 8.7). However, as more women have dementia, overall more women were dispensed antipsychotic medications than men.
Antipsychotics were more likely to be dispensed to people who were also taking Memantine (33% of people on Memantine) compared with other dementia-specific medicines (26% of people on Rivastigmine, 17% of people on Galantamine and 17% of people on Donepezil) (Figure 8.8; Table S8.11). This likely reflects the fact that Memantine is prescribed for moderately severe Alzheimer’s disease, whereas the other three dementia-specific medications are prescribed for mild to moderately severe 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 36% of all antipsychotic scripts that were dispensed to people also on dementia-specific medications were for Risperidone, followed by Quetiapine (30%) and Olanzapine (25%) (Table S8.12).
Figure 8.7: People who were dispensed dementia-specific medications: percentage who were dispensed antipsychotic medications by age and sex in 2023–24
The bar charts show the proportion of people prescribed scripts for dementia-specific and antipsychotic medication is highest in men and women aged 65–69 and lowest in men and women aged 80–84.
| Age | Men | Women |
|---|---|---|
| 30–64 | 24.1% | 24.1% |
| 65–69 | 24.7% | 21.8% |
| 70–74 | 22.3% | 21.0% |
| 75–79 | 21.2% | 20.0% |
| 80–84 | 19.9% | 18.7% |
| 85+ | 20.1% | 19.4% |
| Total | 21.0% | 19.8% |
Source:
AIHW analysis of PBS data maintained by the Australian Government Department of Health, Disability and Ageing
Notes:
- Anti-psychotic medication is defined as ATC code N05A.
- This figure refers to the percentage of people who were dispensed both antipsychotic medication and dementia-specific medication out of all people who were dispensed a dementia-specific medication that year.
Figure 8.8: People who were dispensed dementia-specific medications: percentage who were dispensed antipsychotics by dementia-specific medication in 2023–24
This bar chart shows that the most dispensed dementia-specific medication among people who were also dispensed an antipsychotic was Memantine.
| Dementia-specific medication | Per cent (%) |
|---|---|
| Memantine | 33.0% |
| Rivastigmine | 26.3% |
| Donepezil | 16.8% |
| Galantamine | 16.6% |
Source:
AIHW analysis of PBS data maintained by the Australian Government Department of Health, Disability and Ageing
Notes:
- Anti-psychotic medication is defined as ATC code N05A.
- This figure refers to the percentage of people who were dispensed both antipsychotic medication and dementia-specific medication out of all people who were dispensed a dementia-specific medication that year.
Antipsychotic medicines should only be prescribed to people with dementia following the unsuccessful attempt of managing symptoms of dementia using non-pharmacological treatments, as the combined use of dementia-specific and antipsychotic medicines increases the risk of serious adverse effects, including death. This risk increases over longer periods of use (Dementia Australia 2024; Dyer et al. 2016). Risperidone, which is a type of antipsychotic medicine, is the only antipsychotic currently listed on the PBS that may be prescribed to a person with dementia who displays persistent behavioural disturbances such as psychotic symptoms, restlessness and aggression (known as either ‘changed behaviours’ or ‘behavioural and psychological symptoms of dementia’ (BPSD)). However, inappropriate prescribing of antipsychotics to people living in residential aged care (where over half of people have dementia) is a major issue in Australia.
To reduce inappropriate prescribing of antipsychotic medicines to people with dementia, changes were made to the PBS for prescribing of Risperidone for managing changed behaviours. As of January 2020, prescribers will need to request authority approval from Services Australia to prescribe ‘continuing’ PBS-subsidised Risperidone treatment (beyond 12 weeks of initial use) to people with dementia (Department of Health and Aged Care 2019).
Dementia Australia (2024) Pharmacological treatments for dementia, Dementia Australia website, accessed 26 June 2024.
Department of Health and Aged Care (2019) Revised risperidone PBS listing for behavioural and psychological symptoms of dementia from 1 January 2020 [media release], Department of Health and Aged Care, accessed 10 July 2023.
Dyer SM, Laver K, Pond CD, Cumming RG, Whitehead C and Crotty M (2016) Clinical practice guidelines and principles of care for people with dementia in Australia, Australian Family Physician, 45(12):884–889.
Royal Commission (Royal Commission into Aged Care Quality and Safety) (2021) Final report: Care, Dignity and Respect. Volume 1 Summary and recommendations, Royal Commission, Australian Government, accessed 10 July 2023.