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Treatment and medication

Diagnosis, post-diagnostic support

In addition to other aspects of the health and social care system addressed, many strategies also included aspects related to the clinical treatment, management and medication often used for people with dementia.

Pharmacological interventions

The over prescription and use of anti-psychotic medications was a key focus for a number of strategies. For example, the Welsh strategy commits to ensuring that health boards provide access to evidence-based psychosocial and pharmacological interventions, as well as responding to the recommendations of a parliamentary inquiry. On this latter point, the Irish strategy also commits to the national health executive developing guidance on the appropriate management of medication for people with dementia, in particular on psychotropic medication management.

The Danish strategy commits to reducing the consumption of anti-psychotic medicines amongst people with dementia by five percent before 2025, with funding committed for the monitoring and reviewing of prescribing. Similarly, the English strategy commits to a reduction in the inappropriate prescribing of antipsychotic medication, including a reduction in the variation across different parts of the country.

Both the Cypriot and Portuguese strategies commit to ensuring that people with dementia have access to both pharmacological and non-pharmacological interventions to treat and manage the symptoms of people with dementia depending on appropriateness. Similarly, the Czech strategy commits to ensuring that both non-pharmacological and pharmacological disease treatments are compensated by public health insurance, with consistent standards of treatment between neurology, psychiatry and geriatrics. The Maltese strategy commits to the inclusion of all approved medications for the treatment of Alzheimer’s disease in the government formulary list. Additionally, the Israeli strategy specifically commits to the expansion of drug therapy to delay disease progression and addressing the accompanying symptoms as needed.

The German strategic document included improving information on diagnostic options as well as on pharmacological and non-pharmacological treatments, offering the right support and assistance. Partners committed to exploring how to reduce restrictive measures by both pharmacological and physical means. This includes a Federal Government commitment to funding research into reducing pharmacological interventions, as well as clinical guidance being issued by national medical associations. Similarly, the Slovenian strategy committed to the development of recommendations to ensure interdisciplinary services to adequately treat the person with dementia in line with their symptoms, including the provision, monitoring and review of dementia-specific medications.

Following on from the latter point, the Maltese strategy also proposes that people with dementia should have their medications reviewed every six months, alongside cognitive screening measures. In relation to this, the strategy calls for stronger regulation over the use of antipsychotics in individuals with dementia, through policies whereby justification for starting antipsychotics would be clearly documented. Similarly, Northern Ireland highlights the need for medications for dementia to be prescribed appropriately, with medication reviews as an integral part of the care management process and a range of interventions available to people with dementia and their carers.

The Scottish strategy commits to commissioning and publishing a renewed study on trends in the prescribing of psychoactive medications for people with dementia.

Whilst the French neurodegenerative strategy was more broad in its commitment to ensuring that high quality treatment was available across all areas, the Spanish neuro-degenerative strategy primarily focused on pharmacological interventions, committing to ensuring the availability of relevant medications, as well as establishing recommendations on their use across primary and secondary healthcare. As part of this, it also committed to establishing communication mechanisms between different professional teams regarding medications management.

Non-pharmacological interventions

The Greek strategy proposes to establish a network of 30 day care centres by 2020, operated and funded by a mixture of public, private and non-profit sector organisations. The commitment has been included here to reflect its position within the Greek strategy; the model proposed focuses on treatment and rehabilitation for people with dementia, with a multidisciplinary team (including psychologists, nurses, occupational therapists and social workers) of working within the centres, linking into local memory clinics, with their doctors covering the medical needs which may arise.

Similarly, Italy focuses on the promotion of appropriate interventions (particularly within residential settings) through the development of guidelines and consensus documents regarding the main preventive and care priorities and monitoring these through agreed quality indicators.

The Israeli strategy also focuses on increasing referrals to non-medical treatment, such as psychosocial intervention and the treatment of behavioural and psychological symptoms of dementia. Similarly, the English strategy has a focus on ensuring that where a person with dementia’s needs are complex, skilled assessment and care ensures that the person is not subject to inappropriate care or inappropriately prescribed medication.

Other

The Finnish strategy gave responsibility to local authorities and hospitals to ensure that waiting times are observed at all stages of the clinical pathway of people living with dementia, with access to rehabilitation provided on equal terms to other patient groups. As part of this, these authorities will have responsibility for setting up and introducing clinical pathways for treating people with memory disorders and dementia.

In addition to pharmacological interventions, the Spanish neurodegenerative strategy highlighted the need to provide additional services for people with moderate symptoms to prevent falls and manage other symptoms.

The Luxembourg strategy provides a broad commitment to establishing national standards which guarantee the quality of medical care of people with dementia in line with international standards.

The Maltese strategy contains a commitment to remove age limits for the access to all services for individuals with dementia and make sure that the needs of individuals with early onset dementia are met.

The Scottish strategy also commits to reviewing whether there is a need for a review of national clinical guidelines on specific elements of clinical dementia treatment. Along similar lines, the Northern Irish strategy commits to conducting an audit of interventions available for dementia care across all settings, including nursing and residential care.

 

 
 

Last Updated: Monday 29 April 2019

 

 
 

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