Certain medications are inappropriately prescribed for EHPAD residents with a neuroprogressive disease: however, they have serious side effects and instead of reducing behavioral problems, they cause more of them according to a recent Canadian study . If the recommendations in this area evolve, practices struggle to change.
Antipsychotics, also called neuroleptics, are often prescribed to EHPAD residents suffering from neurodegenerative disease (dementia, Alzheimer’s, etc.), which represent nearly 40% of elderly people in nursing homes in 2023. Among people suffering from neurodegenerative diseases, at least 60% will experience Psychological and Behavioral Symptoms (PCS) which can be difficult to manage for caregivers and caregivers.
Problematic behaviors include irritability, aggression, agitation, delusions, hallucinations, anxiety and depressionloss of sleep or appetite, apathy, wandering, repetitive questioning or even sexually inappropriate behavior and refusal of care.
The phenomenon of overprescription of neuroleptics in nursing homes is not new. The problem was identified in 2009 by the High Authority of Health (HAS) which then estimated the proportion of Alzheimer’s patients on neuroleptics at 18% and reminded prescribers that, apart from proven psychosis or delusional syndrome, “the frequent observed use of neuroleptic drugs or other sedatives is not indicatedespecially in the long term” and implemented a program to improve professional practices. THE plan Alzheimer 2008-2012 also made the reduction in the prescription of antipsychotics one of these objectives, demonstrating that the problem had been clearly identified.
Various research carried out at the time shows the extent of these bad practices : 28% of EHPAD residents suffering from neuroprogressive illness were on long-term antipsychotics in the Toulouse region (PLEIAD study, 2010), and 24% in the Midi-Pyrénées region (IQUARE study, 2012) for example.
Nothing indicates that the various alerts have profoundly changed practices : a study on patients suffering from Alzheimer’s shows, on the contrary, an increase in prescriptions between 2010 and 2014, while an article in the doctor’s daily newspaper in 2017 deplored, based on a study carried out in Marseille, that “the prescription of antipsychotics in demented patients in nursing homes, although completely off-label, (Editor’s note, that is to say outside their official indication) is widely used.
Today, the phenomenon in France is difficult to assess, because there has been no recent study to our knowledge, but it remains very worrying. Antoine Piau, geriatrician at Toulouse University Hospital…
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