The disparities in drug prescribing suggest that Asian and black people with dementia are not getting the same quality of care as white patients. This is according to a new study led by UCL in the UK. Asian people who have dementia are less likely to get anti-dementia drugs, and they take them for shorter periods. The findings were published in Clinical Epidemiology.
The dementia patients from black ethnic groups who are given antipsychotic drugs, which are used to treat dementia-related distress instead of the primary symptoms. They take them for up to 4 weeks longer per year compared to white people in the United Kingdom, thus exceeding the suggested limits on how long antipsychotic drugs should be taken. The lead author of the study, Professor Claudia Cooper, said that their findings are concerning as they appear to reflect the inequalities in the care that people get to treat symptoms linked to dementia.
The alarming rate of racial disparities
The researchers analyzed data from 53,718 people all over the UK who had dementia, and 1,648,889 people without dementia, drawing from The Health Improvement Network primary care database and collected between the years of 2014 and 2016. They found that Asians with dementia were 14% less likely than white patients to be given anti-dementia drugs when they were beneficial, and they got them for an average of 15 fewer days per year.
Anti-dementia drugs, memantine or cholinesterase inhibitors, are the only class of medication available for treating dementia, as they can help with cognitive abilities and memory, while other medications like antipsychotics are sometimes given to treat some of the associated psychological and behavioral symptoms.
Previous studies in America and Australia have also found disparities in drug treatment for dementia for minority ethnic groups, but this is the first time that the issue has been investigated in a large UK study.
The researchers say that the greater socioeconomic disadvantages experienced by ethnic groups that are considered as the minority may lead to barriers to getting proper care, while cultural and language barriers could also contribute to these disparities.
The researchers also found that both Asian and black people with dementia were given antipsychotic drugs for longer than white patients, by 27 and 17 days more, which could put them at greater risk of harmful side effects. As they did not show any significant differences in rates of an initial prescription of antipsychotics, the researchers say that the findings of their study may show differences in the chance of medication being stopped and reviewed when they are no longer needed.
Professor Cooper explained that the rates of antipsychotic prescribing in all ethnic groups exceeding recommendations for treating the often distressing behavioral and psychological symptoms of dementia, like agitation or challenging behaviors, which are the common reasons antipsychotic drugs are prescribed to people with dementia.
While there has been a sharp reduction in antipsychotic prescribing in the UK over the past 10 years, these figures suggest there is still work to do to make sure that people with dementia do not receive harmful antipsychotic drugs if there are no acceptable alternatives.
Investigating antipsychotic drugs
The first author of the study, Dr. Mary Elizabeth Jones commented that while they have yet to find out whether taking antipsychotic drugs for a few weeks more increases the associated risks, which can include falls, strokes, cognitive decline, and even death, it is a potentially significant inequality which we should take seriously. There should be more work to be done to make sure that guidelines are being met consistently, and that dementia services are culturally competent.
Another author of the study, Professor Jill Manthorpe of the NIHR Health and Social Care Workforce Research Unit, King's College London, stated that health professionals should question whether the antipsychotic drugs are being given instead of other forms of support and medicine that could address causes of the distressing symptoms.
She also said that families too should ask if there are other alternatives like social prescribing that may put people in contact with activities and sensory experiences which can help reduce the feelings of distress. Culturally meaningful activities may be helpful, like hearing or playing music or enjoying the experience of tactile objects.
