My new post on The Lancet Student discusses a new internet based therapy for chronic fatigue syndrome. Have a read:
http://www.thelancetstudent.com/blog/digital-doctors-can-internet-based-therapy-be-effective-chronic-fatigue-syndrome
Thursday 22 March 2012
Tuesday 13 March 2012
To prescribe or not to prescribe?
Looking
after the elderly, particularly in care homes, has been a hot topic recently as
we debate the future of our ageing population and reform of the NHS. Thus it
has become more important than ever that we provide a standard of care for the
elderly that is both effective in providing high- quality care and value for
money.
Many patients in care homes are
affected by dementia, which is not surprising since the onset is a direct
consequence of age. Non- pharmacological treatments are usually the first line
of treatment for patients with dementia, but often the symptoms are severe
enough to warrant treatment with anti- psychotics, and as a consequence around
one third of patients suffering from dementia in care homes are treated with
anti- psychotics.
But are we failing to provide an
acceptable standard of care by prescribing so many drugs? New research carried
out in the US suggests that this may be the case. Huybrechts et al utilised the Medicaid database (a database
of medical benefits) to examine the mortality rates of patients over 65
receiving anti- psychotic treatment for dementia in care homes between 2001 and
2005. They found that patients who were receiving treatment with haloperidol
had double the risk of morbidity compared with patients receiving although they
were less likely to exhibit psychiatric symptoms.
This paper appears to be making
an important point: that prescribing anti- psychotics to dementia patients is
actually detrimental to their health and is increasing mortality in care homes.
However, the research is crying out for a control that is not another anti-
psychotic treatment and that more closely resembles more conventional standards
of care. This paper can inform us of differences in the number fatalities
between different anti- psychotics, but lacks the design to tell us that
patients taking these drugs are worse off than those on other treatments (as
was claimed by the BBC).
This paper does send an
informative message- that prescribing already fragile elderly patients powerful
anti- psychotics with potentially debilitating side effects is an ill-advised
strategy in many cases. However, we need further research with study designs
that are able to show us the bigger picture, as well as research into a
legitimate alternative to taking anti- psychotics before we can make decisive
changes in policy. Sadly, this prospect
is probably further off than we think.
original paper (open access):
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