'It’s a chemical cosh': How Covid increased the use of antipsychotics among people with dementia

Karen's mum, Marion, was given an antipsychotic drug in a care home during the first lockdown

Words by ITV News Politics Producer Dominique Heckels 

Locked down and locked up, people living in care homes have had to face a particularly lonely Covid pandemic. Although care homes are doing all they can to lift spirits, the ban on visits from family and friends has had a detrimental impact on residents. 

When asked if the physical or mental health of residents had been impacted during the pandemic, in an exclusive survey of over 100 care homes for ITV's Tonight programme by the National Care Association, nine out of 10 homes said yes.

Despite promises on testing - six out of 10 of the homes polled still aren't allowing contact family visits.

It comes as countless families have told us of their sorrows, forced to stand by and watch loved ones deteriorate over Facetime or through windows. 

In Plymouth, Karen Rogers' mum, Marion has dementia. She hasn’t been hugged since March.

Karen Rogers can only speak with her mum Marion through an open window. Credit: Tonight

Like so many living in care homes, Marion felt abandoned. She became aggressive. 

Karen told Tonight that her mother "didn’t understand why we couldn’t go in, why we couldn't take her out  and she got frustrated and angry."

Last April, Marion violently attacked another resident – as an emergency measure she was drugged using a powerful antipsychotic prescription drug, Risperidone.

The drowsiness has left her unwilling to walk.

Karen says her Mum would "just be like a zombie she just wouldn't communicate with me properly she was just sat there staring at you she just couldn't really talk back.

"It was horrible, horrible, it  made her a shadow of her former self."

Marion did not understand why her daughter wasn't allowed inside to give her a hug. Credit: Tonight

For over six months on a journey through three care homes, Karen's mum was kept on the drugs.

Marion is now at a new care home, Colebrook Manor, where she is being weaned off the drugs. Colebrook Manor's manager, Peter Gaunt,  told us: "It’s a no-brainer."

"If you look at the advice for Risperidone, it's meant to be used for up to six weeks use. So it was never meant for such a long term solution.

"In old fashioned parlance it's called the 'chemical cosh'! So you’ve gone from a situation where you’ve got somebody who was functional to somebody who was sat  quietly in a chair and relatively easy to manage. 

"I believe Karen used the word zombie. Well, it's not a bad analogy in that we were having to do absolutely everything for her."

Before the drugs and the isolation due to Covid, Marion had been far more mobile. Credit: Tonight

Research suggests the increase in prescriptions of antipsychotics is pandemic driven.

In his paper, antipsychotic prescribing to people with dementia during Covid-19, Professor Robert Howard from UCL Institute of Mental Health, found that "although the absolute number of antipsychotic prescriptions for people with dementia decreased" in 2020 - "reductions in the overall number of registered patients meant that the proportion of patients who have been prescribed antipsychotics substantially increased. 

"The proportion of patients who have been prescribed antipsychotics had tended to be constant throughout 2018 and 2019".

In March to July 2020, this percentage increased. With "rates in March, April, and May, 2020, substantially higher than in the same months in 2018 and 2019."

Marion has dementia. She hasn’t been hugged since March. Credit: Tonight

Prof Howard told Tonight that drugging has become one of the few tools left to treat serious lockdown anxiety:  "The best treatments for agitation involve kind of human contact, good nursing care - reassurance, a hug.

"You take away those first-line reassuring treatments and you are not left with much. In fact about seven percent more people with dementia are now given antipsychotics than were before the pandemic - that’s a bad thing .

"They work basically by making people sleepy. Of course, that makes them more likely to have a fall, and there is also evidence that increases the risk of them having a stroke or dying."

For Marion, this risk has now decreased. Colebrook Manor's Manager, Mr Gaunt said:  "As soon as we got the Risperidone removed, very quickly [Marion] came to life, she started making eye contact, she recognized the family and she was able to engage with them.

"Sadly, she hasn’t regained her mobility - that could be the dementia, but it could also be the trauma of not having that family contact that is so important."

The pandemic has seen a rise in the proportion of patients on the antipsychotic drugs. Credit: Tonight

Relieved Marion is now off the drug, Karen can only try to soothe her mum with words of comfort through windows - but her own fears cannot be nursed: "It's too late for some.

"I just worry I’ll never get to hug mum again – I don’t know how long she’s got left." 

Ten months on, Karen finally got that hug. She was granted one contact visit with her mum due to exceptional circumstances - Marion’s deterioration. 

Although more alert for being taken off the Risperidone, the side effects of this lonely pandemic are still very much present - Marion is frail, weak and has lost a considerable amount of weight. 

Care Homes: The Long Year Alone - Tonight is broadcast on ITV at 7:30pm on Thursday 21 January or catch up on the ITV Hub.