Exploring Attitude and Influence of Carers on Antipsychotics in Behavioural and Psychological Symptoms of Dementia (BPSD)

Introduction:
Understanding why Bradford is a national outlier in antipsychotic prescribing in dementia is a priority for the West Yorkshire Integrated Care Board (WYICB).
Following a successful deprescribing project in 36 care homes in 2024/25—where 60% of antipsychotics were discontinued—it became evident that better understanding of carer attitudes was needed. Engagement with deprescribing varied across care homes, and carers’ attitudes appeared to influence deprescribing success.

Method:
A qualitative study was designed to explore carer attitude and influence. Interviews were conducted with 18 carers from 5 care homes across Bradford District and Craven where deprescribing had largely succeeded.

Results:
Of the 18 carers interviewed:

• 89% had received in-house dementia training.
• 94% routinely checked for physical and environmental causes of BPSD.
• 78% wanted more training on non-pharmacological interventions.
• 94% wanted more training on the harmful effects of antipsychotics.
• 100% felt non-pharmacological interventions were not always successful.

Reasons for antipsychotic administration by carers:

• 100% had administered when non-pharmacological interventions were ineffective and the patient remained distressed.
• 28% had administered due to family pressure.
• 6% had administered due to lack of staff resource/time pressures.

Conclusion:
Non-pharmacological interventions are recommended by NICE as first-line treatment for BPSD. However, carers reported administering antipsychotics when these interventions failed or when influenced by family or when time pressured.
Most carers interviewed were dementia-trained and had supported successful deprescribing, although many requested further education on antipsychotic harms and non-pharmacological approaches.

Training appears to enable deprescribing, while staff shortages and family pressure may act as barriers, but more research is needed.

Next Steps:
A bid to the Health and Social Care Delivery Research Programme (HSDR) to conduct a realist review of interventions to reduce antipsychotic use in care homes has been submitted and is supported by a team from Bradford District Care NHS Foundation Trust (BDCFT).