Exploring Attitude and Influence of Paid 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 care staff attitudes was needed. Engagement with deprescribing varied across care homes, and care staff attitudes appeared to influence deprescribing success.

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

Results:
Of the 18 care staff 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 care staff:

• 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, care staff reported administering antipsychotics when these interventions failed or when influenced by family or when time pressured.
Most care staff 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:
More research into non-pharmacological interventions to reduce antipsychotic use for BPSD in care homes is being supported by a team from Bradford District Care NHS Foundation Trust (BDCFT).