AI Article Synopsis
- Antipsychotic medications are commonly prescribed for dementia-related symptoms despite their limited effectiveness and safety risks; this study explores reducing their use through a specific deprescribing intervention and staff education.
- The study involved nursing staff across 23 facilities who worked with 139 long-term care residents on antipsychotics for at least 3 months and aimed to educate on non-drug interventions for managing symptoms.
- Results showed an 81.7% reduction in regular antipsychotic use over 12 months without increasing behavioral symptoms or adverse effects, indicating that a decrease in medication can be achieved safely.
Article Abstract
Objectives: Despite limited efficacy and significant safety concerns, antipsychotic medications are frequently used to treat behavioral and psychological symptoms of dementia (BPSD) in long-term residential care. This study evaluates the sustained reduction of antipsychotic use for BPSD through a deprescribing intervention and education of health care professionals.
Design: Repeated-measures, longitudinal, single-arm study.
Setting: Long-term residential care of older adults.
Participants: Nursing staff from 23 nursing homes recruited 139 residents taking regular antipsychotic medication for ≥3 months, without primary psychotic illness, such as schizophrenia or bipolar disorder, or severe BPSD.
Intervention: An antipsychotic deprescribing protocol was established. Education of general practitioners, pharmacists, and residential care nurses focused on nonpharmacological prevention and management of BPSD.
Measurements: The primary outcome was antipsychotic use over 12-month follow-up; secondary outcomes were BPSD (Neuropsychiatric Inventory, Cohen-Mansfield Agitation Inventory, and social withdrawal) and adverse outcomes (falls, hospitalizations, and cognitive decline).
Results: The number of older adults on regular antipsychotics over 12 months reduced by 81.7% (95% confidence interval: 72.4-89.0). Withdrawal was not accompanied by drug substitution or a significant increase in pro-re-nata antipsychotic or benzodiazepine administration. There was no change in BPSD or in adverse outcomes.
Conclusion: In a selected sample of older adults living in long-term residential care, sustained reduction in regular antipsychotic use is feasible without an increase of BPSD.
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| http://dx.doi.org/10.1016/j.jamda.2018.05.002 | DOI Listing |
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