Henry Brodaty1, Liesbeth Aerts2, Fleur Harrison3, Tiffany Jessop2, Monica Cations2, Lynn Chenoweth4, Allan Shell2, Gordana C Popovic5, Megan Heffernan3, Sarah Hilmer6, Perminder S Sachdev7, Brian Draper8. 1. Dementia Centre for Research Collaboration, School of Psychiatry, University of New South Wales Sydney, New South Wales, Australia; Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales Sydney, New South Wales, Australia; Academic Department for Old Age Psychiatry, Prince of Wales Hospital, Randwick, New South Wales, Australia. Electronic address: h.brodaty@unsw.edu.au. 2. Dementia Centre for Research Collaboration, School of Psychiatry, University of New South Wales Sydney, New South Wales, Australia. 3. Dementia Centre for Research Collaboration, School of Psychiatry, University of New South Wales Sydney, New South Wales, Australia; Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales Sydney, New South Wales, Australia. 4. Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales Sydney, New South Wales, Australia. 5. Stats Central, Mark Wainwright Analytical Centre, University of New South Wales Sydney, New South Wales, Australia. 6. Kolling Institute, Royal North Shore Hospital and University of Sydney, St Leonards, New South Wales, Australia. 7. Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales Sydney, New South Wales, Australia; Neuropsychiatric Institute, Prince of Wales Hospital, Randwick, New South Wales, Australia. 8. Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales Sydney, New South Wales, Australia; Academic Department for Old Age Psychiatry, Prince of Wales Hospital, Randwick, New South Wales, Australia.
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.
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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