Antipsychotic Deprescription for Older Adults in Long-term Care: The HALT Study

Brodaty, Henry; Aerts, Liesbeth; Harrison, Fleur; Jessop, Tiffany; Cations, Monica; Chenoweth, Lynn; Shell, Allan; Popović, Gordana; Heffernan, Megan; Hilmer, Sarah N.; Sachdev, Perminder S.; Draper, Brian

doi:10.1016/j.jamda.2018.05.002

Cited by 72 publications

(78 citation statements)

References 31 publications

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“…These participants did not differ significantly from those who were fully deprescribed in age, time at the facility, time in the HALT study, or type or dose of antipsychotic except that they were less likely to be female. There were no differences in baseline BPSD between groups, as reported previously . No marked differences were noted between represcribing subgroups (ie, discontinued deprescribing vs represcription of regular antipsychotic vs use of PRN antipsychotic; Material S1), although the small size of some of these precluded statistical comparisons.…”

Section: Resultssupporting

confidence: 60%

“…The CMAI item “trying to get to a different place” was erroneously excluded from the questionnaire package, so the total score was pro‐rated for all participants. A complete overview of the primary and secondary outcomes and assessment measures has been published …”

Section: Methodsmentioning

confidence: 99%

“…Antipsychotic medication can be deprescribed without re‐emergence of BPSD for most people with dementia . In the Halting Antipsychotics in Long‐Term care (HALT) withdrawal trial, regular antipsychotic medication was successfully deprescribed for 81.7% of participants at 12 months following intervention . Deprescription of antipsychotics did not lead to re‐emergence of BPSD or to increased agitation, as assessed with the Neuropsychiatric Inventory (NPI) and Cohen‐Mansfield Agitation Inventory (CMAI) …”

Section: Introductionmentioning

confidence: 99%

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Why deprescribing antipsychotics in older people with dementia in long‐term care is not always successful: Insights from the HALT study

Aerts

Cations

Harrison

et al. 2019

Int J Geriat Psychiatry

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Introduction Antipsychotic medications are commonly used to manage behavioural and psychological symptoms of dementia despite their side effects and harms. While the Halting Antipsychotic Use in Long‐Term care (HALT) deprescribing trial was successful at reducing antipsychotic use, 19% of participants had their antipsychotics represcribed or never reached a dose of zero. The aim of this study was to investigate the reasons for represcription of antipsychotic medication and factors associated with ongoing antipsychotic use, relating to care staff requests and perceived behavioural changes. Materials and methods Thirty‐nine of 133 HALT participants never ceased their antipsychotic medication or were represcribed a regular or pro re nata (PRN) antipsychotic after initial deprescribing. The views of nursing staff, general practitioner, and family on the circumstances leading up to these outcomes were collected via a questionnaire‐based approach. This information was triangulated with observation and detailed file audit (including progress notes, medical notes, medication charts, incident reports, and hospital discharge summaries). A consensus panel reconstructed the represcribing context. Results Nurses were the most common drivers of represcribing (63.2%), followed by family members (39.5%), GPs (23.7%), specialists (13.2%), and hospital staff (10.5%). There were multiple drivers for antipsychotic use in 46.2% of participants. Increased agitated and aggressive behaviours were the most commonly reported reasons for represcribing even though these changes were not identified over time on objective measures. Consent and dosage practices remained poor despite education. Discussion Nursing staff are the key drivers of deprescribing particularly in response to perceived worsening agitation and aggression among male residents. The train‐the‐trainer model used in the HALT trial may have been insufficient on its own to improve staff competence and confidence in applying nonpharmacological approaches when responding to behaviour change.

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Section: Resultssupporting

confidence: 60%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Why deprescribing antipsychotics in older people with dementia in long‐term care is not always successful: Insights from the HALT study

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Harrison

et al. 2019

Int J Geriat Psychiatry

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“…When a person with dementia is labelled with terms like "wanderer", "screamer", "hitter" or "sundowner," this can have a tangible negative impact on the way other people interact with them. 19 Simultaneously, the RedUSe program has seen the rates of regular antipsychotic prescription in 150 Australian aged care homes decline by 13%, while the rates of regular benzodiazepine prescription reduced by 21%. At the same time, it is less likely that others, including aged care staff, will seek to understand a person with dementia who has been labelled.…”

Section: Important Issues Raised By the #Banbpsd Campaignmentioning

confidence: 99%

Language paradigms when behaviour changes with dementia: #BanBPSD

Cunningham

Macfarlane

Brodaty

2019

Int J Geriat Psychiatry

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“…Since The BMJ last published an editorial on deprescribing in 20142 at least three systematic reviews have been published345 as well as several studies not included in these reviews 678. Here we consider the latest evidence and guidance on withdrawing drug treatments.…”

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confidence: 99%