Clinical impact of antipsychotic and benzodiazepine reduction: findings from a multicomponent psychotropic reduction program within long-term aged care

Abstract

Objectives: To explore the relationships between dose changes to antipsychotic and/or benzodiazepine medications and resident outcomes, including variations in neuropsychiatric symptoms, quality of life (QoL), and social withdrawal, within a multicomponent, interdisciplinary antipsychotic and benzodiazepine dose reduction program. Design: Prospective, observational, longitudinal study. Intervention: The Reducing Use of Sedatives (RedUSe) project involved 150 Australian Long-Term Care Facilities (LTCFs) incorporating auditing and benchmarking of prescribing, education, and multidisciplinary sedative reviews. Setting: A convenience sample of LTCFs (n = 28) involved in RedUSe between January 2015 and March 2016. Participants: Permanent residents (n = 206) of LTCFs involved in RedUSe taking an antipsychotic and/or benzodiazepine daily. Residents were excluded if they had a severe psychiatric condition where antipsychotic therapy should generally be maintained long-term (e.g., bipolar disorder, schizophrenia) or were considered end-stage palliative. Measurements: Neuropsychiatric symptoms (Neuropsychiatric Inventory, Cohen-Mansfield Agitation Inventory (CMAI)), QoL (Assessment of Quality of Life-4D), and social withdrawal (Multidimensional Observation Scale for Elderly Subjects-withdrawal subscale) were measured at baseline and 4 months where nursing staff completed psychometric tests as proxy raters. Results: There was no evidence that psychometric measures were worsened following dose reductions. In fact, dose reduction was associated with small, albeit non-statistically significant, improvements in behavior, particularly less physically non-aggressive behavior with both drug groups (−0.36 points per 10% reduction in antipsychotic dose, −0.17 per 10% reduction in benzodiazepine dose) and verbally agitated behavior with benzodiazepine reduction (−0.16 per 10% dose reduction), as measured with the CMAI. Furthermore, antipsychotic reduction was associated with non-statistically significant improvements in QoL and social withdrawal. Conclusions: Antipsychotic and benzodiazepine dose reduction in LTCFs was not associated with deterioration in neuropsychiatric symptoms, QoL, or social withdrawal. Trends toward improved agitation with antipsychotic and benzodiazepine dose reduction require further evaluation in larger, prospective, controlled studies.

Process Evaluation of the SImplification of Medications Prescribed to Long-tErm Care Residents (SIMPLER) Cluster Randomized Controlled Trial: A Mixed Methods Study

“…Clinical trials in RACFs are resource intensive, and effective recruitment strategies are paramount to avoid resource wastage and insufficient sample sizes [ 14 , 28 ]. The 38.4% SIMPLER participation rate is similar to several other studies in RACFs [ 4 , 12 , 15 , 29 ]. Recruitment rates were slightly higher among residents for whom third party consent was required compared to those who were able to provide consent to participate (41.8% versus 32.6%).…”

Impact of interdisciplinary approaches to deprescribing psychotropics on clinical outcomes in older residents of long-term care facilities

“…In 39% of residents in the RedUSe study who were prescribed antipsychotics or benzodiazepines at baseline, these medicines had been stopped or were prescribed at a lower dose at 6-month follow-up. In the current paper, Hoyle and colleagues explore the impact of the intervention and subsequent reduction in antipsychotic and benzodiazepine use on resident quality of life, neuropsychiatric symptoms, and social withdrawal at 4 months compared to baseline (Hoyle et al, 2020). At baseline and 4month follow-up, nursing staff in the 28 LTCFs were asked to complete the psychometric assessments for 206 residents included in this study.…”