Inappropriate long-term use of antipsychotic drugs is common among people with dementia living in specialized care units

Abstract

BackgroundAntipsychotic drugs are widely used for the treatment of Behavioral and Psychological Symptoms of Dementia (BPSD), despite their limited efficacy and concerns about safety. The aim of this study was to describe antipsychotic drug therapy among people with dementia living in specialized care units in northern Sweden.MethodsThis study was conducted in 40 specialized care units in northern Sweden, with a total study population of 344 people with dementia. The study population was described in regard to antipsychotic drug use, ADL function, cognitive function and BPSD, using the Multi-Dimensional Dementia Assessment Scale (MDDAS). These data were collected at baseline and six months later. Detailed data about antipsychotic prescribing were collected from prescription records.ResultsThis study showed that 132 persons (38%) in the study population used antipsychotic drugs at the start of the study. Of these, 52/132 (39%) had prescriptions that followed national guidelines with regard to dose and substance.After six months, there were 111 of 132 persons left because of deaths and dropouts. Of these 111 people, 80 (72%) were still being treated with antipsychotics, 63/111 (57%) with the same dose. People who exhibited aggressive behavior (OR: 1.980, CI: 1.515-2.588), or passiveness (OR: 1.548, CI: 1.150-2.083), or had mild cognitive impairment (OR: 2.284 CI: 1.046-4.988), were at increased risk of being prescribed antipsychotics.ConclusionThe prevalence of antipsychotic drug use among people with dementia living in specialized care units was high and inappropriate long-term use of antipsychotic drugs was common.

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

“…10 Despite international recommendations that promote nonpharmacological approaches as the preferred first-line treatment for BPSD, 11 inappropriate antipsychotic prescribing and review practices are commonplace. Up to 50% of people with dementia in longterm care are prescribed antipsychotic medications, [1][2][3]12 sometimes for much longer than the recommended duration 13,14 and to treat non-indicated BPSD. 13,15,16 Antipsychotic medication can be deprescribed without reemergence of BPSD for most people with dementia.…”

“…Up to 50% of people with dementia in longterm care are prescribed antipsychotic medications, [1][2][3]12 sometimes for much longer than the recommended duration 13,14 and to treat non-indicated BPSD. 13,15,16 Antipsychotic medication can be deprescribed without reemergence of BPSD for most people with dementia. [17][18][19][20][21][22] 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.…”

The Effects of Public Reporting on Physical Restraints and Antipsychotic Use in Nursing Home Residents with Severe Cognitive Impairment

“…In March 2012, CMS launched a multifaceted initiative aimed at reducing the unnecessary use of antipsychotic medications in NHs, including the inclusion of an antipsychotics measure in NHC, raising public awareness, regulatory oversight, technical assistance, training, and research . Nonetheless, rates of antipsychotic use remain unacceptably high in NHs …”

Health Conditions, Treatment, and Care of Residents With Dementia in Group Living–Based Care Facilities (Group Homes): Perspectives of Group Home Managers, Japan

“…Antipsychotic drugs, and particularly atypical antipsychotics, are effective for BPSD treatment (Gustaffsson, Karlsson, & Lovheim, 2013;Lawlor, 2004) and are used clinically. However, antipsychotic drugs also increase the incidence of cerebrovascular accidents and the mortality rate and also induce oversedation.…”