Only 10% of the psychotropic drug use for neuropsychiatric symptoms in patients with dementia is fully appropriate. The PROPER I-study

Spek, Klaas van der; Gerritsen, Debby L.; Smalbrugge, Martin; Nelissen-Vrancken, Marjorie; Wetzels, Roland B; Smeets, Claudia H. W.; Zuidema, Sytse U.; Koopmans, Raymond T.C.M.

doi:10.1017/s104161021600082x

Cited by 61 publications

(45 citation statements)

References 24 publications

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“…However, given the many known side-effects (Seitz et al, 2013), inconclusive treatment efficacy (Seitz et al, 2013), and high rate of inappropriate prescription of medication (Moyle et al, 2017a;van der Spek et al, 2016), psychosocial interventions have been advocated as the first-line treatment for managing BPSD (Livingston et al, 2014;Oyebode & Parveen, 2016).…”

Section: Care: Reflections From a Cluster-rct Introductionmentioning

confidence: 99%

Using a therapeutic companion robot for dementia symptoms in long-term care: reflections from a cluster-RCT

Moyle

Jones

Murfield

et al. 2017

Aging & Mental Health

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Section: Care: Reflections From a Cluster-rct Introductionmentioning

confidence: 99%

Using a therapeutic companion robot for dementia symptoms in long-term care: reflections from a cluster-RCT

Moyle

Jones

Murfield

et al. 2017

Aging & Mental Health

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“…2,4,5 A recent study concluded that only 10% of psychotropic agents prescribed for RACF residents with dementia were completely appropriate, particularly with respect to indication and therapy duration. 13 The Reducing Use of Sedatives (RedUSe) intervention was designed to promote the appropriate use of antipsychotics and benzodiazepines in RACFs. "Sedatives" in the RedUSe acronym encompasses both antipsychotics and benzodiazepines.…”

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confidence: 99%

RedUSe: reducing antipsychotic and benzodiazepine prescribing in residential aged care facilities

Westbury

Gee

Ling

et al. 2018

Medical Journal of Australia

108

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Objective: To assess the impact of a multi‐strategic, interdisciplinary intervention on antipsychotic and benzodiazepine prescribing in residential aged care facilities (RACFs). Design, setting: Prospective, longitudinal intervention in Australian RACFs, April 2014 – March 2016. Participants: 150 RACFs (with 12 157 residents) comprised the main participant group; two further groups were consultant pharmacists (staff education) and community pharmacies (prescribing data). Data for all RACF residents, excluding residents receiving respite or end‐stage palliative care, were included. Intervention: A multi‐strategic program comprising psychotropic medication audit and feedback, staff education, and interdisciplinary case review at baseline and 3 months; final audit at 6 months. Main outcome measure: Mean prevalence of regular antipsychotic and benzodiazepine prescribing at baseline, and at 3 and 6 months. Secondary measures: chlorpromazine and diazepam equivalent doses/day/resident; proportions of residents for whom drug was ceased or the dose reduced; prevalence of antidepressant and prn (as required) psychotropic prescribing (to detect any substitution practice). Results: During the 6‐month intervention, the proportion of residents prescribed antipsychotics declined by 13% (from 21.6% [95% CI, 20.4–22.9%] to 18.9% [95% CI, 17.7–20.1%]), and that of residents regularly prescribed benzodiazepines by 21% (from 22.2% [95% CI, 21.0–23.5%] to 17.6% [95% CI, 16.5–18.7]; each, P < 0.001). Mean chlorpromazine equivalent dose declined from 22.9 mg/resident/day (95% CI, 19.8–26.0) to 20.2 mg/resident/day (95% CI, 17.5–22.9; P < 0.001); mean diazepam equivalent dose declined from 1.4 mg/resident/day (95% CI, 1.3–1.5) to 1.1 mg/resident/day (95% CI, 0.9–1.2; P < 0.001). For 39% of residents prescribed antipsychotics and benzodiazepines at baseline, these agents had been ceased or their doses reduced by 6 months. There was no substitution by sedating antidepressants or prn prescribing of other psychotropic agents. Conclusions: The RedUSe program achieved significant reductions in the proportions of RACF residents prescribed antipsychotics and benzodiazepines. Trial registration: Australian New Zealand Clinical Trials, ACTRN12617001257358.

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“…Despite the Dutch guidelines that recommend a maximum use of 3 months, we found that 10% of the persons were treated with antipsychotics continuously (Zuidema et al, 2018). We know from a study in Dutch nursing homes that appropriate prescription of psychotropic drugs according to guidelines is difficult, as only 10% of the prescriptions were appropriate, including 58% for a correct duration of therapy (van der Spek et al, 2016).…”

Section: Discussionmentioning

confidence: 99%

Psychotropic drug use in community-dwelling people with young-onset dementia: two-year course and determinants

Gerritsen¹,

Bakker²,

Bruls³

et al. 2019

Aging & Mental Health

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Objectives: The aim of this study was to describe the course of psychotropic drug use in people with young-onset dementia and to explore possible associations with age, sex, dementia severity, dementia subtype and neuropsychiatric symptoms. Methods: Psychotropic drug use was studied in 198 community-dwelling persons participating in the Needs in Young-onset Dementia study. Data about psychotropic drug use were retrieved at baseline, as well as at 6, 12, 18 and 24 months and was classified into five groups (antiepileptics, antipsychotics, anxiolytics, hypnotics/sedatives and antidepressants) and quantified as 'present' or 'absent'. Generalized Estimating Equation modeling and chi-square tests were used to study associations between the determinants and psychotropic drug use. Results: There was a statistically significant increase in the prevalence of psychotropic drug use from 52.3% to 62.6% during the course of the study. Almost three-quarters (72.4%) of the participants were treated with any psychotropic drug during the study, and more than one-third (37.4%) received psychotropic drugs continuously. Antipsychotics were used continuously in more than 10% of the participants and antidepressants in more than 25%. Increasing age was positively associated (p ¼ .018) with psychotropic drug use at baseline, while apathy symptoms were negatively associated (p ¼ .018). Conclusions: Despite the recommendations of various guidelines, the prolonged use of psychotropic drugs in community-dwelling people with young-onset dementia is high. Therefore, more attention is needed to timely evaluate psychotropic drug use and the introduction of self-management programs for caregivers should be encouraged to support caregivers in dealing with the neuropsychiatric symptoms caused by the dementia.

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Only 10% of the psychotropic drug use for neuropsychiatric symptoms in patients with dementia is fully appropriate. The PROPER I-study

Abstract: The minority of the PD use was fully appropriate. The results imply that PD use for NPS in dementia can be improved; the appropriateness should be optimized with a clinical focus on the appropriate indications, evaluations, and therapy duration.

Cited by 61 publications

References 24 publications

Using a therapeutic companion robot for dementia symptoms in long-term care: reflections from a cluster-RCT

Using a therapeutic companion robot for dementia symptoms in long-term care: reflections from a cluster-RCT

RedUSe: reducing antipsychotic and benzodiazepine prescribing in residential aged care facilities

Psychotropic drug use in community-dwelling people with young-onset dementia: two-year course and determinants

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