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Antipsychotic dose reduction effective in long-term care residents with dementia

Data presented at the Alzheimer’s Association International Conference indicated deprescribing antipsychotics among long-term care residents with a history of behavioral and psychological symptoms of dementia was feasible without returning symptoms, though challenges remain.

“There is broad consensus that using antipsychotics to treat dementia symptoms should be a last resort,” Beth Kallmyer, MSW, vice president of constituent services at the Alzheimer’s Association, said in a press release. “These medicines must be used very carefully because they can blunt behaviors and cause sedation, and they carry serious safety concerns, such as increasing the risk of falls and death. Unfortunately, we still see a systematic use of these drugs in residential care facilities in the United States and around the world. With the right type of care strategies in place, difficult-to-manage behaviors are greatly reduced and the need for the drugs is significantly decreased — as was seen in this study.”

Beth Kallmyer

To reduce inappropriate use of antipsychotics and improve nonpharmacological behavior management, researchers conducted the Halting Antipsychotic use in Long-term Care (HALT) project among 24 long-term care facilities. Study participants (n = 156) were aged 60 years and older, received regular antipsychotic medication, did not have a primary psychotic illness and did not have severe neuropsychiatric symptoms indicated by a total Neuropsychiatric Inventory (NPI) score above 50 and individual domain scores for at least two of delusions, hallucinations, agitation-aggression, anxiety and disinhibition. Assessment occurred 1 month and 1 week prior to deprescribing and 3, 6 and 12 months following initial dose reduction.

Overall, 135 participants achieved antipsychotic cessation, according to researchers. Of these, 76% remained off antipsychotics up to 12 months after initial reduction.

Among 71 participants assessed 6 months after deprescribing, NPI and Cohen-Mansfield Agitation Inventory scores remained stable from baseline to follow-up.

Based on available data, more than 60% of participants were prescribed current antipsychotics after admission to long-term care.

“Results from the project presented today show there are more effective and appropriate alternatives to managing [behavioral and psychological symptoms of dementia], and with well-designed programs to reduce use of antipsychotic medications, cultural barriers can be successfully overcome. We urge prescribers in the U.S. to assess results of this program and understand how they too can continue to work towards more person-centered, non-pharmacological approaches to manage these symptoms,” Kallmyer said in the release. – by Amanda Oldt

Reference:

Brodaty H, et al. Deprescribing antipsychotics in long-term care residents with behavioral and psychological symptoms of dementia. Presented at: Alzheimer’s Association International Conference; July 24-28, 2016; Toronto.

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