Less Is More: The Impact of Deprescribing Psychotropic Drugs on Behavioral and Psychological Symptoms and Daily Functioning in Nursing Home Patients. Results From the Cluster-Randomized Controlled COSMOS Trial

Gedde, Marie Hidle; Husebø, Bettina S.; Mannseth, Janne; Kjome, Reidun Lisbet Skeide; Naik, Mala; Berge, Line Iden

doi:10.1016/j.jagp.2020.07.004

Cited by 35 publications

(40 citation statements)

References 34 publications

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“…The deterioration in BPSD could in theory be caused by the progression of the dementia syndrome itself, rather than being exacerbated by the pandemic restrictions. Arguing against this, change in BPSD over 4 months was substantially lesser in an observational cohort of nursing home residents of which the majority had dementia than what we demonstrate comparing prepandemic and pandemic symptom levels 27…”

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confidence: 57%

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Section: Discussioncontrasting

confidence: 57%

“…Arguing against this, change in BPSD over 4 months was substantially lesser in an observational cohort of nursing home residents of which the majority had dementia than what we demonstrate comparing prepandemic and pandemic symptom levels. 27 …”

Section: Discussionmentioning

confidence: 99%

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“…Psychotropic drugs increases mortality [9] and reduce patients' physical [10,11] and cognitive performances [12]. De-prescribing has been proposed in order to reduce severe adverse events within a multicomponent intervention, showing improved health outcomes in old patients affected by cognitive impairment and BPSD [13]. Together with deprescribing, several guidelines recommend the use of non-pharmacologic interventions as first line treatment for BPSD [14][15][16].…”

Section: Introductionmentioning

confidence: 99%

The doll therapy as a first line treatment for behavioral and psychologic symptoms of dementia in nursing homes residents: a randomized, controlled study

Santagata

Massaia

2021

BMC Geriatr

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Background Patients living with dementia are severely affected by the development of behavioral and psychologic symptoms (BPSD) which represent a burden for patients and caregivers. The use of psychotropic drugs in the control of BPSD is widely diffused, however the use of a first line non-pharmacologic approach is highly recommended. Here we evaluate the effect of doll therapy (DT) in the management of BPSD, on the reduction of caregiver burden and delirium incidence in nursing home residents by a randomized controlled trial. Methods We enrolled fifty-two nursing homes residents living with dementia and BPSD. Subjects were randomized to DT (26) or standard treatment (ST, 26), we measured BPSD, caregiver burden and delirium with standard clinical scales at baseline, after 45 and 90 days. In order to evaluate the presence of BPSD we used Neuropsychiatric Inventory (NPI) scale and the A.Di.CO scale, the caregiver burden was measured by the Greutzner scale and delirium by the Confusion Assessment Method (CAM) scale. Results DT was more effective in reducing agitation and aggressiveness as respect to ST. Moreover DT globally reduced the presence of BPSD as dysphoria, wandering and apathy. We observed a significant reduction of the professional caregiver burden and the incidence of delirium was significantly reduced in subjects treated with DT. Conclusions We show that DT is more effective that ST in the control of BSPD in patients affected by moderate to severe dementia. Moreover we suggest that DT may effective in reducing the incidence of delirium. Trial registration Retrospectively registered in ClinicalTrials.gov the 10th June 2, 2021 trial registration number NCT04920591.

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“…For instance, the WHELD trial demonstrated that antipsychotic drug withdrawal was most beneficial for BPSD and mortality for PwD living in nursing homes when social interactions were promoted in parallel [ 16 ]. Similarly, physician-led medication reviews embedded in the multicomponent COSMOS trial reduced psychotropic drug use without compromising BPSD, and additionally improved communication between health personnel, nursing home patients, and their relatives [ 17 , 18 ]. Additionally, communication is an integral part of the work of all Norwegian general practitioners (GPs) in providing continuity in medical care to their enlisted home-dwelling patients.…”

Section: Introductionmentioning

confidence: 99%

The impact of medication reviews by general practitioners on psychotropic drug use and behavioral and psychological symptoms in home-dwelling people with dementia: results from the multicomponent cluster randomized controlled LIVE@Home.Path trial

Gedde

Husebø

Mannseth

et al. 2022

BMC Med

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Background There is limited knowledge regarding the process of deprescribing psychotropic drugs to people with dementia (PwD) conducted by general practitioners (GP). We investigated the impact of a multicomponent intervention, emphasizing medication reviews, on psychotropic drugs and behavioral and psychological symptoms (BPSD) in home-dwelling PwD and quantified change in patient-GP communication evaluated by their informal caregivers. Methods LIVE@Home.Path is a stepped-wedge closed-cohort cluster randomized controlled trial for people with mild to moderate dementia aged ≥65 and their informal caregivers (dyads) in Norway. Complementary to health care as usual (control condition), municipal coordinators implemented the multicomponent LIVE intervention: Learning, Innovation, Volunteer support, and Empowerment (including medication review by the PwD’s regular GPs). Block-randomization was used to allocate dyads in three groups receiving the intervention sequentially in periods of 6 months duration. Prepandemic data from the first period is reported, resulting in a 1:2 intervention-to-control ratio. Primary outcome was change in psychotropic drug use. Secondary outcomes were changes in BPSD by Neuropsychiatric Inventory and Cornell Scale of Depression in Dementia and patient-GP communication by an adaption of the Clinical Global Impression of Change. Results Four hundred thirty-eight dyads were screened, 280 included, and 237 participated at 6 months (intervention group n=67; control condition n=170). At baseline, 63% used psychotropic medication regularly: antidementia drugs (47%), antidepressants (13%), hypnotics/sedatives (13%), antipsychotics (5%), and anxiolytics (2%). At 6 months, medication reviews were more frequently conducted in the intervention group compared to control (66% vs 42%, P=0.001). We found no differences regarding a change in drug use and BPSD. Patient-GP communication enhanced in the intervention group (mean score 0.95 [standard deviation 1.68] vs 0.41 [1.34], P=0.022). In the intervention group, control group, and overall sample, the informal caregivers of those who had their medications reviewed reported improved patient-GP communication compared to those who did not. Conclusions Change in psychotropic drug use and BPSD did not differ, even though patient-GP communication improved with medication reviews. Restricted psychotropic drug use among PwD likely reflects more judicious prescribing practices in recent years. Nevertheless, medication reviews could be cultivated to optimize pharmacologic treatment for this complex population. Trial registration ClinicalTrials.gov: NCT04043364; registered 15/03/2019.

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Less Is More: The Impact of Deprescribing Psychotropic Drugs on Behavioral and Psychological Symptoms and Daily Functioning in Nursing Home Patients. Results From the Cluster-Randomized Controlled COSMOS Trial

Cited by 35 publications

References 34 publications

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The doll therapy as a first line treatment for behavioral and psychologic symptoms of dementia in nursing homes residents: a randomized, controlled study

The impact of medication reviews by general practitioners on psychotropic drug use and behavioral and psychological symptoms in home-dwelling people with dementia: results from the multicomponent cluster randomized controlled LIVE@Home.Path trial

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