Reasons for (not) discontinuing antipsychotics in dementia

Janus, Sarah I M; Manen, Jeannette G. van; Zuidema, Sytse U.; Snijder, Carina; Drossaert, Constance H.C.; IJzerman, Maarten Joost

doi:10.1111/psyg.12280

Cited by 7 publications

(4 citation statements)

References 33 publications

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“…Overall, the proposed models in this study explained very little of the variance in psychotropic medication use or in the use of opiates. Additional factors that should be considered in future research are beliefs of the staff, access to behavioral health providers, the use of person centered behavioral interventions, activities provided, length of stay of the resident, and timing of medication initiation (Almutairi et al, 2018; Atramont et al, 2018; Helvik et al, 2017; Janus et al, 2018; Kerns et al, 2018; MacLagan et al, 2017; Zhang, Letuchy, & Carnahan, 2018).…”

Section: Discussionmentioning

confidence: 99%

Current Psychotropic Medication Use and Contributing Factors Among Nursing Home Residents With Cognitive Impairment

et al. 2019

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This study described current use and predictors of psychotropics among residents with moderate to severe cognitive impairment. This was a secondary data analysis using baseline data from the first 341 residents in an ongoing trial. Predictive measures included age, gender, race, depressive symptoms, agitation, resistiveness to care, depression, cognition, pain, comorbidities, facility factors, and state. Overall 63% ( n = 211) received at least one psychotropic medication, 16% ( n = 52) an anti-seizure medication, 23% ( n = 77) an anxiolytic, 30% ( n = 99) an antidepressant, 2% ( n = 8) a sedative hypnotic, 28% ( n = 93) an antipsychotic medication, and 9% ( n = 29) an opioid. Testing of models explained 9% to 15% of psychotropic medication use. There were high rates of psychotropic medication use and a limited association between demographic factors, behavioral symptoms, and psychotropic medication use. Continued research is needed to explore the impact of deprescribing, person-centered behavioral interventions, and beliefs of providers on psychotropic medication use.

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Section: Discussionmentioning

confidence: 99%

Current Psychotropic Medication Use and Contributing Factors Among Nursing Home Residents With Cognitive Impairment

et al. 2019

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“…A study that considered the factors regarding PD use found that nurses and general practitioners in nursing homes tended to have a low willingness to discontinue antipsychotics because of barriers such as concerns about negatively affecting residents’ quality of life and the recurrence of BPSD . Furthermore, organizational factors in nursing homes such as the number of physicians and physicians’ perceived beliefs about the positive effects of drugs for patients and care staff could influence the use of antipsychotics . In addition to these studies on antipsychotic use, the qualitative study by Smeets et al developed a conceptual framework for factors related to PD prescription in nursing homes, including physicians’ and nurses’ perceptions, knowledge of PDs and their side‐effects, decision‐making on PD use and withdrawal, and national and local policies .…”

Section: Discussionmentioning

confidence: 99%

Association between changes in the use of psychotropic drugs and behavioural and psychological symptoms of dementia over 1 year among long‐term care facility residents

2018

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Aim: Pharmacological treatments are often used in treating the behavioural and psychological symptoms of dementia (BPSD) in nursing homes, despite the fact that non-pharmacological treatments are recommended as a firstline treatment and can provide a suitable alternative. Because the course of BPSD is known to fluctuate depending on individual symptoms over time, the frequencies of drug use and BPSD, as well as their association, should be observed over a longer period. We investigated the association between the changes in psychotropic drug (PD) use and BPSD, focusing on the number of symptoms, severity, and care burden over 1 year among longterm care facility residents. Methods: A 1-year follow-up study was conducted among older residents with dementia or similar symptoms (n = 312 at baseline; n = 237 at followup) by using a care staff questionnaire in 10 long-term care facilities in Hokkaido, Japan. Medication use was determined based on prescription information. The brief questionnaire form of the Neuropsychiatric Inventory was used to assess BPSD. Results: Among residents followed up for 1 year, new users of PDparticularly anxiolytics and hypnotics-had a significantly increased number and severity of BPSD, compared with non-PD users. Continuing PDs was also related to increased severity over the year. Among residents with any persistent BPSD for 1 year, new use of PDs-particularly anxiolytics and hypnotics-was significantly associated with an increased care burden of BPSD, compared with the non-use of PDs. The discontinuation of PDs was significantly associated with a decreased care burden, compared with the non-use of PDs. Conclusions: Our study suggests that PDs, particularly anxiolytics and hypnotics, may be prescribed carefully in response to exacerbation of BPSD in terms of the number of symptoms, severity, and care burden in long-term care facilities. Continuous monitoring of PDs use and BPSD is important to effectively address BPSD. The ratio of psychotropic drug users either at baseline or follow-up to total participants. ‡ The ratio of psychotropic drug users at follow-up to non-users at baseline. § The ratio of psychotropic drug users at follow-up to users at baseline. ¶ The ratio of psychotropic drug non-users at follow-up to users at baseline.Psychotropic drug use in a care facility

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“…In people with dementia, antidepressants are not very effective at treating depression [6], and atypical antipsychotics have a negligible effect on agitation and psychosis [7]. Non-patient related factors can also influence PTD prescriptions, such as staff-patient ratio and staff distress related to patients' symptoms [8,9], the knowledge gap among NH personnel about the related adverse effects of medication [10], communication education [11], and health care personnel's positive belief or confidence in prescribing or discontinuing medication [12,13]. Moreover, it can be challenging to monitor a drug therapy, as different screening tools for inappropriate prescribing may recommend different pharmacological measures [14].…”

Section: Introductionmentioning

confidence: 99%

Do prescription rates of psychotropic drugs change over three years from nursing home admission?

et al. 2021

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Background In this longitudinal study, we describe how psychotropic drugs (PTDs) are prescribed in nursing home (NH) patients from admission and over a 3-year period, to understand which clinical and environmental factors are associated with PTD prescription. Methods We used data from the Resource Use and Disease Course in Dementia – Nursing Home (REDIC-NH) study, examining physical and mental health, dementia, and PTD prescription during a 3-year period from admission to a NH. Data were collected every six months. At baseline, we included 696 participants from 47 Norwegian NHs. We presented prevalence, incidence, and deprescribing rates of PTD prescriptions for each assessment point. We calculated the odds of receiving PTDs and used a generalized linear mixed model to analyze the variables associated with a change in odds throughout the 3-year period. Results PTD prescriptions were frequent throughout the 3-year period. Antidepressants had the highest prescription rates (28.4%–42.2%). Every PTD category had the highest incidence rate between admission and six months, and antipsychotics had the highest values (49.4%). Deprescribing rates were comparable between assessment points. The odds of antipsychotic prescriptions were lower for older people (OR = 0.96, 95%CI:0.92–0.99, p = 0.023). People with more severe dementia had lower odds of being prescribed sedatives/hypnotics (OR = 0.89, 95%CI:0.85–0.94, p < 0.001). Conclusions PTDs, particularly antidepressants, are widely prescribed over time to NH patients. Older patients are less likely to receive antipsychotics. A higher severity of dementia decreases the odds of being prescribed sedatives/hypnotics. Close attention should be paid to PTD prescriptions during long-term NH stay to avoid prolonged and excessive treatment with these types of drugs. Trial registration ClinicalTrials.gov Identifier: NCT01920100.

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Reasons for (not) discontinuing antipsychotics in dementia

Cited by 7 publications

References 33 publications

Current Psychotropic Medication Use and Contributing Factors Among Nursing Home Residents With Cognitive Impairment

Current Psychotropic Medication Use and Contributing Factors Among Nursing Home Residents With Cognitive Impairment

Association between changes in the use of psychotropic drugs and behavioural and psychological symptoms of dementia over 1 year among long‐term care facility residents

Do prescription rates of psychotropic drugs change over three years from nursing home admission?

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