Reducing Antipsychotic Medication Use in Nursing Homes: A Qualitative Study of Nursing Staff Perceptions

Simmons, Sandra F.; Bonnett, Kemberlee R; Hollingsworth, Emily K.; Kim, Jennifer; Powers, James S.; Habermann, Ralf; Newhouse, Paul; Schlundt, David G.

doi:10.1093/geront/gnx083

Cited by 34 publications

(43 citation statements)

References 44 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In outpatient consultations, psychiatrists were less likely to suggest reduction or discontinuation than service users were to request it [30]. Practitioners in nursing homes felt that antipsychotic reduction could lead to a better quality of life, but were concerned about risk and potential relapse [31,32]. However there is little research directly focusing on the views of mental health professionals in secondary care on antipsychotic reduction and discontinuation (e.g.…”

Section: Introductionmentioning

confidence: 99%

Mental health professionals’ views and experiences of antipsychotic reduction and discontinuation

2019

View full text Add to dashboard Cite

Background The widely established treatment for psychosis is long-term antipsychotic medication. However, many people stop taking this treatment, and request other options. There are also growing concerns about adverse effects, but currently no professional guidelines to support reducing or stopping these drugs. The views and experiences of individual mental health professionals around reducing and stopping antipsychotics are therefore crucial in treatment decisions. Methods We conducted 7 focus groups with prescribing psychiatrists and other members of community-based statutory mental health services in London. Participants discussed their views about, experiences, and processes of antipsychotic reduction and discontinuation. Data were analysed using thematic analysis. Results Participants acknowledged that antipsychotics can have severe adverse effects. They were generally supportive of trying to reduce these drugs to the lowest effective dose, although stopping antipsychotics was less acceptable. Prior experiences of adverse events after reduction or discontinuation meant that both were approached with caution. Reduction was also reported to be hampered by organisational and knowledge barriers. Lack of resources, pressure to discharge, and poor continuity of care were seen as organisational barriers. Knowledge barriers included inadequate evidence about who might be best suited to reduction, and lack of guidance about how this could be done safely. This meant that reduction was often prompted by patients, and sometimes actively discouraged, and stability with maintenance treatment was often favoured. Conclusions Concerns about risk and other barriers means that clinicians are often reluctant to implement reduction or discontinuation of antipsychotic medication. In order to increase the treatment options available to service users, more research and guidance on how to minimise the risks of antipsychotic reduction and discontinuation is required to enable clinicians to engage more constructively with service users requests, offering people more choice and control in managing their mental health condition.

show abstract

Section: Introductionmentioning

confidence: 99%

Mental health professionals’ views and experiences of antipsychotic reduction and discontinuation

2019

View full text Add to dashboard Cite

show abstract

“…Underuse as well as overuse of psychotropic medication have also been reported in this population (Hanlon et al, 2011). Moreover, a recent study on the use of psychotropic medications in care homes identified potential benefits of antipsychotic medication reduction (Simmons, 2017).…”

Section: Psychotropic Medication Usementioning

confidence: 76%

Mental Health, Quality of Life and Medication Use Among Care Home Residents and Community Dwelling Older People

O’Neill¹,

Ryan²,

Slater³

et al. 2019

International Journal of Research in Nursing

View full text Add to dashboard Cite

In most countries, the prevalence of depression in care homes is substantially higher than among community-dwelling older people. Negative media reports and the stigma associated with long-term care perpetuates the belief that community care is associated with a better quality of life than nursing or residential home care. The aim of this paper is to investigate mental health, quality of life and medication use among a sample of care home residents and community dwelling older people. This cross-sectional study comprised of structured interviews with 75 care home residents and 852 community dwelling older adults in a large health and social care trust within the U.K. Data were collected using an abridged version of the World Mental Health-Composite International Diagnostic Interview (WMH-CIDI). Health-related quality of life was assessed using the SF-6D, derived from responses to the SF-12, which was embedded within the screening section of the WMH-CIDI. Results showed a significantly lower level of mental disorders among older people in the care home sample. Health-related quality of life results indicated that although care home participants were significantly more limited in their physical functioning, they reported better mental health and social functioning than older people living in the community. These results were statistically significant. Prescription rates for mental health medication were higher in the care home sample. This study provides tentative findings about mental health and quality of life in care homes, which should be further explored in future research. The study addresses the negative public perception of quality of life in care homes while contributing to the debate around the health care implications of 'ageing in place' for older people. There is a need to address the relationship between mental health, quality of life and medication use among older people across a range of care settings.

show abstract

“…This qualitative study shows limited understanding of what goals of care are and the lack of motivation to initiate conversations with residents and their caregivers. Studies show staff do not know how to lead conversations with residents and their caregivers regarding the risk vs benefits of high‐risk medication and this qualitative study reveals that this extends to conversations about pharmaceutical goals of care. A CCDSS, accompanied with education and training, can guide staff to initiate discussions with the resident and undertake resident assessment of pharmaceutical goals in the care planning.…”

Section: Discussionmentioning

confidence: 89%

Perspectives of residential aged care facilities' staff on the identification and recording of residents' medication‐related goals of care

2019

View full text Add to dashboard Cite

Objective This study primarily aims to explore residential aged care facility (RACF) staff views on the utility of a computerised clinical decision support system (CCDSS) that incorporates validated goal‐directed deprescribing tools and guides to identify residents' goals for medications. Methods A qualitative study was conducted in four RACFs. Semi‐structured interviews or focus groups were conducted with 19 participants, representing various types of clinical and care staff. Results According to staff, the use of a CCDSS was useful as it facilitated resident (including people with dementia), and caregiver engagement to obtain comprehensive information about the residents' goals and medication concerns. Staff perceptions of the increased workload and that some residents and caregivers would have limited involvement in discussions were barriers to the adoption of a CCDSS. Conclusion Integration of a CCDSS into practice, accompanied with staff training and education, has the potential to improve goal‐directed pharmaceutical care.

show abstract

Reducing Antipsychotic Medication Use in Nursing Homes: A Qualitative Study of Nursing Staff Perceptions

Cited by 34 publications

References 44 publications

Mental health professionals’ views and experiences of antipsychotic reduction and discontinuation

Mental health professionals’ views and experiences of antipsychotic reduction and discontinuation

Mental Health, Quality of Life and Medication Use Among Care Home Residents and Community Dwelling Older People

Perspectives of residential aged care facilities' staff on the identification and recording of residents' medication‐related goals of care

Contact Info

Product

Resources

About