Deprescribing antipsychotics in long term care patients with dementia

Abstract

Objective: To develop a clinical protocol for the use of antipsychotic drugs in dementia patients with behavioral disturbances that includes prescribing and deprescribing criteria and to assess its applicability in longterm care institutions. Method: The protocol was developed from an interdisciplinary perspective based on a literature search of the published proposals on antipsychotic drug use in dementia patients. Its applicability to the antipsychotic deprescribing process was assessed in a single center in a prospective before-after study with a follow-up of 6 months after the intervention study. Results: A protocol was developed that includes prescribing and deprescribing criteria. The intervention was performed in 35 patients (21 [60%] female). Antipsychotic treatment was completely withdrawn in 28 patients (80%) and was reduced to the minimum effective dose in 7 (20%). Treatment was resumed in 2 patients due to worsening symptoms. The pre- and 6-month post-test results showed that there were no significant changes in neuropsychiatric symptoms (12.91 ± 12.80 vs 13.76 ± 16.68; P = 0.124). Conclusions: The establishment of a protocol that includes prescribing and deprescribing criteria, in combination with the incorporation of a pharmacist in the multidisciplinary team, can be effective in improving the use of these drugs in elderly dementia patients in long-term care institutions.

Keywords

• Antipsychotic agents
• Deprescribing
• Behavioral symptoms
• Alzheimer’s disease
• Dementia
• Nursing homes