THREE out of four dementia patients in nursing homes who are prescribed antipsychotic drugs to control their symptoms do not need them, a University of New South Wales-led trial has shown.
Despite minimal evidence supporting their effectiveness to manage symptoms of dementia, the use of antipsychotic drugs in Australian nursing homes is widespread and the researchers claim that studies showing the drugs increase the risk of stroke, cognitive decline and death have also been largely ignored.
The results of the Halting Antipsychotic use in Long Term care (HALT) project by the Dementia Collaborative Research Centre (DCRC) have shown the use of anti-psychotic drugs could be drastically reduced by creating awareness about these risks; and training nursing staff to use alternative approaches to manage the symptoms of dementia.
The HALT project successfully eliminated regular antipsychotic medication from the treatment plan in 75% of study participants after six months, following an initial reduction of antipsychotics.
In the trial — which involved 140 residents across 23 NSW care facilities — deprescribing was achieved through training long-term care facility nurses to recognise potential causes of behavioural and psychological symptoms of dementia (BPSD) and encourage the use of non-pharmacological and person-centred approaches to management such as environmental modifications.
UNSW Scientia Professor Henry Brodaty. Photo: Dan White/UNSW.
In Australia, up to 50% of long term nursing home residents have a dementia-related illness, with many experiencing BPSD including delusions, aggression and agitation. This poses major challenges for both residents and nursing facility staff.
DCRC Director Professor Henry Brodaty said the HALT trial showed deprescribing of antipsychotics in long-term care residents with previous BPSD was feasible, however major challenges must be overcome including sustainability and the prevailing culture of prescribing in aged care.
“Often there can be cultural, funding and logistical barriers to moving away from antipsychotics in aged care settings, but we hope the results of this project will serve as a positive example towards a more person-centred approach in Australia and globally,” said Professor Brodaty, who is also Co-Director of UNSW’s Centre for Healthy Brain Ageing (CHeBA).
The HALT project is funded by the Australian Department of Social Services through the Aged Care Service Improvement and Healthy Ageing Grants Fund.
