Hostname: page-component-78c5997874-fbnjt Total loading time: 0 Render date: 2024-11-14T05:20:51.554Z Has data issue: false hasContentIssue false
  • English
  • Français

Halting Antipsychotic Use in Long-Term care (HALT): a single-arm longitudinal study aiming to reduce inappropriate antipsychotic use in long-term care residents with behavioral and psychological symptoms of dementia

Published online by Cambridge University Press:  07 March 2017

Tiffany Jessop ,
Fleur Harrison ,
Monica Cations ,
Brian Draper ,
Lynn Chenoweth ,
Sarah Hilmer ,
Juanita Westbury ,
Lee-Fay Low ,
Megan Heffernan  and
Perminder Sachdev
...Show all authors
Tiffany Jessop
Affiliation:
Dementia Collaborative Research Centre, School of Psychiatry UNSW Australia, Sydney, NSW 2052, Australia
Fleur Harrison
Affiliation:
Dementia Collaborative Research Centre, School of Psychiatry UNSW Australia, Sydney, NSW 2052, Australia
Monica Cations
Affiliation:
Dementia Collaborative Research Centre, School of Psychiatry UNSW Australia, Sydney, NSW 2052, Australia
Brian Draper
Affiliation:
School of Psychiatry UNSW Australia and Clinical Director, Academic Department for Old Age Psychiatry Prince of Wales Hospital, Euroa Centre Prince of Wales Hospital, Randwick, NSW 2031, Australia
Lynn Chenoweth
Affiliation:
Centre for Healthy Brain Ageing (CHeBA), UNSW Australia, Sydney, NSW 2052, Australia
Sarah Hilmer
Affiliation:
Sydney Medical School, The University of Sydney and Head of Department Clinical Pharmacology and Senior Staff Specialist Aged Care, Royal North Shore Hospital Level 12, Kolling Building, St Leonards, NSW 2065, Australia
Juanita Westbury
Affiliation:
Wicking Dementia Research and Education Centre, Faculty of Health, University of Tasmania, Private Bag 143, Hobart, TAS 7001, Australia
Lee-Fay Low
Affiliation:
NHMRC Career Development Fellow Faculty of Health Sciences, The University of Sydney, Room M309B M Block 75 East Street, Lidcombe, NSW 2141, Australia
Megan Heffernan
Affiliation:
Dementia Collaborative Research Centre, School of Psychiatry UNSW Australia, Sydney, NSW 2052, Australia
Perminder Sachdev
Affiliation:
Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, UNSW Australia and Director, Neuropsychiatric Institute, The Prince of Wales Hospital, Randwick, NSW 2031, Australia
Jacqueline Close
Affiliation:
Neuroscience Research Australia, Barker St Randwick, NSW 2031, Australia
Jenny Blennerhassett
Affiliation:
Dementia Collaborative Research Centre, School of Psychiatry UNSW Australia, Sydney, NSW 2052, Australia
Millicent Marinkovich
Affiliation:
Dementia Collaborative Research Centre, School of Psychiatry UNSW Australia, Sydney, NSW 2052, Australia
Allan Shell
Affiliation:
Dementia Collaborative Research Centre, School of Psychiatry UNSW Australia, Sydney, NSW 2052, Australia
Henry Brodaty*
Affiliation:
Dementia Collaborative Research Centre, School of Psychiatry UNSW Australia, Sydney, NSW 2052, Australia
*
Correspondence should be addressed to: Henry Brodaty, Director, Dementia Collaborative Research Centre, School of Psychiatry UNSW Australia, Sydney, NSW 2052, Australia. Phone: +61 2 9385 2585; Fax: +61 2 9385 2200. Email: [email protected].
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Inappropriate use of antipsychotic medications to manage Behavioral and Psychological Symptoms of Dementia (BPSD) continues despite revised guidelines and evidence for the associated risks and side effects. The aim of the Halting Antipsychotic Use in Long-Term care (HALT) project is to identify residents of long-term care (LTC) facilities on antipsychotic medications, and undertake an intervention to deprescribe (or cease) these medicines and improve non-pharmacological behavior management.

Methods:

LTC facilities will be recruited across Sydney, Australia. Resident inclusion criteria will be aged over 60 years, on regular antipsychotic medication, and without a primary psychotic illness or very severe BPSD, as measured using the Neuropsychiatric Inventory (NPI). Data collection will take place one month and one week prior to commencement of deprescribing; and 3, 6 and 12 months later. During the period prior to deprescribing, training will be provided for care staff on how to reduce and manage BPSD using person-centered approaches, and general practitioners of participants will be provided academic detailing. The primary outcome measure will be reduction of regular antipsychotic medication without use of substitute psychotropic medications. Secondary outcome measures will be NPI total and domain scores, Cohen-Mansfield Agitation Inventory scores and adverse events, including falls and hospitalizations.

Conclusion:

While previous studies have described strategies to minimize inappropriate use of antipsychotic medications in people with dementia living in long-term care, sustainability and a culture of prescribing for BPSD in aged care remain challenges. The HALT project aims to evaluate the feasibility of a multi-disciplinary approach for deprescribing antipsychotics in this population.

Keywords

antipsychoticsBPSDaged caredementiaperson-centered caredeprescribinglong-term care
Type
Protocol-only paper
Information
International Psychogeriatrics , Volume 29 , Issue 8 , August 2017 , pp. 1391 - 1403
Copyright
Copyright © International Psychogeriatric Association 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Australian Commission on Safety and Quality in Health Care, A. (2011). Patientcentred Care: Improving Quality and Safety Through Partnerships With Patients and Consumers. Sydney: ACSQHC.Google Scholar
Australian Government, D. o. S. S. (2015). National FrameWork for Action on Dementia 2015–2019. Canberra, Australia: Australian Government, Department of Social Services.Google Scholar
Azermai, M., Petrovic, M., Elseviers, M. M., Bourgeois, J., Van Bortel, L. M. and Vander Stichele, R. H. (2012). Systematic appraisal of dementia guidelines for the management of behavioural and psychological symptoms. Ageing Research Reviews, 11, 78–86.CrossRefGoogle ScholarPubMed
Ballard, C. et al. (2008). A randomised, blinded, placebo-controlled trial in dementia patients continuing or stopping neuroleptics (the DART-AD trial). PLoS Medicine/Public Library of Science, 5, e76.Google Scholar
Ballard, C. et al. (2009). The dementia antipsychotic withdrawal trial (DART-AD): long-term follow-up of a randomised placebo-controlled trial. Lancet Neurology, 8, 151–157.Google Scholar
Ballard, C. et al. (2016). Impact of antipsychotic review and nonpharmacological intervention on antipsychotic use, neuropsychiatric symptoms, and mortality in people with dementia living in nursing homes: a factorial cluster-randomized controlled trial by the well-being and health for people with dementia (WHELD) program. American Journal of Psychiatry, 173, 252–262.Google Scholar
Ballard, C. and Waite, J. (2006). The effectiveness of atypical antipsychotics for the treatment of aggression and psychosis in Alzheimer's disease. Cochrane Database Systematic Review, CD003476.Google Scholar
Banerjee, S. (2009). The use of antipsychotic medication for people with dementia: time for action. A report for the Minister of State for Care Services. In Department of Health (Ed.). http://webarchive.nationalarchives.gov.uk/20130107105354/http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_108302.pdf Google Scholar
Barca, M. L., Engedal, K., Laks, J. and Selbaek, G. (2010). A 12 months follow-up study of depression among nursing-home patients in Norway. Journal of Affective Disorders, 120, 141–148.Google Scholar
Briesacher, B. A., Tjia, J., Field, T., Peterson, D. and Gurwitz, J. H. (2013). Antipsychotic use among nursing home residents. Journal of the American Medical Association, 309, 440–442.CrossRefGoogle ScholarPubMed
Brodaty, H. et al. (2001). Psychosis, depression and behavioural disturbances in Sydney nursing home residents: prevalence and predictors. International Journal of Geriatric Psychiatry, 16, 504–512.Google Scholar
Brodaty, H. et al. (2003). A randomised placebo controlled trial of risperidone for the treatment of agitation and psychosis of dementia. Journal of Clinical Psychiatry, 64, 134–143.Google Scholar
Brooker, D. J. et al. (2016). FITS into practice: translating research into practice in reducing the use of anti-psychotic medication for people with dementia living in care homes. Aging and Mental Health, 20, 709–718.Google Scholar
Cabrera, E. et al. (2015). Non-pharmacological interventions as a best practice strategy in people with dementia living in nursing homes. A systematic review. European Geriatric Medicine, 6, 134–150.Google Scholar
Chenoweth, L. et al. (2014). PerCEN: a cluster randomized controlled trial of person-centered residential care and environment for people with dementia. International Psychogeriatrics, 26, 1147–1160.Google Scholar
Chenoweth, L. et al. (2015). PerCEN trial participant perspectives on the implementation and outcomes of person-centered dementia care and environments. International Psychogeriatrics, 27, 2045–2057.Google Scholar
Chenoweth, L. et al. (2009). Caring for aged dementia care resident study (CADRES) of person-centred care, dementia-care mapping, and usual care in dementia: a cluster-randomised trial. Lancet Neurology, 8, 317–325.Google Scholar
Cohen-Mansfield, J., Marx, M. S. and Rosenthal, A. S. (1989). A description of agitation in a nursing home. Journal of Gerontology, 44, M77–84.Google Scholar
Cornegé-Blokland, E., Kleijer, B. C., Hertogh, C. M. P. M. and van Marum, R. J. (2012). Reasons to prescribe antipsychotics for the behavioral symptoms of dementia: a survey in Dutch nursing homes among physicians, nurses, and family caregivers. Journal of the American Medical Directors Association, 13, 80.e81–80.e86.Google Scholar
Cummings, J. L. (1997). The neuropsychiatric inventory: assessing psychopathology in dementia patients. Neurology, 48, S10–16.Google Scholar
Cummings, J. L., Mega, M., Gray, K., Rosenberg-Thompson, S., Carusi, D. A. and Gornbein, J. (1994). The neuropsychiatric inventory: comprehensive assessment of psychopathology in dementia. Neurology, 44, 2308–2314.Google Scholar
Devanand, D. P. et al. (2012). Relapse risk after discontinuation of risperidone in Alzheimer's disease. New England Journal of Medicine, 367, 1497–1507.Google Scholar
Edvardsson, D., Winblad, B. and Sandman, P. O. (2008). Person-centred care of people with severe Alzheimer's disease: current status and ways forward. Lancet Neurology, 7, 362–367.Google Scholar
Ervin, K., Cross, M. and Koschel, A. (2014). Barriers to managing behavioural and psychological symptoms of dementia: staff perceptions. Collegian, 21, 201–207.Google Scholar
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198.Google Scholar
Fossey, J. et al. (2006). Effect of enhanced psychosocial care on antipsychotic use in nursing home residents with severe dementia: cluster randomised trial. British Medical Journal, 332, 756–761.CrossRefGoogle ScholarPubMed
Hilmer, S. N. and Gnjidic, D. (2013). Rethinking psychotropics in nursing homes. Medical Journal of Australia, 198, 77.Google Scholar
Hinton, L., Franz, C., Reddy, G., Flores, Y., Kravitz, R. and Barker, J. (2007). Practice constraints, behavioral problems, and dementia care: primary care physicians’ perspectives. Journal of General Internal Medicine, 22, 1487–1492.Google Scholar
Jorm, A. F. et al. (1995). The psychogeriatric assessment scales: a multi-dimensional alternative to categorical diagnoses of dementia and depression in the elderly. Psychological Medicine, 25, 447–460.Google Scholar
Kada, S., Nygaard, H. A., Mukesh, B. N. and Geitung, J. T. (2009). Staff attitudes towards institutionalised dementia residents. Journal of Clinical Nursing, 18, 2383–2392.Google Scholar
Kane, J. M. and Correll, C. U. (2010). Past and present progress in the pharmacologic treatment of schizophrenia. The Journal of Clinical Psychiatry, 71, 1115–1124.Google Scholar
Katz, I. R., Jeste, D. V., Mintzer, J. E., Clyde, C., Napolitano, J. and Brecher, M. (1999). Comparison of risperidone and placebo for psychosis and behavioral disturbances associated with dementia: a randomized, double-blind trial. Risperidone study group. Journal of Clinical Psychiatry, 60, 107–115.Google Scholar
Lawton, M. P. and Brody, E. M. (1969). Assessment of older people: self-maintaining and instrumental activities of daily living. The Gerontologist, 9, 179–186.Google Scholar
Leucht, S., Samara, M., Heres, S., Patel, M. X., Woods, S. W. and Davis, J. M. (2014). Dose equivalents for second-generation antipsychotics: the minimum effective dose method. Schizophrenia Bulletin, 40, 314–326.Google Scholar
Logsdon, R. G., Gibbons, L. E., McCurry, S. M. and Teri, L. (1999). Quality of life in Alzheimer's disease: patient and caregiver reports. Journal of Mental Health and Aging, 5, 21–32.Google Scholar
Maguire, A., Hughes, C., Cardwell, C. and O'Reilly, D. (2013). Psychotropic medications and the transition into care: a national data linkage study. Journal of the American Geriatrics Society, 61, 215–221.Google Scholar
McCormack, B. et al. (2010). Developing person-centred practice: nursing outcomes arising from changes to the care environment in residential settings for older people. International Journal of Older People Nursing, 5, 93–107.Google Scholar
National Institute for Health and Care Excellence. (2006). Dementia: supporting people with dementia and their carers in health and social care. Clinical guideline. https://www.nice.org.uk/guidance/cg42 Google Scholar
O'Connor, D. W., Griffith, J. and McSweeney, K. (2010). Changes to psychotropic medications in the six months after admission to nursing homes in Melbourne, Australia. International Psychogeriatrics, 22, 1149–1153.Google Scholar
Peisah, C., Chan, D. K., McKay, R., Kurrle, S. E. and Reutens, S. G. (2011). Practical guidelines for the acute emergency sedation of the severely agitated older patient. Internal Medicine Journal, 41, 651–657.Google Scholar
Pruchno, R. A., Kleban, M. H. and Resch, N. L. (1988). Psychometric assessment of the Multidimensional Observation Scale for Elderly Subjects (MOSES). Journal of Gerontology, 43, P164–169.Google Scholar
Royal Australian and New Zealand College of Psychiatrists, R. (2011). The use of antipsychotics in residential aged care. Clinical Recommendations developed by the RANZCP Faculty of Psychiatry of Old Age (New Zealand).Google Scholar
Scott, I. A. et al. (2015). Reducing inappropriate polypharmacy: the process of deprescribing. Journal of the American Medical Association Internal Medicine, 175, 827–834.Google ScholarPubMed
Snowdon, J., Galanos, D. and Vaswani, D. (2011). Patterns of psychotropic medication use in nursing homes: surveys in Sydney, allowing comparisons over time and between countries. International Psychogeriatrics, 23, 1520–1525.Google Scholar
Stein-Parbury, J., Chenoweth, L., Jeon, Y. H., Brodaty, H., Haas, M. and Norman, R. (2012). Implementing person-centered care in residential dementia care. Clinical Gerontologist, 35, 404–424.Google Scholar
Storey, J. E., Rowland, J. T. J., Conforti, D. A. and Dickson, H. G. (2004). The Rowland Universal Dementia Assessment Scale (RUDAS): a multicultural cognitive assessment scale. International Psychogeriatrics, 16, 13–31.Google Scholar
The Royal Australian & New Zealand College of Psychiatrists. (2013). Assessment and Management of People with Behavioural and Psychological Symptoms of Dementia (BPSD). A handbook for NSW Health Clinicians. North Sydney, NSW: NSW Ministry of Health. https://www.ranzcp.org/Files/Publications/A-Handbook-for-NSW-Health-Clinicians-BPSD_June13_W.aspx Google Scholar
Westbury, J. (2014). Quality use of Psychotropic Medications in RACFs. Canberra, Australia: Pharmaceutical Society of Australia Ltd.Google Scholar
Whitney, J., Close, J. C., Lord, S. R. and Jackson, S. H. (2012). Identification of high risk fallers among older people living in residential care facilities: a simple screen based on easily collectable measures. Archives of Gerontology and Geriatrics, 55, 690–695.Google Scholar
Zaudig, M. (2000). A risk-benefit assessment of risperidone for the treatment of behavioural and psychological symptoms in dementia. Drug Safety, 23, 183–195.Google Scholar
Supplementary material: File

Jessop supplementary material

Jessop supplementary material 1

Download Jessop supplementary material(File)
File 22.2 KB