Antipsychotic Deprescription for Older Adults in Long-term Care: The HALT Study

Henry Brodaty, Liesbeth Aerts, Fleur Harrison, Tiffany Jessop, Monica Cations, Lynn Chenoweth, Allan Shell, Gordana C. Popovic, Megan Heffernan, Sarah Hilmer, Perminder S. Sachdev, Brian Draper

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Objectives: Despite limited efficacy and significant safety concerns, antipsychotic medications are frequently used to treat behavioral and psychological symptoms of dementia (BPSD) in long-term residential care. This study evaluates the sustained reduction of antipsychotic use for BPSD through a deprescribing intervention and education of health care professionals. Design: Repeated-measures, longitudinal, single-arm study. Setting: Long-term residential care of older adults. Participants: Nursing staff from 23 nursing homes recruited 139 residents taking regular antipsychotic medication for ≥3 months, without primary psychotic illness, such as schizophrenia or bipolar disorder, or severe BPSD. Intervention: An antipsychotic deprescribing protocol was established. Education of general practitioners, pharmacists, and residential care nurses focused on nonpharmacological prevention and management of BPSD. Measurements: The primary outcome was antipsychotic use over 12-month follow-up; secondary outcomes were BPSD (Neuropsychiatric Inventory, Cohen-Mansfield Agitation Inventory, and social withdrawal) and adverse outcomes (falls, hospitalizations, and cognitive decline). Results: The number of older adults on regular antipsychotics over 12 months reduced by 81.7% (95% confidence interval: 72.4-89.0). Withdrawal was not accompanied by drug substitution or a significant increase in pro-re-nata antipsychotic or benzodiazepine administration. There was no change in BPSD or in adverse outcomes. Conclusion: In a selected sample of older adults living in long-term residential care, sustained reduction in regular antipsychotic use is feasible without an increase of BPSD.

LanguageEnglish
Pages592-600.e7
JournalJournal of the American Medical Directors Association
Volume19
Issue number7
DOIs
Publication statusPublished - 1 Jul 2018
Externally publishedYes

Keywords

  • Antipsychotic withdrawal
  • behavioral and psychological symptoms of dementia
  • dementia

ASJC Scopus subject areas

  • Nursing(all)
  • Health Policy
  • Geriatrics and Gerontology

Cite this

Brodaty, Henry ; Aerts, Liesbeth ; Harrison, Fleur ; Jessop, Tiffany ; Cations, Monica ; Chenoweth, Lynn ; Shell, Allan ; Popovic, Gordana C. ; Heffernan, Megan ; Hilmer, Sarah ; Sachdev, Perminder S. ; Draper, Brian. / Antipsychotic Deprescription for Older Adults in Long-term Care : The HALT Study. In: Journal of the American Medical Directors Association. 2018 ; Vol. 19, No. 7. pp. 592-600.e7.
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abstract = "Objectives: Despite limited efficacy and significant safety concerns, antipsychotic medications are frequently used to treat behavioral and psychological symptoms of dementia (BPSD) in long-term residential care. This study evaluates the sustained reduction of antipsychotic use for BPSD through a deprescribing intervention and education of health care professionals. Design: Repeated-measures, longitudinal, single-arm study. Setting: Long-term residential care of older adults. Participants: Nursing staff from 23 nursing homes recruited 139 residents taking regular antipsychotic medication for ≥3 months, without primary psychotic illness, such as schizophrenia or bipolar disorder, or severe BPSD. Intervention: An antipsychotic deprescribing protocol was established. Education of general practitioners, pharmacists, and residential care nurses focused on nonpharmacological prevention and management of BPSD. Measurements: The primary outcome was antipsychotic use over 12-month follow-up; secondary outcomes were BPSD (Neuropsychiatric Inventory, Cohen-Mansfield Agitation Inventory, and social withdrawal) and adverse outcomes (falls, hospitalizations, and cognitive decline). Results: The number of older adults on regular antipsychotics over 12 months reduced by 81.7{\%} (95{\%} confidence interval: 72.4-89.0). Withdrawal was not accompanied by drug substitution or a significant increase in pro-re-nata antipsychotic or benzodiazepine administration. There was no change in BPSD or in adverse outcomes. Conclusion: In a selected sample of older adults living in long-term residential care, sustained reduction in regular antipsychotic use is feasible without an increase of BPSD.",
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Brodaty, H, Aerts, L, Harrison, F, Jessop, T, Cations, M, Chenoweth, L, Shell, A, Popovic, GC, Heffernan, M, Hilmer, S, Sachdev, PS & Draper, B 2018, 'Antipsychotic Deprescription for Older Adults in Long-term Care: The HALT Study', Journal of the American Medical Directors Association, vol. 19, no. 7, pp. 592-600.e7. https://doi.org/10.1016/j.jamda.2018.05.002

Antipsychotic Deprescription for Older Adults in Long-term Care : The HALT Study. / Brodaty, Henry; Aerts, Liesbeth; Harrison, Fleur; Jessop, Tiffany; Cations, Monica; Chenoweth, Lynn; Shell, Allan; Popovic, Gordana C.; Heffernan, Megan; Hilmer, Sarah; Sachdev, Perminder S.; Draper, Brian.

In: Journal of the American Medical Directors Association, Vol. 19, No. 7, 01.07.2018, p. 592-600.e7.

Research output: Contribution to journalArticle

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T1 - Antipsychotic Deprescription for Older Adults in Long-term Care

T2 - Journal of the American Medical Directors Association

AU - Brodaty, Henry

AU - Aerts, Liesbeth

AU - Harrison, Fleur

AU - Jessop, Tiffany

AU - Cations, Monica

AU - Chenoweth, Lynn

AU - Shell, Allan

AU - Popovic, Gordana C.

AU - Heffernan, Megan

AU - Hilmer, Sarah

AU - Sachdev, Perminder S.

AU - Draper, Brian

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N2 - Objectives: Despite limited efficacy and significant safety concerns, antipsychotic medications are frequently used to treat behavioral and psychological symptoms of dementia (BPSD) in long-term residential care. This study evaluates the sustained reduction of antipsychotic use for BPSD through a deprescribing intervention and education of health care professionals. Design: Repeated-measures, longitudinal, single-arm study. Setting: Long-term residential care of older adults. Participants: Nursing staff from 23 nursing homes recruited 139 residents taking regular antipsychotic medication for ≥3 months, without primary psychotic illness, such as schizophrenia or bipolar disorder, or severe BPSD. Intervention: An antipsychotic deprescribing protocol was established. Education of general practitioners, pharmacists, and residential care nurses focused on nonpharmacological prevention and management of BPSD. Measurements: The primary outcome was antipsychotic use over 12-month follow-up; secondary outcomes were BPSD (Neuropsychiatric Inventory, Cohen-Mansfield Agitation Inventory, and social withdrawal) and adverse outcomes (falls, hospitalizations, and cognitive decline). Results: The number of older adults on regular antipsychotics over 12 months reduced by 81.7% (95% confidence interval: 72.4-89.0). Withdrawal was not accompanied by drug substitution or a significant increase in pro-re-nata antipsychotic or benzodiazepine administration. There was no change in BPSD or in adverse outcomes. Conclusion: In a selected sample of older adults living in long-term residential care, sustained reduction in regular antipsychotic use is feasible without an increase of BPSD.

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