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

doi:10.1016/j.jamda.2018.05.002

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

J Am Med Dir Assoc. 2018 Jul;19(7):592-600.e7. doi: 10.1016/j.jamda.2018.05.002.

Authors

Affiliations

¹ Dementia Centre for Research Collaboration, School of Psychiatry, University of New South Wales Sydney, New South Wales, Australia; Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales Sydney, New South Wales, Australia; Academic Department for Old Age Psychiatry, Prince of Wales Hospital, Randwick, New South Wales, Australia. Electronic address: h.brodaty@unsw.edu.au.
² Dementia Centre for Research Collaboration, School of Psychiatry, University of New South Wales Sydney, New South Wales, Australia.
³ Dementia Centre for Research Collaboration, School of Psychiatry, University of New South Wales Sydney, New South Wales, Australia; Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales Sydney, New South Wales, Australia.
⁴ Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales Sydney, New South Wales, Australia.
⁵ Stats Central, Mark Wainwright Analytical Centre, University of New South Wales Sydney, New South Wales, Australia.
⁶ Kolling Institute, Royal North Shore Hospital and University of Sydney, St Leonards, New South Wales, Australia.
⁷ Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales Sydney, New South Wales, Australia; Neuropsychiatric Institute, Prince of Wales Hospital, Randwick, New South Wales, Australia.
⁸ Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales Sydney, New South Wales, Australia; Academic Department for Old Age Psychiatry, Prince of Wales Hospital, Randwick, New South Wales, Australia.

PMID: 29941156
DOI: 10.1016/j.jamda.2018.05.002

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.

Keywords: Antipsychotic withdrawal; behavioral and psychological symptoms of dementia; dementia.

Publication types

Clinical Trial
Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Accidental Falls / statistics & numerical data
Aged
Aged, 80 and over
Antipsychotic Agents / administration & dosage*
Australia
Dementia / drug therapy*
Dementia / psychology*
Deprescriptions*
Drug Utilization / statistics & numerical data
Female
Health Personnel / education
Hospitalization / statistics & numerical data
Humans
Longitudinal Studies
Male
Middle Aged
Neuropsychological Tests
Nursing Homes*

Substances

Antipsychotic Agents