A dementia-care strategy based on resident-centered interventions along with reduced antipsychotic use did not aggravate behavioral or psychological symptoms, researchers have found. Early findings are raising hopes that antipsychotics may be used less frequently as a first-line management option in the future, they say.
The Optimizing Practices, Use, Care and Services—Antipsychotics (OPUS-AP) strategy stresses resident-centered care based on nonpharmacologic interventions. Facets include training, coaching, clinical tools and evaluation of clinical practices, plus a change management strategy.
For the study, investigators looked at antipsychotic, benzodiazepine and antidepressant prescriptions; behavioral and psychological symptoms of dementia; and falls every three months for nine months. They also conducted interdisciplinary team interviews.
Antipsychotic de-prescribing was tried for 220 of the 344 participating residents, with complete cessation observed in 116 residents and dose reductions in 72. A decrease in benzodiazepine prescriptions and improvements in Cohen-Mansfield Agitation Inventory (a 29-item scale to systematically assess agitation) scores were observed. Caregivers and clinicians also indicated life quality for the participating residents improved.
“Although reducing use of antipsychotics in the long-term care setting has proven difficult over the years, international and national initiatives are starting to bear fruit,” the authors wrote.
Based on this early success, a second phase of the study has expanded to 129 long-term care facilities across Québec.Full findings appear in the February issue of JAMDA.