A neurology-focused effort to reduce antipsychotic drugs in skilled nursing facilities lowered usage by 68% in people with behavioral and psychological symptoms of dementia, according to a new report published Monday in the Journal of Post-Acute and Long-Term Care Medicine.
The National Partnership data reported that the national prevalence of antipsychotic drugs overall in use declined from 24% in 2011 to 14.5% in 2021. Since 2021, use of the medications has increased by 1.5%, which is why the authors set out to see if they could reduce unnecessary medication.
One of the driving concepts of the program is referred to as “neurology forward,” which centers on treating people with behavioral and psychological symptoms of dementia from a neurology standpoint and not primarily a psychiatric disorder.
The researchers launched the program in three targeted buildings in Indiana. The 49 people studied had dementia and were taking antipsychotic medications. Those with serious mental illness like bipolar 1 or schizophrenia weren’t included.
A team of professionals including primary care doctors, psychologists, neurologists, pharmacists and nursing staff (among others) collaborated on each person’s treatment. The team used psychology screenings and testing, as well as the gradual dose reduction (GDR) methodology to try and reduce antipsychotic use when appropriate.
The team held regular reviews and meetings to assess progress. Evaluations took place in January, March and July of 2021. People in the program were reassessed after their initial evaluation, and medications were adjusted as needed.
Before the program was implemented, antipsychotic medicine rates in the three facilities were 32%, 14% and 18% respectively. Six months after the program began, the proportion of residents using antipsychotic drugs fell to 9.6%, 4.2%, and 6.3%, respectively.
About 35% of the residents involved in the study had significant diagnostic corrections during the review process; many had unsubstantiated diagnoses of schizophrenia or schizoaffective disorder rather than dementia, the authors said.