No harm in withdrawal of psychotropic medication

cost-benefit

A review of the current evidence about withdrawal of psychotic medications for people with dementia in long-term residential aged care has found that it can be achieved without adverse effects for the person with dementia.

The Royal Commission into Aged Care Quality and Safety has highlighted a culture of over-prescribing of psychotropic medication in residential aged care when treating changed behaviours of a person with dementia. Psychotropic medications have been shown to increase the risk of heart attack, stroke and falls while providing no increase in functional ability or quality of life.

Although the Australian clinical practice guideline and principles of care for people with dementia recommend non-pharmacological interventions as the first approach when changed behaviours are observed, this is rarely the case.

Published in Drugs and Ageing, the review titled “Approaches to Deprescribing Psychotropic Medications for Changed Behaviours in Long-Term Care Residents Living with Dementia” examines five areas of research.

  1. Psychotropic use for people with dementia living in long-term aged care
  2. Non-pharmacological approaches for people with dementia living in long-term aged care
  3. Approaches to Deprescribing Psychotropic Medications in Long-Term Aged Care
  4. Facilitators and Barriers to Deprescribing Psychotropic Medications in Long-Term Aged Care
  5. Areas of Future Research

Key findings of the review found to achieve a change in culture of over-prescribing psychotropic medication in long-term aged care required education and training of staff, effective communication between GPs, staff, residents, their families and carers, and a commitment of management to change.

The review is a collaboration between researchers at the Cognitive Decline Partnership Centre, Stephanie Harrison (SAHMRI), Monica Cations (Flinders University), Sarah Hilmer (University of Sydney), Mouna Sawan (University of Sydney), and Tiffany Jessop and Henry Brodaty (UNSW).