Preventing Inappropriate Use of Psychotropic Medications for NH Residents With Dementia

A comprehensive approach to interventions may be effective in reducing inappropriate psychotropic prescribing for nursing home (NH) residents with dementia, a new study suggests.

The study, published online ahead of print in Aging & Mental Health, aimed to collate evidence pertaining to interventions, perceived barriers (and facilitators to implementing them), and the attitudes of stakeholders toward prescribing.

“Psychotropic medications are commonly inappropriately prescribed for people with dementia residing in NHs,” explained researchers. “This population is often multi-morbid, receiving multiple medications and therefore at an increased risk of mortality.”

Researchers conducted an overview of reviews from January 2010 through June 2020 that included evidence from randomized controlled trials attempting to reduce inappropriate prescribing as well as qualitative/mixed method studies of stakeholder views. The final study included 11 systematic reviews out of 273 records. Review quality ranged from critically low to moderate.

There was mixed evidence for education-only interventions, but research indicated that multicomponent interventions, medication review, and interventions aimed at cultural change were more effective than standard care.

According to the study, stakeholders emphasized multidisciplinary collaboration and targeting organizational climate as effective interventions to change psychotropic prescribing behaviors.

NH residents with dementia are at an increased risk of mortality due to receiving multiple medications for comorbidities. Researchers noted that these strategies, in combination with staff education and training, may be effective in reducing inappropriate prescribing of psychotropics.

Reference:
Wiggin DA, Timmons S, Rukundo A, Walsh KA. Improving the appropriateness of psychotropic prescribing for nursing home residents with dementia: An overview of reviews [published online ahead of print May 13, 2021]. Aging Ment Health. 2021;1-8. doi:10.1080/13607863.2021.1922601