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A long-term care center interdisciplinary education program for antipsychotic use in dementia: program update five years later

Published online by Cambridge University Press:  30 November 2011

Stephen Vida ,
Johanne Monette ,
Machelle Wilchesky ,
Michèle Monette ,
Ruby Friedman ,
Anh Nguyen ,
Dolly Dastoor ,
Gabriela Cristache ,
Nadia Sourial  and
Lucie Tremblay
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Stephen Vida
Affiliation:
Donald Berman Maimonides Geriatric Centre, McGill University, Montreal, Quebec, Canada McGill University Health Centre Department of Psychiatry, Montreal, Quebec, Canada
Johanne Monette
Affiliation:
Donald Berman Maimonides Geriatric Centre, McGill University, Montreal, Quebec, Canada Division of Geriatric Medicine, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal, Quebec, Canada Solidage-McGill University-Université de Montréal Research Group on Frailty and Aging, Center for Clinical Epidemiology and Community Studies, Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
Machelle Wilchesky
Affiliation:
Donald Berman Maimonides Geriatric Centre, McGill University, Montreal, Quebec, Canada Center for Clinical Epidemiology and Community Studies, Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
Michèle Monette
Affiliation:
Donald Berman Maimonides Geriatric Centre, McGill University, Montreal, Quebec, Canada Solidage-McGill University-Université de Montréal Research Group on Frailty and Aging, Center for Clinical Epidemiology and Community Studies, Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
Ruby Friedman
Affiliation:
Donald Berman Maimonides Geriatric Centre, McGill University, Montreal, Quebec, Canada Division of Geriatric Medicine, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal, Quebec, Canada
Anh Nguyen
Affiliation:
Donald Berman Maimonides Geriatric Centre, McGill University, Montreal, Quebec, Canada
Dolly Dastoor
Affiliation:
Geriatric Psychiatry Program, Douglas Mental Health University Institute, Montreal, Quebec, Canada
Gabriela Cristache
Affiliation:
Donald Berman Maimonides Geriatric Centre, McGill University, Montreal, Quebec, Canada
Nadia Sourial
Affiliation:
Solidage-McGill University-Université de Montréal Research Group on Frailty and Aging, Center for Clinical Epidemiology and Community Studies, Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
Lucie Tremblay
Affiliation:
Donald Berman Maimonides Geriatric Centre, McGill University, Montreal, Quebec, Canada
Brian Gore*
Affiliation:
Donald Berman Maimonides Geriatric Centre, McGill University, Montreal, Quebec, Canada
*
Correspondence should be addressed to: Brian Gore, Donald Berman Maimonides Geriatric Centre, 5795 Caldwell Avenue, Montreal, Quebec, H4W 1W3, Canada. Phone: +1 (514) 483–2121. Email: brian.gore@videotron.ca.
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Abstract

Background: While antipsychotic (AP) medications are frequently used in long-term care, current evidence suggests that the risks may offset the benefits, necessitating periodic reassessment of their use. The aims of this present study were: (1) to assess rates of AP use five years after our first intervention to determine the long-term impact; and (2) to implement an updated AP reduction educational intervention program at the same center five years later in order to determine whether AP use could be further reduced.

Methods: Participants were residents with dementia receiving AP medication. The educational program component included separate lectures on pharmacologic and non-pharmacologic treatment of behavioral and psychological symptoms of dementia (BPSD). Completion of the Nursing Home Behavior Problems Scale (NHBPS), physician interviews concerning AP treatment plans for subjects with dementia, and AP administration and dose assessment occurred both at baseline and again between four to five months after the educational program.

Results: Of 308 long-term residents with dementia, 53 (17.2%) were receiving regular APs, primarily for agitation, aggressivity, other behavioral problems and psychosis. Of these, six died and one was transferred, leaving 46 participants. At five months, ten (21.7%) residents were no longer receiving APs and seven (15.2%) were on a lower dose; thus, 17 (37.0%) were either discontinued or on a lower dose. There was no worsening of NHBPS scores.

Conclusion: Despite the low prevalence (17.2%) of AP users at the beginning of the current study compared to that observed five years prior (30.5%), it is still possible to further decrease the proportion of users.

Keywords

antipsychotic agentsdementialong-term careprescribing educational programprescribing interventiongeriatrics
Type
Research Article
Information
International Psychogeriatrics , Volume 24 , Issue 4 , April 2012 , pp. 599 - 605
Copyright
Copyright © International Psychogeriatric Association 2011

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