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Int Psychogeriatr. 2017 Aug;29(8):1391-1403. doi: 10.1017/S1041610217000084. Epub 2017 Mar 7.

Halting Antipsychotic Use in Long-Term care (HALT): a single-arm longitudinal study aiming to reduce inappropriate antipsychotic use in long-term care residents with behavioral and psychological symptoms of dementia.

Author information

1
Dementia Collaborative Research Centre,School of Psychiatry UNSW Australia,Sydney,NSW 2052,Australia.
2
School of Psychiatry UNSW Australia and Clinical Director,Academic Department for Old Age Psychiatry Prince of Wales Hospital,Euroa Centre Prince of Wales Hospital,Randwick,NSW 2031,Australia.
3
Centre for Healthy Brain Ageing (CHeBA),UNSW Australia,Sydney,NSW 2052,Australia.
4
Sydney Medical School,The University of Sydney and Head of Department Clinical Pharmacology and Senior Staff Specialist Aged Care,Royal North Shore Hospital Level 12,Kolling Building,St Leonards,NSW 2065,Australia.
5
Wicking Dementia Research and Education Centre,Faculty of Health,University of Tasmania,Private Bag 143,Hobart,TAS 7001,Australia.
6
NHMRC Career Development Fellow Faculty of Health Sciences,The University of Sydney,Room M309B M Block 75 East Street,Lidcombe,NSW 2141,Australia.
7
Centre for Healthy Brain Ageing (CHeBA),School of Psychiatry,UNSW Australia and Director,Neuropsychiatric Institute,The Prince of Wales Hospital,Randwick,NSW 2031,Australia.
8
Neuroscience Research Australia,Barker St Randwick,NSW 2031,Australia.

Abstract

BACKGROUND:

Inappropriate use of antipsychotic medications to manage Behavioral and Psychological Symptoms of Dementia (BPSD) continues despite revised guidelines and evidence for the associated risks and side effects. The aim of the Halting Antipsychotic Use in Long-Term care (HALT) project is to identify residents of long-term care (LTC) facilities on antipsychotic medications, and undertake an intervention to deprescribe (or cease) these medicines and improve non-pharmacological behavior management.

METHODS:

LTC facilities will be recruited across Sydney, Australia. Resident inclusion criteria will be aged over 60 years, on regular antipsychotic medication, and without a primary psychotic illness or very severe BPSD, as measured using the Neuropsychiatric Inventory (NPI). Data collection will take place one month and one week prior to commencement of deprescribing; and 3, 6 and 12 months later. During the period prior to deprescribing, training will be provided for care staff on how to reduce and manage BPSD using person-centered approaches, and general practitioners of participants will be provided academic detailing. The primary outcome measure will be reduction of regular antipsychotic medication without use of substitute psychotropic medications. Secondary outcome measures will be NPI total and domain scores, Cohen-Mansfield Agitation Inventory scores and adverse events, including falls and hospitalizations.

CONCLUSION:

While previous studies have described strategies to minimize inappropriate use of antipsychotic medications in people with dementia living in long-term care, sustainability and a culture of prescribing for BPSD in aged care remain challenges. The HALT project aims to evaluate the feasibility of a multi-disciplinary approach for deprescribing antipsychotics in this population.

KEYWORDS:

BPSD; aged care; antipsychotics; dementia; deprescribing; long-term care; person-centered care

PMID:
28266282
DOI:
10.1017/S1041610217000084
[Indexed for MEDLINE]

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