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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

Published online by Cambridge University Press:  07 March 2017

Tiffany Jessop ,
Fleur Harrison ,
Monica Cations ,
Brian Draper ,
Lynn Chenoweth ,
Sarah Hilmer ,
Juanita Westbury ,
Lee-Fay Low ,
Megan Heffernan  and
Perminder Sachdev
...Show all authors
Tiffany Jessop
Affiliation:
Dementia Collaborative Research Centre, School of Psychiatry UNSW Australia, Sydney, NSW 2052, Australia
Fleur Harrison
Affiliation:
Dementia Collaborative Research Centre, School of Psychiatry UNSW Australia, Sydney, NSW 2052, Australia
Monica Cations
Affiliation:
Dementia Collaborative Research Centre, School of Psychiatry UNSW Australia, Sydney, NSW 2052, Australia
Brian Draper
Affiliation:
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
Lynn Chenoweth
Affiliation:
Centre for Healthy Brain Ageing (CHeBA), UNSW Australia, Sydney, NSW 2052, Australia
Sarah Hilmer
Affiliation:
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
Juanita Westbury
Affiliation:
Wicking Dementia Research and Education Centre, Faculty of Health, University of Tasmania, Private Bag 143, Hobart, TAS 7001, Australia
Lee-Fay Low
Affiliation:
NHMRC Career Development Fellow Faculty of Health Sciences, The University of Sydney, Room M309B M Block 75 East Street, Lidcombe, NSW 2141, Australia
Megan Heffernan
Affiliation:
Dementia Collaborative Research Centre, School of Psychiatry UNSW Australia, Sydney, NSW 2052, Australia
Perminder Sachdev
Affiliation:
Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, UNSW Australia and Director, Neuropsychiatric Institute, The Prince of Wales Hospital, Randwick, NSW 2031, Australia
Jacqueline Close
Affiliation:
Neuroscience Research Australia, Barker St Randwick, NSW 2031, Australia
Jenny Blennerhassett
Affiliation:
Dementia Collaborative Research Centre, School of Psychiatry UNSW Australia, Sydney, NSW 2052, Australia
Millicent Marinkovich
Affiliation:
Dementia Collaborative Research Centre, School of Psychiatry UNSW Australia, Sydney, NSW 2052, Australia
Allan Shell
Affiliation:
Dementia Collaborative Research Centre, School of Psychiatry UNSW Australia, Sydney, NSW 2052, Australia
Henry Brodaty*
Affiliation:
Dementia Collaborative Research Centre, School of Psychiatry UNSW Australia, Sydney, NSW 2052, Australia
*
Correspondence should be addressed to: Henry Brodaty, Director, Dementia Collaborative Research Centre, School of Psychiatry UNSW Australia, Sydney, NSW 2052, Australia. Phone: +61 2 9385 2585; Fax: +61 2 9385 2200. Email: h.brodaty@unsw.edu.au.
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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

antipsychoticsBPSDaged caredementiaperson-centered caredeprescribinglong-term care
Type
Protocol-only paper
Information
International Psychogeriatrics , Volume 29 , Issue 8 , August 2017 , pp. 1391 - 1403
Copyright
Copyright © International Psychogeriatric Association 2017 

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