Dementia
Conditions
Keywords
Antipsychotic, Nursing home, Long-term care
Brief summary
Inappropriate antipsychotic prescribing is a key quality indicator by which clinical outcomes might be monitored and improved in LTC. A multi component intervention to reduce inappropriate antipsychotic prescribing was evaluated in ten Canadian long-term care facilities.
Detailed description
Increasing numbers of older adults are affected by dementia, and many will eventually reside in long-term care (LTC), where antipsychotic use is relatively common. Inappropriate antipsychotic prescribing is a key quality indicator by which clinical outcomes might be monitored and improved in LTC but limited evidence exists on the most effective strategies for reducing inappropriate antipsychotic use. The objective of the study was to evaluate a multicomponent approach to reduce inappropriate prescribing of antipsychotics in LTC. A prospective, randomized stepped-wedge, study design was used to evaluate the effect of the intervention in 10 LTC facilities in Canada. The intervention consisted of an educational in-service, provision of evidence-based tools to assess and monitor neuropsychiatric symptoms (NPS) and monthly interprofessional team meetings.
Interventions
OTHEREducational
Multi component educational intervention in long-term care
Sponsors
Canadian Consortium on Neurodegeneration in Aging
Canadian Frailty Network
Queen's University
Study design
Allocation
RANDOMIZED
Intervention model
SEQUENTIAL
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
Randomized, stepped-wedge cluster trial.
Eligibility
Sex/Gender
ALL
Age
60 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Diagnosis of dementia * Receiving an antipsychotic medication without a diagnosis of psychosis
Exclusion criteria
* Diagnoses of schizophrenia, Huntington's disease * Presence of active hallucinations and/or delusions * Individuals at end of live or receiving palliative care
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of long-term care residents receiving any antipsychotic without a diagnosis of psychosis | 12-months | The proportion of long-term care residents receiving any antipsychotic without a diagnosis of psychosis is a quality indicator is used by the Canadian Institute for Health Information to determine potentially inappropriate antipsychotic use. The quality indicator is calculated using information routinely collected on Resident Assessment Index-Minimum Dataset (RAI-MDS) assessments by determining the number of individuals who received antipsychotics on one of more days in the 7 days preceding index (RAI-MDS item O4a ≥ 1). Individuals with schizophrenia, Huntington's disease, hallucinations, delusions, those with a limited life expectancy and those currently receiving palliative care are excluded from the numerator and denominator of this indicator. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Worsening of behavioral symptoms | 12-months | Proportion of residents who had one or more of the following behavioural symptoms: wandering, physically or verbally abusive, or socially inappropriate behaviours) present on their target RAI-MDS assessment than on their prior assessment. |
| Use of physical restraints | 12-months | Proportion of residents in daily physical restraints as of the target RAI-MDS assessment. |
| Depression: Proportion of residents whose mood from symptoms of depression worsened | 12-months | Proportion of residents whose mood from symptoms of depression worsened compared to the previous RAI-MDS assessment. |
| Falls: Proportion of residents experiencing a fall in the 30 day | 12-months | Proportion of residents experiencing a fall in the 30 days preceding the RAI-MDS assessment. |
| Pain: Proportion of residents who had pain | 12-months | Proportion of residents who had pain on their target RAI=MDS assessment. |
Outcome results
None listed