On 8 January, researchers from Spain published a paper on a review approach to ameliorate but also potentially reduce psychotropic drug prescription in people with dementia in nursing homes. The article was published in BMC Geriatrics. Psychotropic drugs are often prescribed to help with behavioural and psychological symptoms of dementia (BPSD). At the same time, administration can also lead to worse cognitive performance and therefore the drawbacks of medication do not always warrant a continued prescription.
The study included the development of consensus guidelines for the treatment of BPSD by an interdisciplinary team, bringing together a neurologist, a psychiatrist, a geriatrician, 2 GPs and 4 pharmacists. The participants encompassed 240 institutionalised people with dementia from 7 nursing homes who received at least 1 psychotropic drug for the past 3 months. According to the study, professionals established the participants’ current status with regard to their prognosis, level of dependence, and frailty to facilitate decisions on the need to adapt the intensity of treatment, change treatment, or discontinue treatment based on the benefit-risk for the person.
The team noted, that prescription was reduced by 28%, decreasing from 2.71 drugs prescribed by patient to 1.95, 1 month after the review and rising again to 2.01 at 6 months due to reintroduction of medication. Although the authors conclude that the consensus guidelines were useful to review the treatments, they also acknowledged that this study was a pragmatic primary health care approach and that they did not include further clinical evaluations after the initial patient assessment and that only medication-related changes were recorded. The study as well as the guidelines can be found here: https://doi.org/10.1186/s12877-018-1015-9
