Skip to main content
SpringerLink
Log in

Clinical and Economic Outcomes of Interventions to Reduce Antipsychotic and Benzodiazepine Use Within Nursing Homes: A Systematic Review

  • Systematic Review
  • Published:
Drugs & Aging Aims and scope Submit manuscript

Abstract

Background

Antipsychotic and benzodiazepine medications are widely used in nursing homes despite only modest efficacy and the risk of severe adverse effects. Numerous interventions have been implemented to reduce their use. However, the outcomes for the residents and staff and the economic impact on the healthcare system remain relatively understudied.

Objective

The aim was to examine the clinical and economic outcomes reported within interventions to reduce antipsychotic and/or benzodiazepine use in nursing homes.

Methods

Databases searched included PubMed, EMBASE, CINAHL, CENTRAL, Scopus, and ProQuest. We focussed on interventions with professional (e.g. education) and/or organisational (e.g. formation of multidisciplinary teams) components. Data were extracted from the papers that included clinical and/or economic outcomes. Two authors independently reviewed articles for eligibility and quality.

Results

Fourteen studies reported on clinical outcomes for the residents: 13 antipsychotic reduction studies and one study focussing exclusively on benzodiazepine reduction. There was substantial heterogeneity in the types of outcomes reported and the method of reporting. Change in behavioural and psychological symptoms was the most commonly reported outcome throughout the antipsychotic reduction interventions (n = 12 studies) and remained stable or improved in ten of 12 studies. Whilst improvements were seen in emotional responsiveness, measures of sleep, cognitive function, and subjective health score remained unchanged upon benzodiazepine reduction. No interventions included an economic analysis.

Conclusions

Efforts should be made to improve the consistency in reporting of clinical outcomes within interventions to reduce antipsychotic and/or benzodiazepine medications. Additionally, the economic impact of these interventions should be considered. Nonetheless, evidence suggests that interventions that reduce antipsychotic use are unlikely to have deleterious clinical effects. The clinical and economic effects of benzodiazepine reduction remain under-reported.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Kleijer BC, van Marum RJ, Frijters DHM, Jansen PAF, Ribbe MW, Egberts ACG, et al. Variability between nursing homes in prevalence of antipsychotic use in patients with dementia. Int Psychogeriatr. 2014;26(3):363–71.

    Article  PubMed  Google Scholar 

  2. Bourgeois J, Elseviers MM, Azermai M, Van Bortel L, Petrovic M, Vander Stichele RR. Benzodiazepine use in Belgian nursing homes: a closer look into indications and dosages. Eur J Clin Pharmacol. 2012;68(5):833–44.

    Article  CAS  PubMed  Google Scholar 

  3. Westbury J, Jackson S, Peterson G. Psycholeptic use in aged care homes in Tasmania, Australia. J Clin Pharm Ther. 2010;35(2):189–93.

    Article  CAS  PubMed  Google Scholar 

  4. Hilmer SN, Gnjidic D. Rethinking psychotropics in nursing homes. Med J Aust. 2013;198(2):77.

    Article  PubMed  Google Scholar 

  5. Helvik A-S, Šaltytė Benth J, Wu B, Engedal K, Selbæk G. Persistent use of psychotropic drugs in nursing home residents in Norway. BMC Geriatr. 2017;17(1):52.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Chen L, Bell JS, Visvanathan R, Hilmer SN, Emery T, Robson L, et al. The association between benzodiazepine use and sleep quality in residential aged care facilities: a cross-sectional study. BMC Geriatr. 2016;16(1):196.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Defrancesco M, Marksteiner J, Fleischhacker WW, Blasko I. Use of benzodiazepines in Alzheimer’s disease: a systematic review of literature. Int J Neuropsychopharmacol. 2015;18(10):1–11.

    Article  CAS  Google Scholar 

  8. International Psychogeriatric Association. The IPA complete guides to behavioural and psychological symptoms of dementia (BPSD): specialists guide. Northfield: International Psychogeriatric Association; 2015.

    Google Scholar 

  9. The Royal Australian College of General Practitioners. Prescribing drugs of dependence in general practice, Part B. Melbourne. 2015. https://www.racgp.org.au/your-practice/guidelines/drugs-of-dependence-b. Accessed July 31 2017.

  10. Reus VI, Fochtmann LJ, Eyler AE, Hilty DM, Horvitz-Lennon M, Jibson MD, et al. The American Psychiatric Association practice guideline on the use of antipsychotics to treat agitation or psychosis in patients with dementia. Am J Psychiatry. 2016;173(5):543–6.

    Article  PubMed  Google Scholar 

  11. Dementia [revised 2015 Oct]. In: eTG complete [Internet]. Melbourne: Therapeutic Guidelines Limited; 2016 Mar.

  12. Anxiety and associated disorders [2013 July]. In: eTG complete [Internet]. Melbourne: Therapeutic Guidelines Limited; 2016 Mar.

  13. Insomnia, parasomnias and jet lag [2013 July]. In: eTG complete [Internet]. Melbourne: Therapeutic Guidelines Limited; 2016 Mar.

  14. Ballard CG, Waite J, Birks J. Atypical antipsychotics for aggression and psychosis in Alzheimer’s disease. Cochrane Database Syst Rev. 2006;1:CD00476.

    Google Scholar 

  15. Seitz DP, Gill SS, Herrmann N, Brisbin S, Rapoport MJ, Rines J, et al. Pharmacological treatments for neuropsychiatric symptoms of dementia in long-term care: a systematic review. Int Psychogeriatr. 2013;25(2):185–203.

    Article  PubMed  Google Scholar 

  16. Glass J, Lanctôt KL, Herrmann N, Sproule BA, Busto UE. Sedative hypnotics in older people with insomnia: meta-analysis of risks and benefits. BMJ. 2005;331(7526):1169.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Maust DT, Kim HM, Seyfried LS, Chiang C, Kavanagh J, Schneider LS, et al. Antipsychotics, other psychotropics, and the risk of death in patients with dementia: number needed to harm. JAMA Psychiatry. 2015;72(5):438–45.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Cox CA, van Jaarsveld HJ, Houterman S, van der Stegen JC, Wasylewicz AT, Grouls RJ, et al. Psychotropic drug prescription and the risk of falls in nursing home residents. J Am Med Dir Assoc. 2016;17(12):1089–93.

    Article  PubMed  Google Scholar 

  19. Billioti de Gage S, Moride Y, Ducruet T, Kurth T, Verdoux H, Tournier M, et al. Benzodiazepine use and risk of Alzheimer’s disease: case-control study. BMJ. 2014;349:g5205.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Hill KD, Wee R. Psychotropic drug-induced falls in older people: a review of interventions aimed at reducing the problem. Drugs Aging. 2012;29(1):15–30.

    Article  CAS  PubMed  Google Scholar 

  21. Bloch F, Thibaud M, Dugué B, Brèque C, Rigaud A-S, Kemoun G. Psychotropic drugs and falls in the elderly people: updated literature review and meta-analysis. J Aging Health. 2011;23(2):329–46.

    Article  PubMed  Google Scholar 

  22. Hanlon JT, Zhao X, Naples JG, Aspinall SL, Perera S, Nace DA, et al. Central nervous system medication burden and serious falls in older nursing home residents. J Am Geriatr Soc. 2017;65(6):1183–9.

    Article  PubMed  Google Scholar 

  23. Schneider LS, Dagerman KS, Insel P. Risk of death with atypical antipsychotic drug treatment for dementia: meta-analysis of randomized placebo-controlled trials. JAMA. 2005;294(15):1934–43.

    Article  CAS  PubMed  Google Scholar 

  24. US Food and Drug Administration. Information for healthcare professionals: conventional antipsychotics. Silver Spring. 2008. https://www.fda.gov/Drugs/DrugSafety/ucm124830.htm. Accessed August 21 2017.

  25. Iyer S, Naganathan V, McLachlan AJ, Le Couteur DG. Medication withdrawal trials in people aged 65 years and older: a systematic review. Drugs Aging. 2008;25(12):1021–31.

    Article  PubMed  Google Scholar 

  26. Ballard C, Hanney ML, Theodoulou M, Douglas S, McShane R, Kossakowski K, et al. The dementia antipsychotic withdrawal trial (DART-AD): long-term follow-up of a randomised placebo-controlled trial. Lancet Neurol. 2009;8(2):151–7.

    Article  CAS  PubMed  Google Scholar 

  27. Salzman C, Fisher J, Nobel K, Glassman R, Wolfson A, Kelley M. Cognitive improvement following benzodiazepine discontinuation in elderly nursing home residents. Int J Geriatr Psychiatry. 1992;7(2):89–93.

    Article  Google Scholar 

  28. Westbury J, Beld K, Jackson S, Peterson G. Review of psychotropic medication in Tasmanian residential aged care facilities. Australas J Ageing. 2010;29(2):72–6.

    Article  PubMed  Google Scholar 

  29. Azermai M, Stichele RRHV, Van Bortel LM, Elseviers MM. Barriers to antipsychotic discontinuation in nursing homes: an exploratory study. Aging Ment Health. 2014;18(3):346–53.

    Article  PubMed  Google Scholar 

  30. Bourgeois J, Elseviers MM, Azermai M, Van Bortel L, Petrovic M, Vander Stichele RR. Barriers to discontinuation of chronic benzodiazepine use in nursing home residents: perceptions of general practitioners and nurses. Eur Geriatr Med. 2013;5(3):181–7.

    Article  Google Scholar 

  31. Ballard C, Thomas A, Fossey J, Lee L, Jacoby R, Lana MM, et al. A 3-month, randomized, placebo-controlled, neuroleptic discontinuation study in 100 people with dementia: the Neuropsychiatric Inventory median cutoff is a predictor of clinical outcome. J Clin Psychiatry. 2004;65(1):114–9.

    Article  PubMed  Google Scholar 

  32. Curran HV, Collins R, Fletcher S, Kee SC, Woods B, Iliffe S. Older adults and withdrawal from benzodiazepine hypnotics in general practice: effects on cognitive function, sleep, mood and quality of life. Psychol Med. 2003;33(7):1223–37.

    Article  CAS  PubMed  Google Scholar 

  33. Pasina L, Marengoni A, Ghibelli S, Suardi F, Djade CD, Nobili A, et al. A multicomponent intervention to optimize psychotropic drug prescription in elderly nursing home residents: an Italian multicenter, prospective, pilot study. Drugs Aging. 2016;33(2):143–9.

    Article  PubMed  Google Scholar 

  34. Leow JB, Pont L, Low LF. Effect of humour therapy on psychotropic medication use in nursing homes. Australas J Ageing. 2016;35(4):E7–12.

    Article  PubMed  Google Scholar 

  35. Gordon SE, Dufour AB, Monti SM, Mattison MLP, Catic AG, Thomas CP, et al. Impact of a videoconference educational intervention on physical restraint and antipsychotic use in nursing homes: results from the ECHO-AGE pilot study. J Am Med Dir Assoc. 2016;17(6):553–6.

    Article  PubMed  PubMed Central  Google Scholar 

  36. de Souto Barreto P, Lapeyre-Mestre M, Cestac P, Vellas B, Rolland Y. Effects of a geriatric intervention aiming to improve quality care in nursing homes on benzodiazepine use and discontinuation. Br J Clin Pharmacol. 2016;81(4):759–67.

    Article  Google Scholar 

  37. Brooker DJ, Latham I, Evans SC, Jacobson N, Perry W, Bray J, et al. FITS into practice: translating research into practice in reducing the use of anti-psychotic medication for people with dementia living in care homes. Aging Ment Health. 2016;20(7):709–18.

    Article  PubMed  Google Scholar 

  38. Tjia J, Field T, Mazor K, Lemay CA, Kanaan AO, Donovan JL, et al. Dissemination of evidence-based antipsychotic prescribing guidelines to nursing homes: a cluster randomized trial. J Am Geriatr Soc. 2015;63(7):1289–98.

    Article  PubMed  Google Scholar 

  39. Watson-Wolfe K, Galik E, Klinedinst J, Brandt N. Application of the antipsychotic use in dementia assessment audit tool to facilitate appropriate antipsychotic use in long term care residents with dementia. Geriatr Nurs. 2014;35(1):71–6.

    Article  PubMed  Google Scholar 

  40. Westbury J, Tichelaar L, Peterson G, Gee P, Jackson S. A 12-month follow-up study of “RedUSe”: a trial aimed at reducing antipsychotic and benzodiazepine use in nursing homes. Int Psychogeriatr. 2011;23(8):1260–9.

    Article  PubMed  Google Scholar 

  41. Khan F, Curtice M. Non-pharmacological management of behavioural symptoms of dementia. Br J Community Nurs. 2011;16(9):441–9.

    Article  PubMed  Google Scholar 

  42. Westbury J, Jackson S, Gee P, Peterson G. An effective approach to decrease antipsychotic and benzodiazepine use in nursing homes: the RedUSe project. Int Psychogeriatr. 2010;22(1):26–36.

    Article  PubMed  Google Scholar 

  43. Kuske B, Luck T, Hanns S, Matschinger H, Angermeyer MC, Behrens J, et al. Training in dementia care: a cluster-randomized controlled trial of a training program for nursing home staff in Germany. Int Psychogeriatr. 2009;21(2):295–308.

    Article  PubMed  Google Scholar 

  44. Hagen BF, Armstrong-Esther C, Quail P, Williams RJ, Norton P, Le Navenec CL, et al. Neuroleptic and benzodiazepine use in long-term care in urban and rural Alberta: characteristics and results of an education intervention to ensure appropriate use. Int Psychogeriatr. 2005;17(4):631–52.

    Article  PubMed  Google Scholar 

  45. Eide E, Schjøtt J. Assessing the effects of an intervention by a pharmacist on prescribing and administration of hypnotics in nursing homes. Pharm World Sci. 2001;23(6):227–31.

    Article  CAS  PubMed  Google Scholar 

  46. Schmidt I, Claesson CB, Westerholm B, Nilsson LG, Svarstad BL. The impact of regular multidisciplinary team interventions on psychotropic prescribing in Swedish nursing homes. J Am Geriatr Soc. 1998;46(1):77–82.

    Article  CAS  PubMed  Google Scholar 

  47. Meador KG, Taylor JA, Thapa PB, Fought RL, Ray WA. Predictors of antipsychotic withdrawal or dose reduction in a randomized controlled trial of provider education. J Am Geriatr Soc. 1997;45(2):207–10.

    Article  CAS  PubMed  Google Scholar 

  48. Ray WA, Blazer DG, Schaffner W, Federspiel CF. Reducing antipsychotic drug prescribing for nursing home patients: a controlled trial of the effect of an educational visit. Am J Public Health. 1987;77(11):1448–50.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  49. Tjia J, Hunnicutt JN, Herndon L, Blanks CR, Lapane KL, Wehry S. Association of a communication training program with use of antipsychotics in nursing homes. JAMA Intern Med. 2017;177(6):846–53.

    Article  PubMed  Google Scholar 

  50. Rajkumar AP, Ballard C, Fossey J, Corbett A, Woods B, Orrell M, et al. Apathy and its response to antipsychotic review and nonpharmacological interventions in people with dementia living in nursing homes: WHELD, a factorial cluster randomized controlled trial. J Am Med Dir Assoc. 2016;17(8):741–7.

    Article  PubMed  Google Scholar 

  51. Ballard C, Orrell M, YongZhong S, Moniz-Cook E, Stafford J, Whittaker R, et al. Impact of antipsychotic review and nonpharmacological intervention on antipsychotic use, neuropsychiatric symptoms, and mortality in people with dementia living in nursing homes: a factorial cluster-randomized controlled trial by the well-being and health for people with dementia (WHELD) program. Am J Psychiatry. 2016;173(3):252–62.

    Article  PubMed  Google Scholar 

  52. Vida S, Monette J, Wilchesky M, Monette M, Friedman R, Nguyen A, et al. A long-term care center interdisciplinary education program for antipsychotic use in dementia: program update 5 years later. Int Psychogeriatr. 2012;24(4):599–605.

    Article  PubMed  Google Scholar 

  53. Monette J, Monette M, Sourial N, Vandal AC, Wolfson C, Champoux N, et al. Effect of an interdisciplinary educational program on antipsychotic prescribing among residents with dementia in two long-term care centers. J Appl Gerontol. 2013;32(7):833–54.

    Article  PubMed  Google Scholar 

  54. Monette J, Champoux N, Monette M, Fournier L, Wolfson C, du Fort GG, et al. Effect of an interdisciplinary educational program on antipsychotic prescribing among nursing home residents with dementia. Int J Geriatr Psychiatry. 2008;23(6):574–9.

    Article  PubMed  Google Scholar 

  55. Fossey J, Ballard C, Juszczak E, James I, Alder N, Jacoby R, et al. Effect of enhanced psychosocial care on antipsychotic use in nursing home residents with severe dementia: cluster randomised trial. BMJ. 2006;332(7544):756–61.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Ballard C, Powell I, James I, Reichelt K, Myint P, Potkins D, et al. Can psychiatric liaison reduce neuroleptic use and reduce health service utilization for dementia patients residing in care facilities. Int J Geriatr Psychiatry. 2002;17(2):140–5.

    Article  PubMed  Google Scholar 

  57. Earthy A, Collins J, Wong S, Myckatyn M. Ensuring appropriate use of neuroleptics. Can Nurs Home. 2000;11(5):5–10.

    Google Scholar 

  58. Rovner BW, Steele CD, Shmuely Y, Folstein MF. A randomized trial of dementia care in nursing homes. J Am Geriatr Soc. 1996;44(1):7–13.

    Article  CAS  PubMed  Google Scholar 

  59. Thapa PB, Meador KG, Gideon P, Fought RL, Ray WA. Effects of antipsychotic withdrawal in elderly nursing home residents. J Am Geriatr Soc. 1994;42(3):280–6.

    Article  CAS  PubMed  Google Scholar 

  60. Ray WA, Taylor JA, Meador KG, Lichtenstein MJ, Griffin MR, Fought R, et al. Reducing antipsychotic drug use in nursing homes. A controlled trial of provider education. Arch Intern Med. 1993;153(6):713–21.

    Article  CAS  PubMed  Google Scholar 

  61. Gilbert A, Owen N, Innes JM, Sansom L. Trial of an intervention to reduce chronic benzodiazepine use among residents of aged-care accommodation. Aust N Z J Med. 1993;23(4):343–7.

    Article  CAS  PubMed  Google Scholar 

  62. Avorn J, Soumerai S, Everitt D, Ross-Degnan D, Beers M, Sherman D, et al. A randomized trial of a program to reduce the use of psychoactive drugs in nursing homes. N Engl J Med. 1992;327(3):168–73.

    Article  CAS  PubMed  Google Scholar 

  63. Bach LL, Lazzaretto DL, Young CF, Lofholm PW. Improving nursing home compliance via revised antipsychotic use survey tool. Consult Pharm. 2017;32(4):228–38.

    Article  PubMed  Google Scholar 

  64. Azermai M, Wauters M, De Meester D, Renson L, Pauwels D, Peeters L, et al. A quality improvement initiative on the use of psychotropic drugs in nursing homes in Flanders. Acta Clin Belg. 2017;72(3):163–71.

    Article  PubMed  Google Scholar 

  65. Gemelli MG, Yockel K, Hohmeier KC. Evaluating the impact of pharmacists on reducing use of sedative/hypnotics for treatment of insomnia in long-term care facility residents. Consult Pharm. 2016;31(11):650–7.

    Article  PubMed  Google Scholar 

  66. Forsetlund L, Eike M, Gjerberg E, Vist G. Effect of interventions to reduce potentially inappropriate use of drugs in nursing homes: a systematic review of randomised controlled trials. BMC Geriatr. 2011;11(1):16.

    Article  PubMed  PubMed Central  Google Scholar 

  67. Loganathan M, Singh S, Franklin BD, Bottle A, Majeed A. Interventions to optimise prescribing in care homes: systematic review. Age Ageing. 2011;40(2):150–62.

    Article  PubMed  Google Scholar 

  68. Marcum ZA, Handler SM, Wright R, Hanlon JT. Interventions to improve suboptimal prescribing in nursing homes: a narrative review. Am J Geriatr Pharmacother. 2010;8(3):183–200.

    Article  PubMed  PubMed Central  Google Scholar 

  69. Nishtala PS, McLachlan AJ, Bell JS, Chen TF. Psychotropic prescribing in long-term care facilities: impact of medication reviews and educational interventions. Am J Geriatr Psychiatry. 2008;16(8):621–32.

    Article  PubMed  Google Scholar 

  70. Richter T, Meyer G, Mohler R, Kopke S. Psychosocial interventions for reducing antipsychotic medication in care home residents. Cochrane Database Syst Rev. 2012;12:8634.

    Google Scholar 

  71. Thompson Coon J, Abbott R, Rogers M, Whear R, Pearson S, Lang I, et al. Interventions to reduce inappropriate prescribing of antipsychotic medications in people with dementia resident in care homes: a systematic review. J Am Med Dir Assoc. 2014;15(10):706–18.

    Article  PubMed  Google Scholar 

  72. Gurwitz JH, Bonner A, Berwick DM. Reducing excessive use of antipsychotic agents in nursing homes. JAMA. 2017;318(2):118–9.

    Article  PubMed  Google Scholar 

  73. Millar AN, Daffu-O’Reilly A, Hughes CM, Alldred DP, Barton G, Bond CM, et al. Development of a core outcome set for effectiveness trials aimed at optimising prescribing in older adults in care homes. Trials. 2017;18(1):175.

    Article  PubMed  PubMed Central  Google Scholar 

  74. Alldred DP, Kennedy MC, Hughes C, Chen TF, Miller P. Interventions to optimise prescribing for older people in care homes. Cochrane Database Syst Rev. 2016;2:9095.

    Google Scholar 

  75. Reeve E, Ong M, Wu A, Jansen J, Petrovic M, Gnjidic D. A systematic review of interventions to deprescribe benzodiazepines and other hypnotics among older people. Eur J Clin Pharmacol. 2017;73(8):927–35.

    Article  CAS  PubMed  Google Scholar 

  76. Cochrane Effective Practice and Organisation of Care Group. Data collection checklist. Ottawa. 2002. http://methods.cochrane.org/sites/methods.cochrane.org.bias/files/public/uploads/EPOC%20Data%20Collection%20Checklist.pdf. Accessed December 16 2016.

  77. Moher D, Liberati A, Tetzlaff J, Altman DG. The PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097.

    Article  PubMed  PubMed Central  Google Scholar 

  78. Effective Public Health Practice Project. Quality assessment tool for quantitative studies. Hamilton. 2009. http://www.ephpp.ca/tools.html. Accessed July 4 2017.

  79. Ballard C, Orrell M, Sun Y, Moniz-Cook E, Stafford J, Whitaker R, et al. Impact of antipsychotic review and non-pharmacological intervention on health-related quality of life in people with dementia living in care homes: WHELD—a factorial cluster randomised controlled trial. Int J Geriatr Psychiatry. 2016;173(3):252–62.

    Google Scholar 

  80. Cummings J. Neuropsychiatric Inventory—Nursing Home Version (NPI-NH). Los Angeles. 2009. http://www.dementiamanagementstrategy.com/File.axd?id=c9f7405f-3596-4f5f-9f8d-f322e5188678. Accessed July 31 2017.

  81. Declercq T, Petrovic M, Azermai M, Vander Stichele R, De Sutter AI, van Driel ML, et al. Withdrawal versus continuation of chronic antipsychotic drugs for behavioural and psychological symptoms in older people with dementia. Cochrane Database Syst Rev. 2013;3:CD007726.

    Google Scholar 

  82. Simmons SF, Bonnett KR, Hollingsworth E, Kim J, Powers J, Habermann R, et al. Reducing antipsychotic medication use in nursing homes: a qualitative study of nursing staff perceptions. Gerontologist. 2017. https://doi.org/10.1093/geront/gnx083:aheadofprint.

    Google Scholar 

  83. Zwijsen SA, Bosmans JE, Gerritsen DL, Pot AM, Hertogh CMPM, Smalbrugge M. The cost-effectiveness of grip on challenging behaviour: an economic evaluation of a care programme for managing challenging behaviour. Int J Geriatr Psychiatry. 2016;31(6):567–74.

    Article  CAS  PubMed  Google Scholar 

  84. Olivieri-Mui BL, Devlin JW, Ochoa A, Schenck D, Briesacher B. Perceptions vs. evidence: therapeutic substitutes for antipsychotics in patients with dementia in long-term care. Aging Ment Health. 2017. https://doi.org/10.1080/13607863.2016.1277974:1.

    PubMed  Google Scholar 

  85. NHS Centre for Reviews and Dissemination. Systematic review: CRD’s guidance for undertaking reviews in health care. York: University of York; 2009.

    Google Scholar 

Download references

Acknowledgements

The authors thank Michaela Venn for assistance with the search strategy and Colin Curtain for feedback on the manuscript.

Author information

Authors and Affiliations

  1. Pharmacy, School of Medicine, College of Health and Medicine, University of Tasmania, Private Bag 26, Hobart, TAS, 7001, Australia

    Daniel J. Hoyle, Ivan K. Bindoff & Gregory M. Peterson

  2. School of Nursing, Midwifery and Paramedicine, Australian Catholic University, PO Box 650, Ballarat, VIC, 3350, Australia

    Lisa M. Clinnick

  3. Wicking Dementia Research & Education Centre, College of Health and Medicine, University of Tasmania, Private Bag 143, Hobart, TAS, 7001, Australia

    Juanita L. Westbury

Authors
  1. Daniel J. Hoyle
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ivan K. Bindoff
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lisa M. Clinnick
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Gregory M. Peterson
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Juanita L. Westbury
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Daniel J. Hoyle.

Ethics declarations

Conflicts of interest

Daniel Hoyle, Ivan Bindoff, Lisa Clinnick, Gregory Peterson and Juanita Westbury declare that they have no conflict of interest.

Funding

This work was supported in part through co-contribution to a doctoral scholarship (for DH) from the following sources: the Australian Government (through an Australian Postgraduate Award), a top-up scholarship provided by the Department of Health (under the Dementia and Aged Care Service Fund), and the University of Tasmania. The funding organisations did not play a role in the study concept, data analysis, or interpretation.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hoyle, D.J., Bindoff, I.K., Clinnick, L.M. et al. Clinical and Economic Outcomes of Interventions to Reduce Antipsychotic and Benzodiazepine Use Within Nursing Homes: A Systematic Review. Drugs Aging 35, 123–134 (2018). https://doi.org/10.1007/s40266-018-0518-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40266-018-0518-6

Search

Navigation