Deprescribing Psychotropic Medications in Aged Care Facilities: The Potential Role of Family Members

  • Christos Plakiotis
  • J. Simon Bell
  • Yun-Hee Jeon
  • Dimity Pond
  • Daniel W. O’Connor
Conference paper
Part of the Advances in Experimental Medicine and Biology book series (AEMB, volume 821)

Abstract

There is widespread concern in Australia and internationally at the high prevalence of psychotropic medication use in residential aged care facilities. It is difficult for nurses and general practitioners in aged care facilities to cease new residents’ psychotropic medications when they often have no information about why residents were started on the treatment, when and by whom and with what result. Most existing interventions have had a limited and temporary effect and there is a need to test different strategies to overcome the structural and practical barriers to psychotropic medication cessation or deprescribing. In this chapter, we review the literature regarding psychotropic medication deprescribing in aged care facilities and present the protocol of a novel study that will examine the potential role of family members in facilitating deprescribing. This project will help determine if family members can contribute information that will prove useful to clinicians and thereby overcome one of the barriers to deprescribing medications whose harmful effects often outweigh their benefits. We wish to understand the knowledge and attitudes of family members regarding the prescribing and deprescribing of psychotropic medications to newly admitted residents of aged care facilities with a view to developing and testing a range of clinical interventions that will result in better, safer prescribing practices.

Keywords

Psychotropic medication Deprescribing Aged care facilities Older adults Dementia 

References

  1. 1.
    Australian Institute of Health and Welfare (2013) Residential aged care and aged care packages in the community 2011–12 [Online]. http://www.aihw.gov.au/aged-care/residential-and-community-2011-12/. Accessed 11 Feb 2014
  2. 2.
    Hosia-Randell H, Pitkala K (2005) Use of psychotropic drugs in elderly nursing home residents with and without dementia in Helsinki, Finland. Drugs Aging 22(9):793–800PubMedCrossRefGoogle Scholar
  3. 3.
    Snowdon J, Galanos D, Vaswani D (2011) Patterns of psychotropic medication use in nursing homes: surveys in Sydney, allowing comparisons over time and between countries. Int Psychogeriatr 23(9):1520–1525PubMedCrossRefGoogle Scholar
  4. 4.
    Rattinger GB, Burcu M, Dutcher SK, Chhabra PT, Rosenberg PB, Simoni-Wastila L et al (2013) Pharmacotherapeutic management of dementia across settings of care. J Am Geriatr Soc 61(5):723–733PubMedCentralPubMedCrossRefGoogle Scholar
  5. 5.
    Wood-Mitchell A, James IA, Waterworth A, Swann A, Ballard C (2008) Factors influencing the prescribing of medications by old age psychiatrists for behavioural and psychological symptoms of dementia: a qualitative study. Age Ageing 37(5):547–552PubMedCrossRefGoogle Scholar
  6. 6.
    Kaur S, Mitchell G, Vitetta L, Roberts MS (2009) Interventions that can reduce inappropriate prescribing in the elderly: a systematic review. Drugs Aging 26(12):1013–1028PubMedCrossRefGoogle Scholar
  7. 7.
    Brulhart MI, Wermeille JP (2011) Multidisciplinary medication review: evaluation of a pharmaceutical care model for nursing homes. Int J Clin Pharm 33(3):549–557PubMedCrossRefGoogle Scholar
  8. 8.
    Reeve E, Shakib S, Hendrix I, Roberts MS, Wiese MD (2013) Development and validation of the patients’ attitudes towards deprescribing (PATD) questionnaire. Int J Clin Pharm 35(1):51–56PubMedCrossRefGoogle Scholar
  9. 9.
    Reeve E, Wiese MD, Hendrix I, Roberts MS, Shakib S (2013) People’s attitudes, beliefs, and experiences regarding polypharmacy and willingness to deprescribe. J Am Geriatr Soc 61(9):1508–1514PubMedCrossRefGoogle Scholar
  10. 10.
    Reeve E, To J, Hendrix I, Shakib S, Roberts MS, Wiese MD (2013) Patient barriers to and enablers of deprescribing: a systematic review. Drugs Aging 30(10):793–807PubMedCrossRefGoogle Scholar
  11. 11.
    Woodward M (2003) Deprescribing: achieving better health outcomes for older people through reducing medications. J Pharm Pract Res 33(4):323–328Google Scholar
  12. 12.
    Alexander GC, Sayla MA, Holmes HM, Sachs GA (2006) Prioritizing and stopping prescription medicines. CMAJ 174(8):1083–1084PubMedCentralPubMedCrossRefGoogle Scholar
  13. 13.
    Ostini R, Hegney D, Jackson C, Williamson M, Mackson JM, Gurman K et al (2009) Systematic review of interventions to improve prescribing. Ann Pharmacother 43(3):502–513PubMedCrossRefGoogle Scholar
  14. 14.
    Bain KT, Holmes HM, Beers MH, Maio V, Handler SM, Pauker SG (2008) Discontinuing medications: a novel approach for revising the prescribing stage of the medication-use process. J Am Geriatr Soc 56(10):1946–1952PubMedCentralPubMedCrossRefGoogle Scholar
  15. 15.
    Le Couteur D, Banks E, Gnjidic D, McLachlan A (2011) Deprescribing. Aust Prescr 34:182–185Google Scholar
  16. 16.
    Ostini R, Hegney D, Jackson C, Tett SE (2012) Knowing how to stop: ceasing prescribing when the medicine is no longer required. J Manag Care Pharm 18(1):68–72PubMedGoogle Scholar
  17. 17.
    Scott IA, Gray LC, Martin JH, Mitchell CA (2012) Minimizing inappropriate medications in older populations: a 10-step conceptual framework. Am J Med 125(6):529–537e4PubMedCrossRefGoogle Scholar
  18. 18.
    Draper B, Brodaty H, Low LF (2006) A tiered model of psychogeriatric service delivery: an evidence-based approach. Int J Geriatr Psychiatry 21(7):645–653PubMedCrossRefGoogle Scholar
  19. 19.
    Hartikainen S, Lonnroos E, Louhivuori K (2007) Medication as a risk factor for falls: critical systematic review. J Gerontol A Biol Sci Med Sci 62(10):1172–1181PubMedCrossRefGoogle Scholar
  20. 20.
    Taipale HT, Bell JS, Gnjidic D, Sulkava R, Hartikainen S (2012) Sedative load among community-dwelling people aged 75 years or older: association with balance and mobility. J Clin Psychopharmacol 32(2):218–224PubMedCrossRefGoogle Scholar
  21. 21.
    Schneeweiss S, Setoguchi S, Brookhart A, Dormuth C, Wang PS (2007) Risk of death associated with the use of conventional versus atypical antipsychotic drugs among elderly patients. CMAJ 176(5):627–632PubMedCentralPubMedCrossRefGoogle Scholar
  22. 22.
    The Royal Australian and New Zealand College of Psychiatrists (2009) Practice Guideline 10: Antipsychotic medications as a treatment of behavioural and psychological symptoms in dementia [Online]. https://www.ranzcp.org/Resources/Statements-Guidelines/Practice-Guidelines.aspx. Accessed 09 Feb 2014
  23. 23.
    Declercq T, Petrovic M, Azermai M, Vander Stichele R, De Sutter AI, van Driel ML et al (2013) Withdrawal versus continuation of chronic antipsychotic drugs for behavioural and psychological symptoms in older people with dementia. Cochrane Database Syst Rev 3:CD007726Google Scholar
  24. 24.
    O’Connor DW, Griffith J, McSweeney K (2010) Changes to psychotropic medications in the six months after admission to nursing homes in Melbourne, Australia. Int Psychogeriatr 22(7):1149–1153PubMedCrossRefGoogle Scholar
  25. 25.
    Maguire A, Hughes C, Cardwell C, O’Reilly D (2013) Psychotropic medications and the transition into care: a national data linkage study. J Am Geriatr Soc 61(2):215–221PubMedCrossRefGoogle Scholar
  26. 26.
    Azermai M, Vander Stichele RRH, Van Bortel LM, Elseviers MM (2013) Barriers to antipsychotic discontinuation in nursing homes: an exploratory study. Aging Ment Health 18:346–353. http://dx.doi.org/10.1080/13607863.2013.832732Google Scholar
  27. 27.
    Hilmer SN, Gnjidic D, Le Couteur DG (2012) Thinking through the medication list—appropriate prescribing and deprescribing in robust and frail older patients. Aust Fam Physician 41(12):924–928PubMedGoogle Scholar
  28. 28.
    The Department of Health (2012) Guiding principles for medication management in residential aged care facilities [Online]. http://www.health.gov.au/internet/main/publishing.nsf/Content/nmp-pdf-resguide-cnt.htm Accessed 09 Feb 2014
  29. 29.
    Tjia J, Gurwitz JH, Briesacher BA (2012) Challenge of changing nursing home prescribing culture. Am J Geriatr Pharmacother 10(1):37–46PubMedCentralPubMedCrossRefGoogle Scholar
  30. 30.
    Rovner BW, Edelman BA, Cox MP, Shmuely Y (1992) The impact of antipsychotic drug regulations on psychotropic prescribing practices in nursing homes. Am J Psychiatry 149(10):1390–1392PubMedGoogle Scholar
  31. 31.
    Rendina N, Brodaty H, Draper B, Peisah C, Brugue E (2009) Substitute consent for nursing home residents prescribed psychotropic medication. Int J Geriatr Psychiatry 24(3):226–231PubMedCrossRefGoogle Scholar
  32. 32.
    Crotty M, Halbert J, Rowett D, Giles L, Birks R, Williams H et al (2004) An outreach geriatric medication advisory service in residential aged care: a randomised controlled trial of case conferencing. Age Ageing 33(6):612–617PubMedCrossRefGoogle Scholar
  33. 33.
    Nishtala PS, McLachlan AJ, Bell JS, Chen TF (2008) Psychotropic prescribing in long-term care facilities: impact of medication reviews and educational interventions. Am J Geriatr Psychiatry 16(8):621–632PubMedCrossRefGoogle Scholar
  34. 34.
    Roberts MS, Stokes JA, King MA, Lynne TA, Purdie DM, Glasziou PP et al (2001) Outcomes of a randomized controlled trial of a clinical pharmacy intervention in 52 nursing homes. Br J Clin Pharmacol 51(3):257–265PubMedCentralPubMedCrossRefGoogle Scholar
  35. 35.
    Crotty M, Whitehead C, Rowett D, Halbert J, Weller D, Finucane P et al (2004) An outreach intervention to implement evidence based practice in residential care: a randomized controlled trial [ISRCTN67855475]. BMC Health Serv Res 4(1):6PubMedCentralPubMedCrossRefGoogle Scholar
  36. 36.
    Westbury J, Jackson S, Gee P, Peterson G (2010) An effective approach to decrease antipsychotic and benzodiazepine use in nursing homes: the RedUSe project. Int Psychogeriatr 22(1):26–36PubMedCrossRefGoogle Scholar
  37. 37.
    Westbury J, Tichelaar L, Peterson G, Gee P, Jackson S (2011) A 12-month follow-up study of “RedUSe”: a trial aimed at reducing antipsychotic and benzodiazepine use in nursing homes. Int Psychogeriatr 23(8):1260–1269PubMedCrossRefGoogle Scholar
  38. 38.
    Campbell NC, Murray E, Darbyshire J, Emery J, Farmer A, Griffiths F et al (2007) Designing and evaluating complex interventions to improve health care. BMJ 334(7591):455–459PubMedCentralPubMedCrossRefGoogle Scholar
  39. 39.
    National Health and Medical Research Council (2007) National statement on ethical conduct in human research (2007) - Updated December 2013 [Online]. http://www.nhmrc.gov.au/guidelines/publications/e72. Accessed 09 Feb 2014
  40. 40.
    Alzheimer's Australia (2013) Participate in research [Online]. http://www.fightdementia.org.au/research-publications/clinical-trials--research-projects.aspx. Accessed 09 Feb 2014
  41. 41.
    Gale NK, Heath G, Cameron E, Rashid S, Redwood S (2013) Using the framework method for the analysis of qualitative data in multi-disciplinary health research. BMC Med Res Methodol 13:117PubMedCentralPubMedCrossRefGoogle Scholar
  42. 42.
    Cumbler E, Wald H, Kutner J (2010) Lack of patient knowledge regarding hospital medications. J Hosp Med 5(2):83–86PubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  • Christos Plakiotis
    • 1
    • 2
  • J. Simon Bell
    • 3
    • 4
    • 5
  • Yun-Hee Jeon
    • 6
  • Dimity Pond
    • 7
  • Daniel W. O’Connor
    • 1
  1. 1.Department of Psychiatry, School of Clinical Sciences at Monash HealthMonash UniversityMelbourneAustralia
  2. 2.Aged Psychiatry Academic UnitMonash University, Kingston CentreCheltenhamAustralia
  3. 3.Centre for Medicine Use and SafetyMonash UniversityMelbourneAustralia
  4. 4.Sansom Institute, School of Pharmacy and Medical SciencesUniversity of South AustraliaAdelaideAustralia
  5. 5.Faculty of Health Sciences, School of PharmacyUniversity of Eastern FinlandKuopioFinland
  6. 6.Sydney Nursing SchoolThe University of SydneySydneyAustralia
  7. 7.Discipline of General PracticeThe University of NewcastleNewcastleAustralia

Personalised recommendations