396 Psychosocial interventions reduce antipsychotic medications in residential care homes

September 25, 2013

PEARLS 396, June 2013, written by Brian R McAvoy

Clinical question
How effective are psychosocial interventions for reducing the prescribing of antipsychotic medications in residential care homes?

Bottom line
All the studies investigated complex interventions comprising educational approaches. Three offered education and training for nursing staff, and 1 offered multidisciplinary team meetings as the main component of the intervention. In all the studies, the interventions led to a reduction in the proportion of residents with antipsychotic drug use or a reduction in days with antipsychotic use per 100 days per resident, but the overall magnitude of the effect was unclear. Overall, there was no indication reduction of antipsychotic medication was related to replacement of antipsychotic medication with other psychotropic medication.

The review was based on a small number of heterogeneous studies with important methodological shortcomings, and 3 of the 4 included studies were published in the 1990s. However, the most recent and methodologically most rigorous study showed the most pronounced effect. Follow-up periods were different between studies, ranging from 5 to 13 months (mean = 9 months). Reporting of adverse effects was insufficient. Costs of interventions were not reported in any of the studies, preventing any assumptions about cost comparison or cost- effectiveness.

In residential care homes, antipsychotic medication is commonly prescribed to control so-called "behavioural and psychological symptoms of dementia" such as agitation, aggression or restlessness. However, it is questionable whether antipsychotic medication is effective and safe. Adverse effects, such as sedation, falls, and cardiovascular symptoms, are frequent. Therefore, antipsychotic medication should be avoided if possible.

Cochrane Systematic Review
Richter T et al. Psychosocial interventions for reducing antipsychotic medications in care home residents. Cochrane Reviews, 2012, Issue 12. Art. No.: CD008634.DOI: 10.1002/14651858. CD008634.pub2. This review contains 4 studies involving 33 care homes and 4337 residents.

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.