Reducing antipsychotic use in people with dementia living in nursing homes

Analysis of research article by Clarissa Giebel for the Mental Elf

Article: Ballard C, et al. (2015) 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. American Journal of Psychiatry 2015 http://dx.doi.org/10.1176/appi.ajp.2015.15010130

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Image source: NHS PhotoLibrary

‘This is a really substantial randomised controlled trial, that takes into account a complex set of interventions. It is great to see that the trial integrated evidence-based interventions, which were based on existing manuals, such as the Seattle protocol for the exercise intervention. This increases the trial credibility and methodological strength.

As the authors point out, there needs to be a shift away from solely prescribing antipsychotics to using nonpharmacological interventions also, or, in some cases, as an alternative. Hence, it’s recommended that practice guidelines are changed. Indeed, a shift towards nonpharmacological interventions isn’t specific to antipsychotic prescription only. There are many areas in which nonpharmacological interventions can be effective, such as cognition or everyday functioning (Giebel & Challis, 2015). Plus, with the majority of people with dementia being 65 years or older, and most likely already taking several medications, we should be trying to avoid offering more medication wherever possible. Looking at the interventions offered here also, increasing social activities and physical functioning will have additional benefits to the residents’ well-being and cardiovascular functioning.’

Read the full analysis via the Mental Elf