The impact of psycholeptic reduction in residential aged care facilities: Preliminary findings

Introduction: Psycholeptic medications are commonly prescribed in residential aged care facilities (RACFs). Antipsychotics are often used to treat behavioural symptoms and benzodiazepines are frequently given for sleep disturbances and anxiety. Despite modest efficacy for these symptoms and risk of severe adverse effects, evidence suggests that psycholeptics are not regularly reviewed or reduced. Previous psycholeptic reduction programs have lacked resident outcome monitoring, impacting upon their suitability to detect barriers to psycholeptic reduction.

Aims: To assess the impact that psycholeptic reduction has on residents of RACFs within a multifaceted intervention to improve psycholeptic prescribing (the Reducing the Use of Sedatives Project; RedUSe).

Methods: RedUSe consists of educational sessions supported by benchmarking of psycholeptic prescribing, and multidisciplinary psycholeptic reviews. This prospective cohort study aims to recruit over 200 residents taking regular antipsychotics and/or benzodiazepines from RACFs involved in RedUSe. At the conclusion of the study, residents will be grouped according to whether or not they have their psycholeptics reduced. Resident behaviour is assessed by staff using the Neuropsychiatric Inventory-Nursing Home version and Cohen-Mansfield Agitation Inventory (CMAI) at baseline and four months of RedUSe. Resident falls are assessed continuously over this time.

Results: Interim results indicate that benzodiazepine and antipsychotic use decreased in 14 of 46 residents prescribed regular benzodiazepines and 7 of 20 residents prescribed regular antipsychotics, respectively. Behavioural measures did not differ significantly besides the total CMAI score which increased in the antipsychotic reduction group 15.43±7.53 (n=7, P<0.05). The benzodiazepine (n=22 falls, 8 residents) and antipsychotic (n=4 falls, 2 residents) reduction groups had less falls than residents who continued/increased their benzodiazepine (n=31 falls, 11 residents) or antipsychotic medication (n=26 falls, 8 residents).

Discussion: The translation of psycholeptic reduction into resident outcomes will address the absence of monitoring from similar psycholeptic reduction programs. Preliminary results suggest that decreasing psycholeptics are unlikely to affect most resident behaviours. Ongoing data collection and analysis will provide further clarity.