Hoyle, DJ and Bindoff, IK and Clinnick, LM and Peterson, GM and Westbury, JL, Clinical and economic outcomes of interventions to reduce antipsychotic and benzodiazepine use within Nursing Homes: a systematic review, Drugs and Aging, 35, (2) pp. 123-134. ISSN 1170-229X (2018) [Refereed Article]
Copyright 2018 Springer International Publishing AG, part of Springer Nature
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.
|Item Type:||Refereed Article|
|Keywords:||antipsychotic, benzodiazepine, nursing home, deprescribing, systematic review|
|Research Division:||Biomedical and Clinical Sciences|
|Research Group:||Pharmacology and pharmaceutical sciences|
|Research Field:||Clinical pharmacology and therapeutics|
|Objective Group:||Specific population health (excl. Indigenous health)|
|Objective Field:||Health related to ageing|
|UTAS Author:||Hoyle, DJ (Dr Daniel Hoyle)|
|UTAS Author:||Bindoff, IK (Dr Ivan Bindoff)|
|UTAS Author:||Clinnick, LM (Dr Lisa Clinnick)|
|UTAS Author:||Peterson, GM (Professor Gregory Peterson)|
|UTAS Author:||Westbury, JL (Associate Professor Juanita Breen)|
|Web of Science® Times Cited:||22|
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