Impact of interdisciplinary approaches to deprescribing psychotropics on clinical outcomes in older residents of long-term care facilities

Concerns about the appropriateness of psychotropic medicines use among residents of long-term care facilities (LTCFs) have been voiced for many years. In 1980, a study of 173 LTCFs in the United States reported a high prevalence of antipsychotic prescribing and called for further research to identify techniques for the management of neuropsychiatric symptoms which rely less upon psychotropics (Ray et al., Reference Ray, Federspiel and Schaffner1980). More recent studies report that approximately one in five residents of LTCFs in the United States, England, and Australia are prescribed antipsychotics (Briesacher et al., Reference Briesacher, Tjia, Field, Peterson and Gurwitz2013; Harrison et al., Reference Harrison2020; Szczepura et al., Reference Szczepura2016). Benzodiazepines, which are often used for conditions such as sleep disturbance and anxiety, are dispensed to nearly one in three residents in Australian LTCFs (Harrison et al., Reference Harrison2020). Typical and atypical antipsychotics have been associated with a higher risk of serious adverse drug events (ADEs) including cerebrovascular events and death among older people living with dementia (Maust et al., Reference Maust2015; Schneider et al., Reference Schneider, Dagerman and Insel2006). Benzodiazepines and antipsychotics have also been associated with increased risk of falls in older people. Treatment with these medicines may be appropriate when used in line with guideline recommendations and with concurrent nonpharmacological strategies and monitoring. However, the high prevalence of antipsychotic and benzodiazepine use in LTCFs suggests that not all use is in accordance with guidelines. Antipsychotics are often used in the absence of documented consent from residents or family members and continued for long durations (Westaway et al., Reference Westaway, Sluggett, Alderman, Moffat, Procter and Roughead2020). In accord, improving psychotropic use in LTCFs was identified as an urgent priority in the interim report of the ongoing Royal Commission into Aged Care Quality and Safety in Australia (Royal Commission into Aged Care Quality and Safety, 2019).