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Title: Supporting antipsychotic deprescribing in people with dementia with a person-centred care intervention

Lynn Chenoweth

University of New South Wales, Australia

Biography

Lynn Chenoweth is Professor of Nursing, Centre for Healthy Brain Ageing, University of NSW, Australia.  Lynn’s interdisciplinary research program focuses on: safe and effective health and aged care systems; healthy ageing in life transitions; and person-centred models of dementia and aged care. She has led 65 funded research studies of over $AU6M and is CI on studies worth $AU9M, has 165 peer reviewed publications and 15 book chapters.

Abstract

Antipsychotic and other tranquilising medicines are prescribed to help care staff manage behaviour in one-quarter of older people living in Australian long-term care homes. While these medicines pose significant health risks, particularly for people with dementia, reliance on their use occurs when staff are not educated to respond to resident behaviour using nonpharmacological approaches. There is strong evidence in the literature to suggest that person-centred responses can help reduce these behaviours in long-term care residents, in respect of being able to provide them with personal care without resistance and in helping the person attain well-being, despite physical, social and cognitive limitations. The Halting Antipsychotic use in Long-Term care (HALT) single-arm study assessed whether a person-centred care intervention was effective in reducing antipsychotic use in 139 people 60 years and over with changed behaviours living in 24 Australian long-term care homes. A train-the-trainer approach delivered person-centred care education and support for 22 HALT (nurse) champions and 135 direct care staff, along with non-pharmacological dementia management education for visiting general practitioners (GP) and individualised antipsychotic deprescribing protocols for participating residents. At 12 months follow-up approximately three-quarters of the HALT study residents remained deprescribed without an escalation in the behaviours for which antipsychotics were previously prescribed. The HALT nurse champions completed open-ended questionnaires and semi-structured interviews to identify the contextual elements they considered most critical to achieving success with the study intervention. They reported that person-centred approaches helped care staff to respond proactively to resident behaviours in without reliance on antipsychotic medicines, enabled by managerial support, nurse champion empowerment to lead change, and the re-education and cooperation of the residents’ GPs and their families. These findings emphasise the importance of a whole systems approach to initiate and sustain care practice improvements in dementia services.