REDUCING ANTIPSYCHOTIC USE IN NURSING HOME RESIDENTS WITH DEMENTIA

摘要

Inappropriate use of antipsychotics in elderly nursing home (NH) residents with dementia has gained national attention. Adverse effects from the use of these drugs can result in poor health outcomes, as well as increased mortality rates. The overarching aim of this study was to determine the perception of NH employees of symptoms and situations that prompt the initiation or continuance of antipsychotics in dementia residents and to identify perceptions of major challenges to reduction in antipsychotic use. A survey was administered to 319 NH employees (i.e., directors of nursing, administrators, staff nurses, social service, and activity personnel) from Louisiana. Participants were asked to rank order their perception of the importance of the role that nine symptoms or situations have played in the initiation or use of antipsychotics in dementia residents. In conjunction with descriptive statistics to analyze survey results, content analysis of participants’ comments from open-ended questions was performed. Findings (ranked in the order from most to least important) were: combativeness; psychosis; resident placed on antipsychotic during treatment in acute care behavioral/mental health facility; agitation; admitted to NH on antipsychotic; severe sleep pattern disruption; wandering; resistance to care; and family requested. Responses overwhelmingly highlighted the need and interest for educational opportunities about evidence-based, non-pharmacological interventions and potential adverse effects of antipsychotics. Findings from this survey were used to tailor a statewide educational intervention targeting NH staff. Recommendations that emerged from survey findings can also be used by interested stakeholders from other geographical regions to reduce the use of antipsychotics.