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. 2021 Aug;38(8):671-685.
doi: 10.1007/s40266-021-00875-1. Epub 2021 Jul 7.

What Makes Deprescription of Psychotropic Drugs in Nursing Home Residents with Dementia so Challenging? A Qualitative Systematic Review of Barriers and Facilitators

Amalie Elisabeth Moth  1 , Pernille Hølmkjær  2 , Anne Holm  1 , Maarten Pieter Rozing  1 , Gritt Overbeck  1
Affiliations

What Makes Deprescription of Psychotropic Drugs in Nursing Home Residents with Dementia so Challenging? A Qualitative Systematic Review of Barriers and Facilitators

Amalie Elisabeth Moth et al. Drugs Aging. 2021 Aug.

Abstract

Background: Behavioral and psychological symptoms of dementia are frequently experienced in the nursing home setting and place a substantial burden on patients, relatives, and nursing home staff. Despite guidelines recommending non-pharmacological treatments, psychotropic drugs are often prescribed to address these symptoms. This is the case despite their effects being limited, and there being a risk of side effects and adverse events for the patient. Several studies have aimed to reduce the use of psychotropic drugs, with varying results. The reasons behind these variations are not well understood.

Objectives: The objective of this systematic review was to investigate which factors nursing home general practitioners and nursing home staff experience as barriers or facilitators when attempting to deprescribe psychotropic drugs in nursing home residents.

Methods: We searched PubMed, EMBASE, psycINFO, Web of Science, and CINAHL between April and September 2020. An inductive method using thematic analysis of the qualitative findings was applied for the derivation of themes. Quantitative studies were included but described descriptively and separately.

Results: Of 8204 unique records, 14 studies were included in the review. Of these, nine were interview or focus group studies and five were survey studies. Thematic analysis resulted in five major themes identified as either facilitators or barriers or both: (1) 'Operationality and routines'; (2) 'Lack of resources and qualifications'; (3) 'Patient-related outcomes', which points to a strong belief in negative patient-related outcomes of discontinuation and a downplay of side effects of the medication; (4) 'Policies', including support and buy-in from nursing home leadership; and (5) 'Collaboration' between physicians and nursing home staff. Themes 1 and 4 consist of facilitators. Theme 2 consists of barriers. Theme 3 and 5 consist of both facilitators and barriers. Evaluation of closed-ended questions from the surveys supported the findings.

Conclusions: Deprescribing psychotropic drugs used for behavioral and psychological symptoms of dementia in nursing home residents is challenging. Resources need to be in place for deprescribing, as well as there being a focus on the positive patient-related outcomes of doing so. Managerial support, staff routines, and interprofessional collaboration are some factors facilitating the process, in addition to there being routines and systematic procedures in place allowing for operationality and a common understanding. Addressing these barriers and facilitators is necessary to ensure that deprescribing can be understood as meaningful and pursued among healthcare professionals in the nursing home setting.

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Conflict of interest statement

Amalie Moth, Pernille Hølmkjær, Anne Holm, Maarten Rozing, and Gritt Overbeck have no conflicts of interest that are directly relevant to the content of this article.

Figures

Fig. 1
Fig. 1
Flow chart of study selection
See this image and copyright information in PMC

References

    1. Selbæk G, Engedal K, Bergh S. The prevalence and course of neuropsychiatric symptoms in nursing home patients with dementia: a systematic review. J Am Med Dir Assoc. 2013;14(3):161–169. doi: 10.1016/j.jamda.2012.09.027. - DOI - PubMed
    1. Selbaek G, Engedal K, Benth J, Bergh S. The course of neuropsychiatric symptoms in nursing-home patients with dementia over a 53-month follow-up period. Int Psychogeriatr. 2014;26(1):81–91. doi: 10.1017/s1041610213001609. - DOI - PubMed
    1. Waldemar G, Dubois B, Emre M, Georges J, McKeith IG, Rossor M, et al. Recommendations for the diagnosis and management of Alzheimer's disease and other disorders associated with dementia: EFNS guideline. Eur J Neurol. 2007;14(1):e1–e26. doi: 10.1111/j.1468-1331.2006.01605.x. - DOI - PubMed
    1. National Institute for Health and Care Excellence (UK). Dementia: Assessment, management and support for people living with dementia and their carers. London: National Institute for Health and Care Excellence (UK); 2018. PMID: 30011160. - PubMed
    1. APA Work Group on Alzheimer’s Disease and other Dementias, Rabins PV, Blacker D, Rovner BW, Rummans T, Schneider LS, Tariot PN, Blass DM; Steering Committee on Practice Guidelines, McIntyre JS, Charles SC, Anzia DJ, Cook IA, Finnerty MT, Johnson BR, Nininger JE, Schneidman B, Summergrad P, Woods SM, Berger J, Cross CD, Brandt HA, Margolis PM, Shemo JP, Blinder BJ, Duncan DL, Barnovitz MA, Carino AJ, Freyberg ZZ, Gray SH, Tonnu T, Kunkle R, Albert AB, Craig TJ, Regier DA, Fochtmann LJ. American Psychiatric Association practice guideline for the treatment of patients with Alzheimer’s disease and other dementias. Second edition. Am J Psychiatry. 2007;164(12 Suppl):5–56. PMID: 18340692. - PubMed

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