Reducing the use of antipsychotics in dementia care through staff education and family participation

Abstract

Background: The widespread use of antipsychotic medication to treat the behavioural and psychological symptoms of dementia in residential aged care facilities is a world wide concern. Despite evidence of the numerous adverse effects of antipsychotic drugs, and the efficacy of non-pharmacological approaches, prescription rates are increasing in aged care.

Methods: This controlled before and after study aimed to investigate if an education intervention with family participation in dementia care improved the use of antipsychotic drugs. Antipsychotic use was measured by audit of residents’ clinical records. Three similar rural residential aged care facilities (RACF’s) participated in the study. At site 1 and 2 staff undertook training in dementia care using an on-line learning tool and peer reviewed literature on the use of antipsychotic drugs in dementia. Additionally, family members participated in ‘resident life story telling’ at site 2. Site 3 acted as the control.

Results: At sites 1 and 2, twenty five staff (25%) volunteered to participate in training. No training was provided at the control site. Across the three sites 47 residents had a clinical diagnosis of dementia with 30 of this group prescribed antipsychotic medication at baseline. At the intervention sites the use of antipsychotic medication reduced from 85% to 69% at site 1 and from 50% to 38% at site 2. At the control site medication use increased from 61% from 69%.

Conclusion: Dementia education for staff, especially with family participation in resident life story telling, may reduce antipsychotic medication use in residential aged care. Additionally, positive clinical implications such as reduction in falls were observed. The encouraging findings of this small study support further investigation in a larger sample.