Behavioural intervention reduces need for antipsychotics in dementia treatment

A new study has suggested that dementia patients may not require as high a dosage of antipsychotic medication that was once thought. By recognising and addressing challenging behaviours of sufferers at 93 nursing homes across the state of Massachusetts, it was found that their unmet needs could often be met without resorting to medication.

Antipsychotics are commonly prescribed to residents of nursing homes to treat cognitive impairment, but while this is a ubiquitous practice, it may not be the best approach, as study leader Dr Jennifer Tjia, Associate Professor of Quantitative Health Sciences at the University of Massachusetts Medical School, explains:

"This is the largest study to show that it is possible to reduce antipsychotic use in the nursing home population. This intervention focused on treating the residents as human beings with needs, not as patients with problems. We don't medicate babies when they cry or act out, because we assume that they have a need that we need to address. However, when people with dementia are unable to communicate, the current approach medicates them when they have undesirable behaviours."

Research has shown that the use of antipsychotics can lead to increased risk of stroke and even death, while presenting minimal benefits in the treatment of dementia’s behavioural symptoms.

"Since 1987, no fewer than 11 controlled studies have been published that report varying efficacy in reducing antipsychotics in nursing homes using a variety of approaches. The largest successful intervention enrolled 12 nursing homes; however it was time and resource intensive," Tjia continued. "In contrast, the Oasis programme reached almost 100 nursing homes, and was effective."

The Oasis intervention was employed in 93 nursing homes between 2011 and 2013, and focuses on training staff to identify and respond adequately to bahviours associated with dementia. When compared to 831 homes which were not employing the programme, it was found that prevalence of antipsychotic prescriptions decreased from 34% to 27% over nine months, with no increase in psychotropic medicine use or behavioural disturbances.

Tjia added that if antipsychotic use is to be kept to a minimum, Oasis would be a key tool for training staff in nursing homes.