Dementia Collaborative Research Centre,School of Psychiatry UNSW Australia,Sydney,NSW 2052,Australia.
School of Psychiatry UNSW Australia and Clinical Director,Academic Department for Old Age Psychiatry Prince of Wales Hospital,Euroa Centre Prince of Wales Hospital,Randwick,NSW 2031,Australia.
Int Psychogeriatr. 2017 Aug;29(8):1391-1403. doi: 10.1017/S1041610217000084. Epub 2017 Mar 7.
Inappropriate use of antipsychotic medications to manage Behavioral and Psychological Symptoms of Dementia (BPSD) continues despite revised guidelines and evidence for the associated risks and side effects. The aim of the Halting Antipsychotic Use in Long-Term care (HALT) project is to identify residents of long-term care (LTC) facilities on antipsychotic medications, and undertake an intervention to deprescribe (or cease) these medicines and improve non-pharmacological behavior management.
LTC facilities will be recruited across Sydney, Australia. Resident inclusion criteria will be aged over 60 years, on regular antipsychotic medication, and without a primary psychotic illness or very severe BPSD, as measured using the Neuropsychiatric Inventory (NPI). Data collection will take place one month and one week prior to commencement of deprescribing; and 3, 6 and 12 months later. During the period prior to deprescribing, training will be provided for care staff on how to reduce and manage BPSD using person-centered approaches, and general practitioners of participants will be provided academic detailing. The primary outcome measure will be reduction of regular antipsychotic medication without use of substitute psychotropic medications. Secondary outcome measures will be NPI total and domain scores, Cohen-Mansfield Agitation Inventory scores and adverse events, including falls and hospitalizations.
While previous studies have described strategies to minimize inappropriate use of antipsychotic medications in people with dementia living in long-term care, sustainability and a culture of prescribing for BPSD in aged care remain challenges. The HALT project aims to evaluate the feasibility of a multi-disciplinary approach for deprescribing antipsychotics in this population.
尽管有修订后的指南和相关风险及副作用证据，但仍存在不合理使用抗精神病药物来治疗痴呆患者的行为和心理症状（BPSD）的情况。Halting Antipsychotic Use in Long-Term care（HALT）项目的目的是确定长期护理（LTC）机构中使用抗精神病药物的患者，并采取干预措施减少（或停止）这些药物的使用，改善非药物行为管理。
将在澳大利亚悉尼招募 LTC 设施。居民纳入标准为年龄在 60 岁以上，正在服用常规抗精神病药物，且无原发性精神病或非常严重的 BPSD，这将通过神经精神问卷（NPI）进行测量。数据收集将在开始减药前一个月和一周进行；并在 3、6 和 12 个月后进行。在减药前期间，将为护理人员提供关于如何使用以患者为中心的方法减少和管理 BPSD 的培训，参与者的全科医生将获得学术详细信息。主要结果测量将是在不使用替代精神药物的情况下减少常规抗精神病药物的使用。次要结果测量将是 NPI 总分和各领域评分、科恩-曼斯菲尔德激越量表评分以及不良事件，包括跌倒和住院。
虽然以前的研究已经描述了减少长期护理中痴呆患者不合理使用抗精神病药物的策略，但在老年护理中开具 BPSD 药物的可持续性和文化仍然是挑战。HALT 项目旨在评估多学科方法在这一人群中减少抗精神病药物使用的可行性。
