Harrison Stephanie L, Cations Monica, Jessop Tiffany, Hilmer Sarah N, Sawan Mouna, Brodaty Henry
Registry of Older South Australians, South Australian Health and Medical Research Institute (SAHMRI), PO Box 11060, Adelaide, SA, Australia.
NHMRC Cognitive Decline Partnership Centre, The University of Sydney, Sydney, NSW, Australia.
Drugs Aging. 2019 Feb;36(2):125-136. doi: 10.1007/s40266-018-0623-6.
Psychotropic medications have a high risk of serious adverse events and small effect size for changed behaviours for people with dementia. Non-pharmacological approaches are recommended as first-line treatment for changed behaviours, yet psychotropic medications remain highly prevalent in long-term aged care settings. This narrative review describes the current evidence regarding deprescribing psychotropic medications for people with dementia in long-term care. Deprescribing psychotropic medications can be achieved without harm to the person with dementia, and most people experience no withdrawal symptoms. Interventions to deprescribe psychotropic medications should be multifactorial, including lowering the dose of the medication over time, educational interventions and psychological support. However, implementing this is a significant challenge due to the overreliance on psychotropic medications for behavioural management in long-term aged care. Facilitators to deprescribing psychotropic medications in long-term care include multidisciplinary teams with adequate training, education and managerial support, engaging residents and families and change 'champions'. Deprescribing practices should be person-centred, and an individualised deprescribing protocol should be in place, followed by careful monitoring of the individual. The person with dementia and their family, general practitioner, pharmacist, and allied health and direct care staff should all be involved throughout the deprescribing process. Direct care staff need adequate support, education and training, so they can effectively help the individual and implement person-centred approaches in the absence of psychotropic medications. Effective communication between residents and staff and amongst staff is consistently shown to be an important factor for deciding whether deprescribing of a medication should occur and the successful implementation of deprescribing psychotropic medications.
精神药物对痴呆症患者有严重不良事件的高风险，且对行为改变的效果甚微。非药物方法被推荐作为行为改变的一线治疗方法，但精神药物在长期老年护理机构中仍然非常普遍。这篇叙述性综述描述了目前关于在长期护理中为痴呆症患者停用精神药物的证据。停用精神药物可以在不伤害痴呆症患者的情况下实现，而且大多数人不会出现戒断症状。停用精神药物的干预措施应该是多方面的，包括随着时间的推移降低药物剂量、教育干预和心理支持。然而，由于长期老年护理中过度依赖精神药物进行行为管理，实施这一措施面临重大挑战。长期护理中停用精神药物的促进因素包括经过充分培训、教育和管理支持的多学科团队，让居民和家庭参与以及变革“倡导者”。停用药物的做法应以患者为中心，应制定个性化的停用药物方案，随后对个体进行仔细监测。痴呆症患者及其家人、全科医生、药剂师、专职医疗人员和直接护理人员都应参与整个停用药物过程。直接护理人员需要足够的支持、教育和培训，以便在没有精神药物的情况下有效地帮助个体并实施以患者为中心的方法。居民与工作人员之间以及工作人员之间的有效沟通一直被证明是决定是否应该停用药物以及成功实施停用精神药物的一个重要因素。
