Abstract
Background
Dementia is often accompanied by neuropsychiatric symptoms. Psychotropic drugs for
the treatment of neuropsychiatric symptoms are frequently used to manage these problems,
but they are of limited effectiveness and can have serious side effects. Psychosocial
interventions are advocated as first line treatment and may help to reduce psychotropic
drug use.
Aims
To assess the effect of multidisciplinary psychosocial interventions in nursing homes
on the psychotropic drug prescription rate.
Methods
Literature obtained from searches in 9 electronic databases was systematically reviewed.
In addition, the pooled effects of specific psychosocial interventions in homogenous
subgroups were analyzed (meta-analysis).
Results
Eleven randomized controlled studies that investigated multiple psychotropic drugs
interventions (psychotropic drugs in 3, antipsychotics in 9, and antidepressants in
5 studies) as well as different types of psychosocial interventions were included.
We separately analyzed interventions directed at the care staff level (educational
programs in 3, in-reach services or consultation in 1, cultural or process change
in 6 studies) and the individual resident level in 1 study. In 7 out of 9 studies
reporting on antipsychotic drug use, the physician was actively involved. Nine studies
in which antipsychotic drug use was specified reported a significant decrease in prescription
rate as a result of psychosocial interventions [relative risk (RR) 0.71, 95% confidence
interval (CI) 0.59–0.88], whereas meta-analysis of 5 studies investigating antidepressant
drug use failed to show a significant effect (RR 0.82, 95% CI 0.64–1.02). Pooled effect
sizes of 6 studies investigating cultural change, showed a significant decrease in
antipsychotic drug use (RR 0.65, 95% CI 0.57–0.73). Effect sizes of 2 studies on educational
programs on antipsychotic use were nonsignificant (RR 1.50, 95% CI 0.49–4.64). Sensitivity
analysis of 7 studies reporting on antipsychotic drug use involving prescribing physicians
showed a more robust decrease (RR 0.66, 95% CI 0.54–0.80).
Conclusions
The results of this study show that psychosocial interventions may lead to a substantial
reduction of antipsychotic drug prescription, especially in studies that reported
on cultural change and that involved prescribing physicians. Conspicuously, a profound
lack of information was observed in many studies as to what exactly constituted the
care-as-usual treatment in the control group.
Keywords
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