Abstract
Objectives
Antipsychotic medications are often used for the first-line management of behavioral
and psychological symptoms of dementia (BPSD) contrary to guideline recommendations.
The Optimizing Practices, Use, Care and Services–Antipsychotics (OPUS-AP) strategy
aims to improve the well-being of long-term care (LTC) residents with major neurocognitive
disorder (MNCD) by implementing a resident-centered approach, nonpharmacologic interventions,
and antipsychotic deprescribing in inappropriate indications.
Design
Prospective, closed cohort supplemented by a developmental evaluation.
Setting and Participants
Residents of designated wards in 24 LTC centers in Québec, Canada.
Methods
Provincial guidelines were disseminated, followed by the implementation of an integrated
knowledge translation and mobilization strategy, including training, coaching, clinical
tools, evaluation of clinical practices, and a change management strategy. Antipsychotic,
benzodiazepine, and antidepressant prescriptions; BPSD; and falls were evaluated every
3 months, for 9 months, from January to October 2018. Semistructured interviews (n = 20)
were conducted with LTC teams to evaluate the implementation of OPUS-AP.
Results
Of 1054 residents, 78.3% had an MNCD diagnosis and 51.7% an antipsychotic prescription.
The cohort included 464 residents with both MNCD and antipsychotic prescription. Antipsychotic
deprescribing (cessation or dose decrease) was attempted in 220 of the 344 residents
still admitted at 9 months. Complete cessation was observed in 116 of these residents
(52.7%) and dose reduction in 72 (32.7%), for a total of 188 residents (85.5%; 95%
confidence interval: 80.1%, 89.8%). A decrease in benzodiazepine prescriptions and
improvements in Cohen-Mansfield Agitation Inventory scores were observed among residents
who had their antipsychotics deprescribed. Caregivers and clinicians expressed satisfaction
as a result of observing an improved quality of life among residents.
Conclusions and Implications
Antipsychotic deprescribing was successful in a vast majority of LTC residents with
MNCD without worsening of BPSD. Based on this success, phase 2 of OPUS-AP is now under
way in 129 LTC centers in Québec.
Keywords
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Article info
Publication history
Published online: October 25, 2019
Footnotes
This work was funded by the Ministry of Health and Social Services of the province of Québec, and the Canadian Foundation for Healthcare Improvement (CFHI). Funding to complete the analysis of the results was provided by the Centre for Aging and Brain Health Innovation (CABHI).
The authors declare no conflict of interest.
Identification
Copyright
© 2019 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
