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DEPRESCRIBING ANTIPSYCHOTICS IN LONG TERM CARE RESIDENTS WITH NEUROPSYCHIATRIC SYMPTOMS AND DEMENTIA

Authors:

Abstract

Background Antipsychotic medications continue to be used in the management of Behavioral and Psychological Symptoms of Dementia (BPSD) despite adverse effects and revised guidelines. The Halting Antipsychotic use in Long Term care (HALT) project aimed to deprescribe these medications and improve non-pharmacological behavior management. Method We recruited residents from 24 long term care facilities who were aged 60+ years, on regular antipsychotic medication, without a primary psychotic illness, and without severe neuropsychiatric symptoms. Consenting participants were assessed one month and one week prior to deprescribing. Training was provided for facility nurses on how to manage neuropsychiatric symptoms and a dose reduction schedule was sent to and approved by GPs before deprescribing commenced. Participants were re-assessed 3, 6 and 12 months later. The primary outcome measure was reduction of regular antipsychotic medication without use of substitute psychotropic medications. The secondary outcome measures were NPI total and domain scores and Cohen-Mansfield Agitation Inventory (CMAI) score. Results Of 157 residents recruited, 133 commenced deprescribing and 125 achieved antipsychotic cessation. Of these, 76% remain off the antipsychotic medication up to 12 months following initial reduction. NPI and CMAI scores remained stable from baseline to 6 month follow-up with a similar trend seen for those who have reached 12 month follow up. Conclusion Deprescribing of antipsychotics in long term care residents with previous BPSD is feasible without re-emergence of BPSD; however, challenges still exist regarding sustainability and culture of prescribing in aged care. The impact of facility and individual factors on outcomes and reasons for recommencement following deprescribing warrant further investigation.
IIAGG 2017 World Congress
age. The ndings suggest the importance of considering both
contextual and motivational factors that could contribute to
affect-health links across the lifespan.
MORE INTERESTED BUT LESS EVALUATED:
SITUATION CONSTRUALS’ LINK TO TRAIT-
RELEVANT BEHAVIOR IN OLD AGE
E.E.Noftle1, C.Gust1, W. Fleeson2, 1. Willamette University,
Salem, Oregon, 2. Wake Forest University, Winston-Salem,
North Carolina
Most research on personality development in later life
uses trait questionnaires, which, despite their benets, have
several drawbacks. Trait questionnaires necessitate focusing
on average behavior, often neglect context, and typically only
track slow-moving processes over long periods. The current
research employs two techniques which confront these obsta-
cles. First, Big-Five personality states assessed across repre-
sentative spans of daily life solves the problem of exclusive
focus on averages. Second, inclusion of situational construals
facilitates inquiry into context and chronic momentary pro-
cesses. In two studies, older adults (aged 65–81) reported
on situations and behavior using ESM and were compared
with young and middle-aged adults (total N = 303). After
attending this session, participants will appreciate that not
only did older adults differ from other adults in trait-relevant
behavior and situational construals, suggesting development
in both traits and contexts, but they also differed in situa-
tion-behavior contingencies, suggesting changing strengths
of processes in later adulthood.
SESSION 4340 (PAPER)
MENTAL HEALTH AND AGING
PATIENT-PROVIDER COMMUNICATION AND
BENEFIT FINDING IN OLDER CANCER PATIENTS
M.Doherty1,2, D. Gardner2, 1. CUNY Graduate Center,
New York, New York, 2. Silberman School of Social Work,
New York, New York
Effective communication between medical providers
and cancer patients plays a critical role in ensuring high-
quality cancer care, and is associated with better treatment
decisions, greater adherence, fewer unwanted medical
interventions, and improved health outcomes. Provider
communication may also be associated with positive cop-
ing and post-traumatic growth in cancer patients. This
paper presents an analysis of a nationally representative
dataset of the experiences of cancer survivors that exam-
ined the relationship between patient age and the experi-
ence of post-traumatic growth (i.e., benet nding), and
whether this relationship was mediated by the depth and
quality of clinical communication (operationalized as: dis-
cussion of follow-up procedures, treatment side-effects,
patient emotional and social needs, and lifestyle factors).
The cross-sectional data were analyzed using multivari-
ate regression models to examine the effects of a) patient
age on benet nding; b) depth of clinical communication
on benet nding; and c) patient age on depth of clinical
communication. Findings supported previous evidence that
older adults with cancer have considerable unmet infor-
mational needs, and that attentive clinical communication
may enhance psychological adaptation to cancer. In the
absence of adequate clinical communication, older adults
may not experience the opportunities for benet nding
that younger cancer patients are afforded. The authors
discuss implications for social work practice, policy and
future research in cancer care and health care for older
adults. Social workers may benet from greater apprecia-
tion of the informational needs of older adults, and the
skills needed to support effective patient-provider com-
munication and shared decision making for aging cancer
patients.
DEPRESCRIBING ANTIPSYCHOTICS IN LONG TERM
CARE RESIDENTS WITH NEUROPSYCHIATRIC
SYMPTOMS AND DEMENTIA
H.Brodaty1, T. Jessop1, F. Harrison1, M.Cations1, A.Shell1,
L.Chenoweth2, 1. Dementia Collaborative Research
Centrre, University of New South Wales, Sydney, New
South Wales, Australia, 2. Centre for Healthy Brain Ageing
(CHeBA), Sydney, New South Wales, Australia
Background
Antipsychotic medications continue to be used in the
management of Behavioral and Psychological Symptoms of
Dementia (BPSD) despite adverse effects and revised guide-
lines. The Halting Antipsychotic use in Long Term care
(HALT) project aimed to deprescribe these medications and
improve non-pharmacological behavior management.
Method
We recruited residents from 24 long term care facilities
who were aged 60+ years, on regular antipsychotic medica-
tion, without a primary psychotic illness, and without severe
neuropsychiatric symptoms. Consenting participants were
assessed one month and one week prior to deprescribing.
Training was provided for facility nurses on how to manage
neuropsychiatric symptoms and a dose reduction schedule
was sent to and approved by GPs before deprescribing com-
menced. Participants were re-assessed 3, 6 and 12months
later. The primary outcome measure was reduction of regular
antipsychotic medication without use of substitute psycho-
tropic medications. The secondary outcome measures were
NPI total and domain scores and Cohen-Manseld Agitation
Inventory (CMAI) score.
Results
Of 157 residents recruited, 133 commenced deprescrib-
ing and 125 achieved antipsychotic cessation. Of these, 76%
remain off the antipsychotic medication up to 12months fol-
lowing initial reduction. NPI and CMAI scores remained sta-
ble from baseline to 6month follow-up with a similar trend
seen for those who have reached 12month follow up.
Conclusion
Deprescribing of antipsychotics in long term care resi-
dents with previous BPSD is feasible without re-emergence
of BPSD; however, challenges still exist regarding sustain-
ability and culture of prescribing in aged care. The impact of
facility and individual factors on outcomes and reasons for
recommencement following deprescribing warrant further
investigation.
Innovation in Aging, 2 0 1 7, Vol. 1, No. S1
1066
Copyedited by: OUP
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