About this project. The majority of people with dementia will experience Behavioural and Psychological Symptoms (BPSD) during the course of their illness which may include delusions, aggression and agitation and this poses a great challenge to carers in nursing homes. Compounding this issue are significant workforce shortages in the aged care sector preventing individualised approaches to care and specifically, a lack of staff trained in dementia care. As a result, GPs and geriatricians may feel pressure to prescribe psychotropic medications including antipsychotics to manage BPSD in nursing home residents despite best practice guidelines suggesting non-pharmacological approaches should be tried before resorting to medication.
Another important health issue for older people is they are at greater risk of polypharmacy which is when multiple medications are taken at one time. There is accumulating evidence to support stopping medicines, or deprescribing, in older people generally and antipsychotics particularly due to minimal evidence supporting their efficacy for treatment of BPSD and increases in the risk of stroke, cognitive decline and death.
Current research suggests that stopping antipsychotic medications can be carried out successfully in people with BPSD when person centred care and good management of people with dementiais practiced. This can be achieved without emergence of challenging behaviours or the use of other medicines. Several countries have promulgated policies against use of antipsychotics in nursing homes and it is hoped similar trends will emerge in Australia.
The HALT study proposes a model for deprescribing antipsychotics in residential care through person-centred approaches to managing challenging behaviours. A targeted, evidence-based training package has been developed to up-skill general practitioners and nursing home staff in this area, as well as in the quality use of medicines.
HALT is collaboration between consumers, residential aged care providers, staff, general practitioners, pharmacists, the Dementia Behaviour Management Advisory Service (DBMAS), the National Prescribing Service (NPS) and specialists to reduce inappropriate antipsychotic use in nursing home residents and respectively reduce adverse events associated with these medications such as cognitive decline, falls, parkinsonism, hospitalisations, stroke and death. The results of this project will be used to support the development of a nationally applicable and sustainable approach to the care of people with challenging behaviours in long-term care facilities.
The HALT project is funded by the Australian Department of Social Services through the Aged Care Service Improvement and Healthy Ageing Grants Fund.
The HALT Team (from left)
Tiffany Jessop - Project Coordinator
Fleur Harrison - Research Psychologist
Allan Shell - Academic GP
Monica Cations - Research Psychologist
Linda Nattrass - Administrative Assistant