Published online Dec 9, 2014. doi: 10.5497/wjp.v3.i4.174
Revised: October 2, 2014
Accepted: October 23, 2014
Published online: December 9, 2014
Over the past three decades, concerns about the high prevalence of antipsychotic use in the nursing homes (NHs) for the management of behavioral and psychological symptoms of dementia continue to be emphasized and intervened by many. However, despite the numerous side effects and the recent blackbox warning by the United States Food and Drug Administration about the increased risks for stroke and sudden death associated with the use of antipsychotics in dementia, the prevalence of antipsychotic use in NHs remains high. While the use of antipsychotics appeared to have modest efficacy in reducing symptoms of aggression and psychosis in dementia, there is insufficient evidence to routinely recommend the use of alternative psychopharmacological treatments for these symptoms. Hence, clinicians have to balance the safety warnings against the need to treat these symptoms in order to prevent harm to the resident that may result from his/her dangerous behaviors. Although the use of antipsychotics may be warranted in some cases, organizational, resource and training support should be provided to encourage and equip NH staff to participate in interventions so as to minimize inappropriate use of these medicines in NHs. This review will discuss the place in therapy, the trend and appropriateness of antipsychotic use in NHs, as well as the effectiveness of current and future strategies for reducing antipsychotic use in the NHs.
Core tip: While antipsychotics may be used to manage symptoms of severe aggression and psychosis when the safety of the resident is threatened, there should be routine reviews of the appropriateness of antipsychotic use as well as training and support of the care staff in providing psychosocial intervention to treat the symptoms so as to reduce antipsychotic use in nursing homes. Reported studies evaluating interventions to improve antipsychotic use appropriateness in nursing homes are limited by the small sample sizes and absence of control groups. Future research should address these methodological issues while exploring safer therapeutic alternatives to manage these symptoms.