Abstract
BackgroundThe majority of nursing home residents with dementia experience behavioural and psychological symptoms like apathy, agitation, and anxiety. According to analyses of prescription prevalence in Germany, antipsychotic drugs are regularly prescribed as first-line treatment of neuropsychiatric symptoms in persons with dementia, although guidelines clearly prioritise non-pharmacological interventions. Frequently, antipsychotic drugs are prescribed for inappropriate reasons and for too long without regular reviewing. The use of antipsychotics is associated with adverse events like increased risk of falling, stroke, and mortality. The aim of the study is to investigate whether a person-centred care approach, successfully evaluated in nursing homes in the United Kingdom, can be implemented in German nursing homes and, in comparison with a control group, can result in a clinically relevant reduction of the proportion of residents with antipsychotic prescriptions.Methods/designThe study is a cluster-randomised controlled trial comparing an intervention group (two-day initial training on person-centred care and ongoing training and support programme) with a control group. Both study groups will receive, as optimised usual care, a medication review by an experienced psychiatrist/geriatrician providing feedback to the prescribing physician. Overall, 36 nursing homes in East, North, and West Germany will be randomised. The primary outcome is the proportion of residents receiving at least one antipsychotic prescription (long-term medication) after 12 months of follow-up. Secondary outcomes are residents’ quality of life, agitated behaviour, as well as safety parameters like falls and fall-related medical attention. A health economic evaluation and a process evaluation will be performed alongside the study.DiscussionTo improve care, a reduction of the current high prescription rate of antipsychotics in nursing homes by the intervention programme is expected.Trial registrationClinicalTrials.gov: NCT02295462Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-015-0268-3) contains supplementary material, which is available to authorized users.
Highlights
The majority of nursing home residents with dementia experience behavioural and psychological symptoms like apathy, agitation, and anxiety
Recent data show that antipsychotics are prescribed for almost 30 % of German nursing home residents [1]
All antipsychotics are associated with an increased risk of stroke, and the risk might even be higher in patients/residents receiving atypical antipsychotics compared to those receiving conventional antipsychotics [11]
Summary
The majority of nursing home residents with dementia experience behavioural and psychological symptoms like apathy, agitation, and anxiety. Antipsychotic drugs are prescribed for inappropriate reasons and for too long without regular reviewing. The use of antipsychotics is associated with adverse events like increased risk of falling, stroke, and mortality. Prescription rates of antipsychotic drugs for residents in German nursing homes are considerably high [1] and have not changed for years [2,3,4,5]. Antipsychotics are often prescribed for too long without carrying out a regular review [7]. Both long-term and short-term use of antipsychotics increase mortality compared to non-users [8,9,10], with cardiac death and infections being the main causes. Adverse effects include sedation, dizziness and increased risk of falling and fall-related injuries, tremor and rigidity [12,13,14,15,16], worsening of cognitive function [17], and other effects which are most likely to result in reduced quality of life (QoL) and well-being as well as withdrawal from social life and participation
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