The DECIDE‐initiative: A multi‐dimensional project aiming to reduce sedative drugs of patients with dementia in long term care

Abstract

AbstractPrescription prevalence of sedative drugs – mostly used for the treatment of neuropsychiatric symptoms ‐ in patients with dementia in Germany is approximately 40%. Since sedative drugs cause a variety of adverse effects and might reduce quality of life significantly, the aim must be to use sedative drugs only as much as necessary and as little as possible.The DECIDE initiative was founded at the Department of Psychiatry at the Technical University of Munich and funded by the Bavarian State Ministry of Health. DECIDE uses a multidimensional approach to raise awareness among all stakeholders in the health care system for a more conscious and responsible use of sedative medication in people with dementia and thus to sustainably reduce the frequency of prescriptions.The DECIDE initiative includes a webpage (www.decide.bayern) with thorough and comprehensive information for informal and formal caregivers, legal guardians, nursing staff and doctors; a telephone hotline for patients and caregivers; network building; awareness campaigns; and continuing education.A particular important component of the DECIDE‐initiative is the DECIDE LTC‐visits. So far, 30 randomly chosen LTC facilities in Bavaria have been visited by a medical specialist for gerontopsychiatry. In each facility the gerontopsychiatrist offered a training event for the nursing home staff in order to explain behavioral symptoms, non‐pharmacological interventions, and the effects and side effects of sedative drugs, as well as the potential for deprescribing. In each attending LTC facility the prescription prevalence of sedative drugs was assessed. Medical and nursing records were checked in order to find out, if deprescribing – according to a deprescribing algorithm that was recently developed within the DECIDE project (Roßmeier et al., 2022, Nervenarzt) ‐ could be recommended. The prescribing prevalence as assessed in 1492 residents with dementia was 51%. In 70 out of 202 residents describing could be recommended and was discussed with the treating physician.One year follow‐up visits will show if the DECIDE initiative is able to sensitize physicians and nursing homes to the problem of sedating psychopharmacotherapy and the potential for deprescribing, reflected then in a lower prescription prevalence.