Deprescribing is the intentional withdrawal of unnecessary medications from a patientÕs regimen to manage polypharmacy and improve outcomes. Antipsychotics can be a target of deprescription when used to manage symptoms of dementia in elderly residents of long-term care facilities (LTCFs). Their benefit is not well-defined for this indication, and they are associated with serious side effects. Current guidelines are unclear regarding how deprescribing of antipsychotics impacts patient outcomes compared to standard care.
Our literature review followed the Cochrane systematic review steps to evaluate the evidence base for efficacy of antipsychotic deprescription interventions in elderly patients in LTCFs with dementia. We performed a search of Medline, PubMed, and Google Scholar databases between January-March 2021. Studies were included if participants were elderly, living in LTCFs, and were taking antipsychotics for dementia. Studies that focused on other patient populations, the outpatient setting, or antipsychotic use for other indications were excluded from our analysis. We assessed each study for bias using the Cochrane GRADE tool.
We identified 8 relevant studies for review: 4 longitudinal cohort studies and 4 randomized controlled trials encompassing 1,046 participants. Each study presented validated measures on the following outcomes: behavioral and psychological symptoms of dementia, quality of life, and cognitive function. Of the 8 studies, 3 found a significant positive relationship between antipsychotic deprescription and the outcomes of interest, while 5 studies found no significant change in these outcomes upon deprescription.
At this time, our synthesis of the review is incomplete. Results and conclusions will be reported upon completion.