DEprescribing and Care to reduce Antipsychotics in DEmentia (DECADE)-A Hybrid Effectiveness-Implementation Pilot Study

OBJECTIVES: The aim of DEprescribing and Care to reduce Antipsychotics in Dementia (DECADE) was to evaluate a multifaceted intervention to reduce antipsychotic use among nursing home residents with dementia without medication shifts (increase in the use of other psychotropic medications) or worsening Behavioral and Psychological Symptoms of Dementia (BPSD).

METHODS: From June 2022 to January 2024, a type 2 hybrid effectiveness-implementation pilot study was conducted across six Danish nursing homes. The intervention included education for general practitioners and healthcare professionals, medication reviews, and individualized care plans for 40 residents with dementia using antipsychotic medications. The data collection focused on implementation, antipsychotic use, psychotropic medication use, and BPSD. Implementation was assessed through fidelity analysis and surveys assessing providers' perceptions of the models' acceptability, appropriateness, feasibility, and healthcare providers' self-reported knowledge and competence. Changes in antipsychotic use, medication shifts, and BPSD scores measured effectiveness.

RESULTS: Fidelity was generally high, but participation in education was low. About half of the respondents considered the model appropriate and feasible. The intervention led to a significant reduction in antipsychotic use among the 40 included residents, with a decrease of 97.6 mg in olanzapine equivalents corresponding to a daily mean use of 5.9 mg olanzapine equivalents at baseline to a daily mean use of 4.8 mg, at study end (averaged reduction of 1.1 mg/day). In total, 36% of the residents achieved ≥50% reductions, and without an increase in the use of other psychotropic drugs or worsening of BPSD.

CONCLUSIONS: DECADE reduced antipsychotic use without worsening BPSD, highlighting its potential for broader applications. Multidisciplinary collaboration and ongoing education regarding antipsychotic use in dementia care are essential.