Psychosoziale Interventionen bei Pflegeheimbewohnern zur Reduktion von Antipsychotika
Abstract
Background
Antipsychotic medication is regularly prescribed in care homes to control 'behavioural and psychological symptoms of dementia' despite moderate efficacy, significant adverse effects, and available non‐pharmacological alternatives.
Objectives
To evaluate the effectiveness of psychosocial interventions to reduce antipsychotic medication in care home residents.
Search methods
The Cochrane Dementia and Cognitive Improvement Group's Specialized Register, MEDLINE, EMBASE, CINAHL, PsycINFO, LILACS, a number of trial registers and grey literature sources were searched on 19th December 2011.
Selection criteria
Individual or cluster‐randomised controlled trials comparing a psychosocial intervention aimed at reducing antipsychotic medication with usual care in care home residents or comparing two different approaches.
Data collection and analysis
Two review authors independently assessed the retrieved articles for relevance and methodological quality and extracted data. Critical appraisal of studies addressed risk of bias through selection bias, performance bias, attrition bias, and detection bias, as well as criteria related to cluster design. Authors of relevant studies were contacted for additional information.
Owing to clinical heterogeneity of interventions, statistical heterogeneity was not assessed and no meta‐analysis performed. Study results are presented in a narrative form.
Main results
Four cluster‐randomised controlled studies met the inclusion criteria. All of them investigated complex interventions comprising educational approaches. Three studies offered education and training for nursing staff, one study offered multidisciplinary team meetings as main component of the intervention. There was one high‐quality study, but overall the methodological quality of studies was moderate.
The studies revealed consistent results for the primary end point. All studies documented a decrease of the proportion of residents with antipsychotic drug use or a reduction in days with antipsychotic use per 100 days per resident, respectively. In summary, the reviewed evidence on psychosocial interventions targeting professionals is consistent with a reduction of antipsychotic medication prescription in care home residents. However, owing to heterogeneous approaches, summary effect sizes cannot be determined.
Authors' conclusions
There is evidence to support the effectiveness of psychosocial interventions for reducing antipsychotic medication in care home residents. However, the review was based on a small number of heterogeneous studies with important methodological shortcomings. The most recent and methodologically most rigorous study showed the most pronounced effect.
PICO
Plain language summary
Psychosoziale Interventionen bei Pflegeheimbewohnern zur Reduktion von Antipsychotika
In Pflegeheimen werden Antipsychotika regelmäßig verschrieben, um sogenannte "Verhaltensauffälligkeiten und psychologische Symptome von Demenzerkrankungen", wie Aufregung, Aggression oder Unruhe zu kontrollieren. Allerdings ist fraglich, ob Antipsychotika wirksam und sicher sind. Häufig treten unerwünschte Wirkungen wie Sedierung, Stürze und kardiovaskuläre Probleme auf. Daher sollten Antipsychotika soweit wie möglich vermieden werden. Dieser Review untersucht, ob psychosoziale Interventionen zur Reduktion der Gabe von Antipsychotika in Pflegeheimen wirksam sind. Unter psychosozialen Interventionen verstehen wir Programme, die unterschiedliche nicht‐pharmakologische Komponenten beinhalten, wie etwa Gespräche mit dem Personal, mit den Bewohnern oder beiden. Wir schlossen vier randomisierte kontrollierte Studien in den Review ein. Alle Studien untersuchten, neben anderen Komponenten, Weiterbildungsmaßnahmen für das Personal in Pflegeheimen. Die methodologische Qualität von drei Studien war eingeschränkt, eine Studie zeigte hohe Qualität. Alle Studien zeigten, dass die Interventionen zu einer Reduktion des Einsatzes von Antipsychotika führten ‐ die Gesamtstärke des Effekts bleibt jedoch unklar.
