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Antipsychotic use persists in hospitalized dementia patients despite interventionAntipsychotics Stay High Despite New Care Plans

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Key Takeaway
Recognize that antipsychotic use persists in hospitalized dementia patients; this intervention did not demonstrate a reduction.

This study is a secondary analysis of data from a cluster-randomized trial (RCT) evaluating Function Focused Care for Acute Care Using the Evidence Integration Triangle (FFC-AC-EIT) versus Education Only in 455 hospitalized older adults living with dementia across 12 nursing homes in two states. The primary outcome was antipsychotic use at admission, discharge, and 1 month post discharge. Results showed a statistically significant difference between groups over time (Pillai's Trace = 0.05, p = 0.001). In the intervention group, antipsychotic use was 15% at admission, 23% at discharge, and 18% at 1 month; in the control group, use was 20% at admission, 20% at discharge, and 21% at 1 month. The intervention group showed an increase then decrease, while the control group remained stable. Safety outcomes (adverse events, serious adverse events, discontinuations, tolerability) were not reported. Key limitations include the secondary data analysis design and no evidence to support the value of FFC-AC-EIT in decreasing antipsychotic use. This analysis confirms continued antipsychotic use during and after hospitalization, highlighting the need for interventions to reduce use. However, no causal inference can be drawn, and the clinical relevance of the statistical difference is uncertain.

Antipsychotics Stay High Despite New Care Plans

Imagine an elderly person walking into a hospital with confusion and memory loss. They need help getting better. But sometimes they leave with new strong medicines. These drugs can calm restlessness but also cause side effects.

Older adults with dementia face a tough reality. Many live in nursing homes. They get sick and need hospital care. Doctors often prescribe antipsychotic drugs to manage behavior. These are powerful medications. They work on brain chemicals to stop agitation.

But here is the problem. Many patients start these drugs in the hospital. They keep taking them when they go home. This happens even when the original reason for the drug is gone. The goal is to stop using these drugs when possible.

The Old Way Of Thinking

For years, doctors have relied on these strong drugs. They see them as a quick fix for restlessness. The old way was to medicate first. Then try other things later. This approach keeps patients on pills for a long time.

What changed this time? Researchers tried a new method called Function Focused Care. This plan focuses on helping people do their daily tasks. It uses non-drug strategies to manage behavior. The idea is to solve the root cause of the problem.

Think of the brain like a busy factory. Sometimes things get jammed up. The old way just adds more workers to the line. The new way clears the jam first. Function Focused Care does exactly that. It removes obstacles that cause distress.

The plan trains staff to watch for triggers. It teaches them to change the environment. Maybe the room is too loud. Maybe the schedule is confusing. The team fixes these issues. This helps the patient feel more in control.

Researchers looked at 455 older adults in nursing homes. They split the homes into two groups. One group got the new Function Focused Care plan. The other group got standard education only. They tracked drug use from admission to one month later.

On admission, 17 percent of patients took these drugs. This number went up to 21 percent at discharge. By one month later, it dropped to 19 percent. The new care plan did not stop this rise. In fact, drug use went up in the new group too.

This doesn't mean this treatment is available yet.

The study showed no big difference between the groups. Both groups saw similar rates of drug use. The new plan did not lower the numbers. This is surprising because the plan looked good on paper. Real life is often different from the plan.

Why Results Were Mixed

The study had some limits. It looked at a specific group of patients. These people were mostly female and white. They lived in two states. The sample size was large but not huge. Still, the results were clear. The new method did not work as hoped.

Experts say we need better tools. We need ways to stop doctors from starting these drugs too quickly. We also need ways to stop them from continuing the drugs after discharge. The current system is hard to change. Habits are strong in hospitals.

If you care for an older adult with dementia, talk to the doctor. Ask why they need these strong drugs. Ask if there are other options first. Sometimes simple changes help more than pills.

Do not stop the medicine without asking. These drugs can be dangerous if stopped too fast. But you can ask for a review. Ask the team to try non-drug methods first. This might lower the need for pills.

This study shows we still have work to do. We need new ways to help patients. We need to train staff better. We need to change how hospitals think about behavior. It will take time to fix this.

More research is needed to find a better solution. Until then, patients will likely stay on these drugs. The goal is to reduce their use safely. We are moving in the right direction. But the path is long and hard.

Study Details

Study typeRct
EvidenceLevel 2
Follow-up1.0 mo
PublishedMay 2026
View Original Abstract ↓
Given the persistent use of antipsychotics during hospitalization and continued use post discharge, there is a need to consider alternative treatment options. The purpose of this study was to evaluate the use of antipsychotics in a sample of hospitalized older adults living with dementia and determine if exposure to Function Focused Care resulted in a decrease in antipsychotic use between admission, discharge, and 1 month post hospitalization. This was a secondary data analysis using data from the study Testing the Effectiveness of the Function Focused Care for Acute Care Study Using the Evidence Integration Triangle (FFC-AC-EIT). A total of 455 residents from 12 nursing homes in two states were included in the study. Sites were randomized to FFC-AC-EIT versus Education Only. The mean age of the participants was 82 years (Standard deviation [] = 8.5) and the majority was female (63%), White older adults (65%), married (36%), with high school or more education (81%), and moderate to severe cognitive impairment based on a Saint Louis University Mental Status Exam score of 7.5 ( = 6.0). Overall, on admission, 17% were on an antipsychotic medication, at discharge, this increased to 21%, and at 1 month, it decreased to 19%. The repeated-measure analysis showed there was a significant difference in antipsychotic use between treatment groups over time (Pillai's Trace of .05,  = 8.9,  = .001). The intervention group increased in usage from 15% on admission to 23% at discharge and decreased to 18% at 1-month post discharge. Conversely, the control group remained essentially the same over time at 20% on admission and discharge and 21% at 1-month post discharge. The findings from this study confirm that there continues to be use of antipsychotics during hospital admissions, and individuals are still discharged on these medications and continued on these medications over time. There was no evidence to support the value of our FFC-AC-EIT in terms of decreasing the use of antipsychotics over time. Future research is needed to develop interventions focused on decreasing the use of antipsychotics.
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