Adherence to Guideline Recommendations on Psychotropic Drug Use for Challenging Behavior in Dementia

Objective: Psychotropic drugs are frequently prescribed for challenging behavior in residents with dementia in nursing homes. Recommendations on psychotropic drug use for challenging behavior are described in the Dutch multidisciplinary guideline “Problem behavior in dementia.” This study aimed to gain insight into the adherence to guideline recommendations on drug type and timing of evaluations of different types of psychotropic drugs for challenging behavior in a national sentinel network of Dutch nursing homes.

Design: Prospective observational study.

Setting and Participants: Data on psychotropic drug use of residents in a sentinel network of 22 nursing homes across the Netherlands were collected during a 3-month measurement period in 2021.

Methods: Physicians completed registration forms integrated into the electronic health record after reporting on psychotropic drug use in progress notes. Prescribed drug type(s), type of drug intervention (start/stop/change in dosage/evaluation), and drug indications were recorded. Adherence to guideline recommendations on drug type was achieved if prescribed psychotropic drugs were recommended for the specified indication. Adherence to guideline recommendations on timing of evaluations was achieved if evaluations were reported within 7 days after starting.

Results: A total of 1279 forms on psychotropic drug use for specified challenging behaviors in 599 residents were collected. Recommended psychotropic drugs were used in 57% of all forms. The highest rate of recommended psychotropic drugs was for psychotic behavior (80%), followed by agitation (48%). Adherence was lowest for nighttime restlessness (22%). Of all newly started prescriptions, 17% were evaluated within the recommended 7 days after starting.

Conclusions and Implications: Adherence to guideline recommendations on drug type was present in just over half of the cases. Frequently, evaluations were not reported or were performed after the recommended time frame. Further research is needed to determine the reasons for non-recommended psychotropic drug use, low evaluation reporting rates, and factors that influence adherence. The use of a sentinel network may increase awareness and adherence.