Choosing Wisely Talks | Choosing Wisely and Deprescribing: Managing Dementia Without Antipsychotics - Shared screen with speaker view
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how would you implement these strategies in long term care homes where staffing/ supports are an issue?
Thanks for this question April. We will pose it to the panel.
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Insights regarding safety between 1st and 2nd gen antipsychotics?
There are many PRIVATE facilities, who are obviously concerned about the "bottom line", that employ staff with minimal or no education with respect to Anti-psychotics. Does anyone have any suggestion how to champion this process at these facilities?
Sounds like you have a wonderful physician Roger!
Any particular resource you would recommend for interdisciplinary teaching? It can be hard to do the topic of antipsychotics vs. non-medication interventions justice in a short conversation on the ward
Pharmacist from Pennsylvania, USA
Pharmacist from México
Geriatric Nurse Practitioner
How can we let the public know about these issues and especially the non-pharmaceutical, lifestyle methods that have to be put in place by the patient and family? Doctors, especially less experienced ones in this area of care, usually reach for the prescription pad and often have no time to do anything else.
As a community pharmacist I’m wondering how I can best support my patients who present new prescriptions for antipsychotic medications for neuropsychiatric symptoms, as I find this is often still the first go to strategy for many prescribers.
Link to ‘Dementia lives here’ FYI
when antipsychotics are employed, do you have a time frame for measuring effectiveness and at what point would one consider a dose increase, change of agent , or actual discontinuation.
Regarding the safety of quetiapine, what reference can we source to speak to colleagues regarding same?
Please define low dose Quetiapine.
The government has been doing commercials on increasing the awareness of dementia. Modifiable risks factors including non-pharm interventions could be shared through commercials, education and advocacy
This is the resource for stroke risk from using atypical antipsychotics that we discussed today. All treatment dose ranges are defined in the methods.
Low dose quetiapine is defined as <125mg/day total daily dose.
I am watching a friend losing more and more cognitive function and part of this has to do with her husband being very ill (both at home). How much does stress and grief impact on cognitive function for those already diagnosed with dementia.
What dose range for quetiapine do you use?
what about using ssri's and benzos in dementia- I get a lot of requests from nurses and families for ativan
In our LTC we often use as needed (PRN) low dose antipsychotics with behaviors to assess if we are likely to see improvement before starting a more regular dose.
Many people are on antipsychotics in LTC because they came in on them from the hospital where they were given for delirium and never taken off.
Good resources from BC for stopping meds: https://sharedcarebc.ca/our-work/polypharmacy
In BC they have just announced that Dr's can prescribe for a person to get a year pass to a National Park. Why can we not implement prescribing non-pharm interventions ie. recreation therapist, music therapist etc.
Good pamphlet from Fraser Health in BC for family and residents attached.
Caregivers generally know the "patient" best, therefore caregivers and patients must be made comfortable to ask questions about the doctor's recommendations. Also be given the time to ask questions.
Thank you Roger for your perspective. I really appreciate learning from you.
Great point Roger! patients need direct advice, and specific tools to improve their health.
Cookbook by Neurologists: https://www.amazon.com/30-Day-Alzheimers-Solution-Definitive-Preventing/dp/0062996959
Very enriching to listen to Roger!
thank you all :)
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