title: Halting Antipsychotic Use in Long-Term care (HALT): a single-arm longitudinal study aiming to reduce inappropriate antipsychotic use in long-term care residents with behavioral and psychological symptoms of dementia.
abstract: Inappropriate use of antipsychotic medications to manage Behavioral and Psychological Symptoms of Dementia (BPSD) continues despite revised guidelines and evidence for the associated risks and side effects. The aim of the Halting Antipsychotic Use in Long-Term care (HALT) project is to identify residents of long-term care (LTC) facilities on antipsychotic medications, and undertake an intervention to deprescribe (or cease) these medicines and improve non-pharmacological behavior management.
  
  
  
  LTC facilities will be recruited across Sydney, Australia. Resident inclusion criteria will be aged over 60 years, on regular antipsychotic medication, and without a primary psychotic illness or very severe BPSD, as measured using the Neuropsychiatric Inventory (NPI). Data collection will take place one month and one week prior to commencement of deprescribing; and 3, 6 and 12 months later. During the period prior to deprescribing, training will be provided for care staff on how to reduce and manage BPSD using person-centered approaches, and general practitioners of participants will be provided academic detailing. The primary outcome measure will be reduction of regular antipsychotic medication without use of substitute psychotropic medications. Secondary outcome measures will be NPI total and domain scores, Cohen-Mansfield Agitation Inventory scores and adverse events, including falls and hospitalizations.
  
  
  
  While previous studies have described strategies to minimize inappropriate use of antipsychotic medications in people with dementia living in long-term care, sustainability and a culture of prescribing for BPSD in aged care remain challenges. The HALT project aims to evaluate the feasibility of a multi-disciplinary approach for deprescribing antipsychotics in this population.
authors.affiliation: Dementia Collaborative Research Centre,School of Psychiatry UNSW Australia,Sydney,NSW 2052,Australia.
authors.forename: Tiffany
authors.initials: T
authors.lastname: Jessop
authors.affiliation: Dementia Collaborative Research Centre,School of Psychiatry UNSW Australia,Sydney,NSW 2052,Australia.
authors.forename: Fleur
authors.initials: F
authors.lastname: Harrison
authors.affiliation: Dementia Collaborative Research Centre,School of Psychiatry UNSW Australia,Sydney,NSW 2052,Australia.
authors.forename: Monica
authors.initials: M
authors.lastname: Cations
authors.affiliation: School of Psychiatry UNSW Australia and Clinical Director,Academic Department for Old Age Psychiatry Prince of Wales Hospital,Euroa Centre Prince of Wales Hospital,Randwick,NSW 2031,Australia.
authors.forename: Brian
authors.initials: B
authors.lastname: Draper
authors.affiliation: Centre for Healthy Brain Ageing (CHeBA),UNSW Australia,Sydney,NSW 2052,Australia.
authors.forename: Lynn
authors.initials: L
authors.lastname: Chenoweth
authors.affiliation: Sydney Medical School,The University of Sydney and Head of Department Clinical Pharmacology and Senior Staff Specialist Aged Care,Royal North Shore Hospital Level 12,Kolling Building,St Leonards,NSW 2065,Australia.
authors.forename: Sarah
authors.initials: S
authors.lastname: Hilmer
authors.affiliation: Wicking Dementia Research and Education Centre,Faculty of Health,University of Tasmania,Private Bag 143,Hobart,TAS 7001,Australia.
authors.forename: Juanita
authors.initials: J
authors.lastname: Westbury
authors.affiliation: NHMRC Career Development Fellow Faculty of Health Sciences,The University of Sydney,Room M309B M Block 75 East Street,Lidcombe,NSW 2141,Australia.
authors.forename: Lee-Fay
authors.initials: LF
authors.lastname: Low
authors.affiliation: Dementia Collaborative Research Centre,School of Psychiatry UNSW Australia,Sydney,NSW 2052,Australia.
authors.forename: Megan
authors.initials: M
authors.lastname: Heffernan
authors.affiliation: Centre for Healthy Brain Ageing (CHeBA),School of Psychiatry,UNSW Australia and Director,Neuropsychiatric Institute,The Prince of Wales Hospital,Randwick,NSW 2031,Australia.
authors.forename: Perminder
authors.initials: P
authors.lastname: Sachdev
authors.affiliation: Neuroscience Research Australia,Barker St Randwick,NSW 2031,Australia.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Close
authors.affiliation: Dementia Collaborative Research Centre,School of Psychiatry UNSW Australia,Sydney,NSW 2052,Australia.
authors.forename: Jenny
authors.initials: J
authors.lastname: Blennerhassett
authors.affiliation: Dementia Collaborative Research Centre,School of Psychiatry UNSW Australia,Sydney,NSW 2052,Australia.
authors.forename: Millicent
authors.initials: M
authors.lastname: Marinkovich
authors.affiliation: Dementia Collaborative Research Centre,School of Psychiatry UNSW Australia,Sydney,NSW 2052,Australia.
authors.forename: Allan
authors.initials: A
authors.lastname: Shell
authors.affiliation: Dementia Collaborative Research Centre,School of Psychiatry UNSW Australia,Sydney,NSW 2052,Australia.
authors.forename: Henry
authors.initials: H
authors.lastname: Brodaty
mesh_terms: D000368:Aged; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D001315:Australia; D001521:Behavior Therapy / Q000379:methods; D003704:Dementia / Q000188:drug therapy* / Q000628:therapy*; D005260:Female; D006707:Homes for the Aged; D006801:Humans; D057970:Inappropriate Prescribing / Q000517:prevention & control*; D008134:Long-Term Care; D008137:Longitudinal Studies; D008297:Male; D009735:Nursing Homes; D000066553:Problem Behavior / Q000523:psychology
chemical_list: D014150:Antipsychotic Agents
keywords: BPSD; aged care; antipsychotics; dementia; deprescribing; long-term care; person-centered care