Quality Statement 7: Medication Review for Dosage Reduction or Discontinuation

Resources Quality Statements Advisory Committee About

7

Medication Review for Dosage Reduction or Discontinuation

People living with dementia who are prescribed psychotropic medications to help reduce agitation or aggression receive a documented medication review on a regular basis to consider reducing the dosage or discontinuing the medication.

Background

Evidence for the effectiveness of psychotropic medications to treat behavioural symptoms in dementia is usually based on short-term trials (e.g., 12–20 weeks long); the benefit of long-term (i.e., maintenance) medication therapy is unclear. Because of the risk of severe adverse events from these types of medications, people living with dementia and symptoms of agitation or aggression who are prescribed psychotropic medications should be considered for regular dosage reductions or medication discontinuation by an interprofessional team once the behavioural symptoms have stabilized. However, it is important to consider the risk for relapse in behavioural symptoms during or after the withdrawal of medication.

What This Quality Statement Means

For Patients

There should be a regular review of your medications to see if the dosage can be reduced or the medications stopped altogether.

For Clinicians

If prescribing psychotropic medications to a person with dementia, conduct and document a medication review at least once a month in hospital or every 3 months in long-term care to determine whether the dosage can be reduced or discontinued.

For Health Services

Ensure there are systems, processes, and resources in place in hospitals and longterm care homes to conduct regular documented medication reviews for people who are prescribed psychotropic medications. These reviews should occur at least once a month in hospital or every 3 months in long-term care.

Quality Indicators

Process Indicator

Percentage of people living with dementia and symptoms of agitation or aggression who are on psychotropic medications who have had a medication review (within the past month in an inpatient setting or within the past 3 months in a long-term care home)

Denominator: total number of people living with dementia and symptoms of agitation or aggression who are receiving a psychotropic medication

Numerator: number of people in the denominator who have had a medication review (within the past month in an inpatient setting or within the past 3 months in a long-term care home)

Data source: local data collection

Percentage of people living with dementia and symptoms of agitation or aggression who are on psychotropic medications and who have their psychotropic medications tapered or discontinued during a medication review

Denominator: total number of people living with dementia and symptoms of agitation or aggression who are receiving a psychotropic medication and have undergone a medication review

Numerator: number of people in the denominator who have their psychotropic medications tapered or discontinued during a medication review

Data source: local data collection

Definitions Used Within This Quality Statement

Medication review

This is performed at least once a month in a hospital inpatient setting or every 3 months in a long-term care setting, or sooner according to clinical need.

Psychotropic medications

These categories of psychotropic medications are typically used for reducing symptoms of agitation and aggression in people living with dementia:

Antipsychotics
Antidepressants
Mood stabilizers
Benzodiazepines
Other hypnotics

Evidence to Improve Care