Quality Statement 4: Indications for Psychotropic Medications

Resources Quality Statements Advisory Committee About

4

Indications for Psychotropic Medications

People living with dementia are prescribed psychotropic medications to help reduce agitation or aggression only when they pose a risk of harm to themselves or others or are in severe distress.

Background

Because of their potential for adverse events, psychotropic medications should not be considered first-line therapy for people living with dementia. In particular, the use of antipsychotics is cautioned for people living with dementia as it is associated with an increased risk of serious adverse events, such worsening cognition, parkinsonism, diabetes, sedation, cerebrovascular disease, and premature death. Nonpharmacological interventions should be considered first-line therapy for people living with dementia, and psychotropic medications should be used only when people pose a risk of harm to themselves or others or are in severe distress.

What This Quality Statement Means

For Patients

Medications should be used only if you are in severe distress or if there is a concern you might harm yourself or someone else.

For Clinicians

Only prescribe psychotropic medications to reduce agitation or aggression in people living with dementia when they pose a risk of harm to themselves or others or are in severe distress. If psychotropic medications are prescribed, provide information to people and their caregivers about the risks and side effects of the medication, the rationale for prescribing it, and the plan for reviewing and reducing or discontinuing its use.

For Health Services

Ensure that hospitals and long-term care homes have systems, processes, and resources in place to document the rationale, plan for review, and provide information to people living with dementia and their caregivers when psychotropic medications are prescribed.

Quality Indicators

Process Indicator

Percentage of people living with dementia and symptoms of agitation or aggression who are prescribed a psychotropic medication typically used to reduce distress, without clear documentation that they are in severe distress or pose a risk of harm to themselves or others

Denominator: total number of people living with dementia with symptoms of agitation or aggression who are prescribed a psychotropic medication typically used to reduce distress
Numerator: number of people in the denominator who are prescribed the psychotropic medication without clear documentation that they are in severe distress or pose a risk of harm to themselves or others
Data source: local data collection

Definitions Used Within This Quality Statement

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