Clinical Practice Guidelines for the Appropriate Use of Psychotropic Medications in People Living with Dementia and in Residential Aged Care
Psychotropic medications are widely prescribed to people living with dementia and in residential aged care. High and variable rates of psychotropic medication use in Australian and international residential aged care is a source of concern for consumers, clinicians and policy makers.
The Centre for Medicine Use and Safety, Monash University has led a multidisciplinary project to develop Clinical Practice Guideline for the Appropriate Use of Psychotropic Medications in People Living with dementia and in Residential Aged Care (the Guidelines).
The Guidelines have been developed for prescribers and senior clinical staff including registered nurses and pharmacists. The Clinical Practice Guideline for the Appropriate Use of Psychotropic Medications in People Living with dementia and in Residential Aged Care: Summary of Recommendations and Good Practice Statements provides 15 recommendations and 49 good practice statements about antipsychotics, benzodiazepines and antidepressants. These medications are among the three most common psychotropics in residential aged care facilities. The Guidelines have been developed to be relevant to people living with dementia and in residential aged care or who are high-level home care packages.
The Guideline Development Group developed recommendations and good practice statements based on systematic evidence review of published literature and consideration of benefits and harms, certainty of the evidence, values and preferences, resources, equity, accessibility and feasibility.
The Guidelines recognise that prescribers, pharmacists, aged care providers, nursing and aged care staff all have responsibilities in facilitating the active involvement of people living with dementia in decision-making in relation to the use of psychotropic medications. The Guidelines highlight the importance of obtaining informed consent from the person living with dementia and/or their substitute decision-maker, and documenting target symptoms and anticipated treatment outcomes. The Guidelines outline requirements for monitoring for treatment effectiveness and adverse events, and presents psychotropic discontinuation strategies.
The Guidelines and supporting documents were commissioned by the Dementia Centre for Research Collaboration (DCRC) and developed by a national multidisciplinary Guideline Development Group led by Monash University’s Centre for Medicine Use and Safety.
Supporting Materials to Implement the Guidelines
The Guidelines can be accessed:
Clinical Practice Guideline for the Appropriate Use of Psychotropic Medications in People Living with dementia and in Residential Aged Care - Online via MAGICapp
The Companion Guide is for anyone who is impacted by dementia. This includes people living with all types of dementia, their carers and families. The Companion Guide is also for the wider public. Health and care professionals may find the Companion Guide useful for shared decision-making.
Companion Guide – English
Companion Guide – Chinese (Simplified)
Companion Guide – Chinese (Traditional)
Companion Guide – Italian
Companion Guide – Greek
Companion Guide – Vietnamese
These medication factsheets are provide an overview of the Guideline. There are nine factsheets and each factsheet focusses on a medication and a step of the medication process (initiation, monitoring and discontinuation). The medication factsheets are aimed at RACF registered nurses, enrolled nurses and aged care workers. Members of the public may find these resources useful as well.
This microlearning video series is designed to support safe and appropriate use of psychotropic medications for people living with dementia and in residential aged care.
The video series includes 12 short, practical modules (approximately 5-7 minutes each) designed for health and care staff in residential aged care. The video series was developed by researchers from Monash University and Flinders University, based on stakeholder consultation as part of the Evidence-based Medication knowledge Brokers in Residential Aged CarE (EMBRACE) trial.
To view the microlearning video series, click here.
A series of 9 Quality Use of Medicine education sessions have been developed to support the implementation of the Guidelines into residential aged care facilities. The education sessions have been developed to align with the Pharmaceutical Society of Australia Guidelines for Quality Use of Medicine services and the Guidelines. The aim of the education sessions are to empower staff with the knowledge to support the appropriate use of antipsychotics for changed behaviours in people living with dementia.
The education sessions have been designed as a face-to-face group education activity delivered to RACF registered nurses, enrolled nurses, and aged care workers. Each education session will run for up to 70-minutes.
Each education session focuses on one psychotropic medication (antipsychotics, benzodiazepines and antidepressants) and on a step of the medication process (initiation, adverse events and monitoring and discontinuation).
Each education session has four supporting documents:
- Facilitator notes - intended for the facilitator
- PowerPoint slide deck - intended to be presented to attendees by facilitator
- Didactic script - intended to support the facilitator when presenting PowerPoint slides
- Case study handout - intended to be used by attendees when reviewing the case study and discussion questions
Each education session begins with a brief overview on the use of the psychotropic medication in people living with dementia and changed behaviours. Attendees will work through a case study in small groups. Attendees will present their case study answers and the facilitator will support group discussion. The facilitator will end the education session with a brief conclusion of the key take home messages.
Each component of the education activity will include interactive components to promote group discussion.
- The initiation education sessions takes staff through the risks and benefits of the psychotropic medication for people living with dementia. It teaches nurses and aged care staff the steps they should take prior to considering initiation of the psychotropic medication.
- The adverse events and monitoring education sessions reviews some key adverse events of the psychotropic medication and teaches nurses and aged care staff monitoring requirements for the psychotropic medication.
- The discontinuation education sessions teaches nurses and aged care staff when discontinuation should be considered for the psychotropic medication and monitoring requirements during the discontinuation process.
We encourage the facilitator as part of preparation for this education activity to review relevant parts of the Guideline and its supporting material.
Each education session can be downloaded below:
To support the Guideline Good Practice Statements 20, 28, and 36, researchers at Monash University’s Centre for Medicine Use and Safety have drafted an adverse event monitoring tool for residents who use antipsychotics, benzodiazepines and antidepressants. The tool is designed for use by residential care nurses or care workers, to support the detection of signs and symptoms of adverse events that reduce quality of life or cause significant resident harm, are observable or measurable by nurses or care workers, and can be assessed at a single time point.
Other psychotropic adverse event monitoring tools for use in residential aged care have been reviewed at "Brigid E McInerney, Amanda J Cross, Justin P Turner, J Simon Bell. Systematic Review of Psychotropic Adverse Drug Event Monitoring Tools for Use in Long-Term Care Facilities. J Am Med Dir Assoc 2023 Jun;24(6):773-781.e5.
Supporting Guideline Reports
A record of the evidence review process can be found in:
- Technical Report Part 1 - Guideline Methodology
- Technical Report Part 2 - Results of Systematic Search and Evidence Review
Non-technical information relating to process of guideline development can be found in the administrative report.
The Dissemination Plan for the Guideline can be found in the document below.