SynthesisDrugs & aging2021
What Makes Deprescription of Psychotropic Drugs in Nursing Home Residents with Dementia so Challenging? A Qualitative Systematic Review of Barriers and Facilitators.
Synthesis in Drugs & aging, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 3 of them syntheses that pooled it.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
14 citing papers in PubMed, 3 syntheses or guidelines pooled it, 40 citations in OpenAlex.
- Discontinuing antidepressant medication: a qualitative evidence synthesis and logic model based on health professionals' views.BMC health services research · 2025Pooled it
- Patients' experiences with GLP1-RAs - a systematic review.Scandinavian journal of primary health care · 2025Pooled it
- A systematic review of quantitative studies exploring staff views on antipsychotic use in residents with dementia in care homes.International journal of clinical pharmacy · 2023Pooled it
- Effects of deprescribing antidepressants in nursing home residents with dementia-a cluster randomized controlled trial.BMC primary care · 2025Trial
- Tailoring a complex intervention to reduce antidepressants in institutionalized older persons with dementia.BMC health services research · 2022Trial
- The Impact of a Stepwise Method Involving Family Caregivers in Managing Challenging Behavior and Pain in Nursing Home Residents With Dementia.International journal of geriatric psychiatry · 2026Article
- Implementing antipsychotic reduction in long-term care: interdisciplinary and lived-experience insights into system-level barriers and facilitators.The Gerontologist · 2026Article
- A qualitative study on the challenges in deprescribing for elderly patients with polypharmacy.Frontiers in medicine · 2026Article
- Psychotropic medications versus non-pharmacologic approaches for managing behavioural and psychological symptoms in Australian aged care residents with dementia: general practitioners' and physicians' perspectives.Therapeutic advances in psychopharmacology · 2025Article
- The Impact of Training in Multimodal Communication Skills on Psychotropic Medication Use in Dementia Care.Cureus · 2024Article
- Healthcare professionals' experiences with the use of antipsychotics in dementia.Exploratory research in clinical and social pharmacy · 2024Article
- Article
- An integrative systematic review of nurses' involvement in medication deprescription in long-term healthcare settings for older people.Therapeutic advances in drug safety · 2024Review
- Article
Corrections and comments
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Authors and funding
5 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundBehavioral and psychological symptoms of dementia are frequently experienced in the nursing home setting and place a substantial burden on patients, relatives, and nursing home staff. Despite guidelines recommending non-pharmacological treatments, psychotropic drugs are often prescribed to address these symptoms. This is the case despite their effects being limited, and there being a risk of side effects and adverse events for the patient. Several studies have aimed to reduce the use of psychotropic drugs, with varying results. The reasons behind these variations are not well understood.
objectivesThe objective of this systematic review was to investigate which factors nursing home general practitioners and nursing home staff experience as barriers or facilitators when attempting to deprescribe psychotropic drugs in nursing home residents.
methodsWe searched PubMed, EMBASE, psycINFO, Web of Science, and CINAHL between April and September 2020. An inductive method using thematic analysis of the qualitative findings was applied for the derivation of themes. Quantitative studies were included but described descriptively and separately.
resultsOf 8204 unique records, 14 studies were included in the review. Of these, nine were interview or focus group studies and five were survey studies. Thematic analysis resulted in five major themes identified as either facilitators or barriers or both: (1) 'Operationality and routines'; (2) 'Lack of resources and qualifications'; (3) 'Patient-related outcomes', which points to a strong belief in negative patient-related outcomes of discontinuation and a downplay of side effects of the medication; (4) 'Policies', including support and buy-in from nursing home leadership; and (5) 'Collaboration' between physicians and nursing home staff. Themes 1 and 4 consist of facilitators. Theme 2 consists of barriers. Theme 3 and 5 consist of both facilitators and barriers. Evaluation of closed-ended questions from the surveys supported the findings.
conclusionsDeprescribing psychotropic drugs used for behavioral and psychological symptoms of dementia in nursing home residents is challenging. Resources need to be in place for deprescribing, as well as there being a focus on the positive patient-related outcomes of doing so. Managerial support, staff routines, and interprofessional collaboration are some factors facilitating the process, in addition to there being routines and systematic procedures in place allowing for operationality and a common understanding. Addressing these barriers and facilitators is necessary to ensure that deprescribing can be understood as meaningful and pursued among healthcare professionals in the nursing home setting.
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