Antipsychotics: Past, Present, and Future (Part 2): Article 2 of 3.

Area of Science:

• Geriatric Medicine
• Psychopharmacology
• Healthcare Policy

Background:

• The use of antipsychotics in nursing facilities is complex, reflecting broader healthcare system issues.
• Decades of efforts to reduce unwarranted antipsychotic use have shown limited success, with psychotropic medications still widely prescribed.
• Current understanding of behavior, person-centered care, and medication use in these settings is incomplete.

Purpose of the Study:

• To analyze the diverse perspectives and key players involved in past efforts to manage antipsychotic use in nursing facilities.
• To evaluate the outcomes of these initiatives and identify lessons learned.
• To lay the groundwork for future recommendations for improving medication management in long-term care.

Main Methods:

• Review of historical efforts to influence medication use, particularly antipsychotics, in nursing facilities.
• Analysis of fragmented and often ineffectual improvement initiatives.
• Examination of the results of interventions targeting psychotropic medication use.

Main Results:

• Past improvement efforts have been described as fragmented, ineffectual, and politically challenging.
• Despite significant reductions in indiscriminate antipsychotic use, psychotropics remain prevalent in nursing facilities.
• The overall improvement in managing residents with dementia and other behavioral issues is unclear.

Conclusions:

• The history of antipsychotic use in nursing facilities reveals persistent challenges in medication management.
• Past interventions have not fully resolved the issue of inappropriate psychotropic prescribing.
• Further research and refined strategies are needed to achieve lasting improvements in person-centered care and medication practices.