CHROME 2.0 Reduces Psychotropic Prescribing, Improving Neuropsychiatric Symptoms and Falls in People With Dementia

The CHemical Restraints avOidance MEthodology (CHROME) was developed to help general physicians with quality prescribing of psychotropics for people with dementia (PwD). A new enhanced version (CHROME 2.0) was implemented and tested for improved outcomes.

This was an observational, 13-month, prospective, 4-wave study.

All residents with dementia at 10 Albertia nursing homes participated in the study.

Neuropsychiatric syndromes and psychotropic prescriptions were first reviewed by physicians to comply with CHROME, and at the third and fourth waves, with CHROME 2.0, which included more stringent diagnostic criteria, implementation of environmental adaptations, and nonpharmacologic therapies. Medical data were extracted from the centralized information technology management software.

A total of 673 residents were eligible, of whom 410 PwD (mean age ± SD, 87.2 ± 7.3 years; 78.3% female) completed the study. Frequency of ≥1 neuropsychiatric diagnosis was reduced from 76.7% to 36.1%, and frequency of ≥1 psychotropic prescribing was reduced from 84.1% to 39.8%. The highest relative reduction was observed for typical antipsychotics (93.2%), followed by other hypnotics (90.7%), short-intermediate benzodiazepines (86.4%), atypical antipsychotics (67.6%), long benzodiazepines (64.3%), and antidepressants (48.9%). Improvement was observed in all neuropsychiatric symptoms (d = 0.37), particularly hallucinations (69.5%), apathy (64.0%), depression (59.1%), delusions (59.0%), and appetite/eating symptoms (57.5%). Frequency of ≥1 fall diminished from 11.5% to 6.6% (P < .005). Monthly psychotropic costs per 100 PwD were reduced from €6.506 to €2.429.

A significant decrease in psychotropic medication can be achieved concurrently with a marked improvement in both neuropsychiatric symptoms and falls. Psychotropic overprescription seems related to a culture of overestimating the capabilities of psychotropics while underestimating the potential of psychosocial interventions and the need for human contact of PwD. CHROME's limitation of psychotropics for severe cases contributed to shifting from a drug-centered care paradigm to a psychosocially more humane and integrative one that seems cost-effective and replicable, and should be further researched and implemented.