Pharmacotherapy for long-term care residents with dementia-associated behavioral disturbance

The Nursing Home Reform Amendments of the Omnibus Budget Reconciliation Act (OBRA) of 1987 have resulted in specific mandates for documentation regarding behavioral indication for psychotropic drugs and the monitoring of their efficacy and side effects. The national guidelines also require drug holidays, behavioral management in lieu of drugs when possible, systematic dosage reductions unless contraindications are documented, and an overall reduction of drugs considered unnecessary. This article describes OBRA 87 guidelines for benzodiazepine and antipsychotic drug use in long-term care facilities. Specific pharmacological interventions for persons with behavioral disturbances associated with dementia, the phenomena most significantly affected by these federal guidelines, are summarized.