Reducing Multiple Medications to Improve Dementia Symptoms

Hands holds a glass of water with medication bottles on the table.

Award Date: 2017

Project Lead(s): Sanjeev Kumar, Clinician Scientist, Staff Psychiatrist and Medical Head, Geriatric Inpatient Services

Project Title: Improving Care for Neuropsychiatric Symptoms of Dementia

What is the issue?

Agitation and aggression are two symptoms of dementia. They are very challenging for patients, families, caregivers, and the healthcare system. There are some mood-altering medications that can reduce these symptoms, but they have significant side effects.

What did we do?

We studied a new approach for reducing the use of multiple medications in long-term care residents. Our goal was to see if this new method, called the Integrated Care Pathway, would reduce symptoms of agitation and aggression.

First, we provided recommendations to the clinical team. Our goal was to reduce medications in 18 residents with Alzheimer’s disease or dementia who have symptoms of agitation and establish fresh starting points. Then we provided recommendations to introduce non-medication interventions followed by medications one at a time in a fixed order. We assessed patients after each one was added.

What did we find?

The new approach successfully reduced agitation in all participants in a shorter time than the usual method. They also took significantly fewer mood-altering medications. Some participants continued on medications outside the plan, making it difficult to establish fresh starting points. There were challenges putting non-medication strategies in place in a timely fashion.