Deprescribing Antipsychotics in Care Home Residents for Behavioural and Psychological Symptoms of Dementia (BPSD)

Introduction:

Antipsychotics in dementia are associated with higher risks of a wide range of serious health outcomes. Bradford is a national outlier in antipsychotic prescribing with 14.9% of dementia patients prescribed antipsychotics in March 2024 compared to 9% across England. Understanding and addressing the overuse of antipsychotics in BPSD is a priority for the Trust and the West Yorkshire Integrated Care Board (WYICB).

Method:

This 12-month quantitative service development project involved 78 care homes across Bradford District and Craven. Residents meeting deprescribing criteria were identified by a mental health nurse and care home staff at 47 homes, with 36 followed up by non-medical prescribers (NMP). Deprescribing plans were communicated to GPs, next of kin, and carers, with ongoing support/reviews provided by the care home liaison team.

Results:

A total of 146 residents met the deprescribing criteria, of whom 60 were excluded and 86 were taken forward. Deprescribing was initiated in 58 of these residents.

Of these 58, antipsychotics were successfully deprescribed with no recurrence of BPSD in 35 residents (60%). A further 12 residents (21%) had their antipsychotic reduced and were stabilised on a lower dose. In the remaining 11 residents (19%), antipsychotic reduction was halted or the drug was restarted soon after withdrawal due to BPSD.

Conclusion:

Antipsychotics were stopped or reduced in 81% of residents where deprescribing was attempted. Deprescribing was not attempted in 60 residents due to staff concerns about recent deterioration, illness, or agitation. Study limitations included limited NMP and care home liaison capacity. Variation in care home engagement with deprescribing has prompted a qualitative study examining carer attitude and influence. One year later (April 2025), antipsychotic prescribing in dementia fell to 13.6%. System-wide engagement ensures antipsychotic prescribing rates continue to fall and are now at 12.8% (December 2025), the lowest level for many years.