The impact of sedative reduction on agitation and falls in aged care facilities: preliminary findings

Sedative medications, predominantly antipsychotics (APs) and benzodiazepines (BZs), are commonly prescribed in residential aged care facilities (RACFs). APs are often used to treat behavioural and psychological symptoms of dementia, while BZs are frequently given for insomnia and anxiety. Despite only modest efficacy for these indications, the risk of severe adverse effects, and guidelines recommending only short-term use, evidence suggests that sedative medications are not regularly reduced due to fear that the initial symptoms may deteriorate. Previous sedative reduction programs have lacked resident monitoring, impacting upon their widespread clinical acceptance and uptake for addressing barriers to sedative reduction. The aim of this research is to assess the impact that sedative reduction has on residents of RACFs involved in a multifaceted program to improve sedative use (the Reducing the Use of Sedatives project; RedUSe). We studied the effect that sedative reduction had on agitation and falls in a preliminary sample of 67 residents participating in RedUSe. Residents were classified as AP/BZ ‘reducers’ or ‘nonreducers’ based on their AP and BZ use over four months. Resident agitation was evaluated using the Cohen-Mansfield Agitation Inventory (CMAI). Nurses kept a record of falls for participating residents. Results indicate that there were no changes in agitation between BZ reducers and non-reducers (p = 0.5), and AP reducers and non-reducers (p = 0.2). There were also no differences in the mean number of falls between BZ reducers and non-reducers (p = 0.5), or AP reducers and non-reducers (p = 0.2). The preliminary results, albeit based on a small sample, suggest that sedative reduction has no impact on agitation or falls.