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Results of a "drug holiday." (tapering the dosage of psychotropic drugs in nursing home patients) (Chemical Restraint Reduction: Report on Two Projects)

There is no question that, when used properly, psychotropic drugs provide an effective way to control extreme agitation or psychotic-type behaviors among nursing home residents. The crucial step, however, is to begin older patients on a low dose of the drug with incremental increases as necessary and then to monitor them carefully. Once the patient is clinically stabilized over a period of weeks to months, the drug should be reduced gradually over time until the behaviors are managed with the lowest possible effective dose. For the most part, physicians are careful not to overuse drugs such as haloperidol or to prescribe them when they aren't indicated. The problem usually arises when, having prescribed a psychotropic for acute usage, the physician fails to taper the dose and/or its frequency once the acute need has passed. OBRA requires physicians and caregivers to use the least amount of psychotropic medication possible and to document dosage and specific behaviors.

At the Jewish Home and Hospital for Aged of New York, we have attempted to address this situation by using the "drug holiday" approach, specifically, by tapering the use of haloperidol. Of the 1300 patients in our two facilities in Manhattan and the Bronx, 60 were receiving haloperidol, usually in doses of 1 mg or less once or twice daily, at the outset of our project. The drug holiday included 40 residents who gave consent, regardless of the dosage of haloperidol they were receiving or their diagnoses for indication.

At the end of the study period, we found that we were able to safely withhold the drug on Mondays and Thursdays in over half of the residents who had been maintained on a low-dose regimen. It is important to note that part of this success can be attributed to haloperidol's long half-life. Little or no difference in overall behavior or agitation level was noted. In addition, in those residents who completed the study, family and staff noted little difference in behavior when residents were on the drug holiday.


While preliminary, the results of our study are promising. Studies on larger populations are needed to determine the effectiveness of the drug holiday as a means of reducing the use of psychotropic drugs in the nursing home.
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Author:Neufeld, Richard
Publication:Nursing Homes
Date:Jul 1, 1994
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