Antipsychotic Deprescription for Older Adults in Long-term Care: The HALT Study

J Am Med Dir Assoc. 2018 Jul;19(7):592-600.e7. doi: 10.1016/j.jamda.2018.05.002.


Objectives: Despite limited efficacy and significant safety concerns, antipsychotic medications are frequently used to treat behavioral and psychological symptoms of dementia (BPSD) in long-term residential care. This study evaluates the sustained reduction of antipsychotic use for BPSD through a deprescribing intervention and education of health care professionals.

Design: Repeated-measures, longitudinal, single-arm study.

Setting: Long-term residential care of older adults.

Participants: Nursing staff from 23 nursing homes recruited 139 residents taking regular antipsychotic medication for ≥3 months, without primary psychotic illness, such as schizophrenia or bipolar disorder, or severe BPSD.

Intervention: An antipsychotic deprescribing protocol was established. Education of general practitioners, pharmacists, and residential care nurses focused on nonpharmacological prevention and management of BPSD.

Measurements: The primary outcome was antipsychotic use over 12-month follow-up; secondary outcomes were BPSD (Neuropsychiatric Inventory, Cohen-Mansfield Agitation Inventory, and social withdrawal) and adverse outcomes (falls, hospitalizations, and cognitive decline).

Results: The number of older adults on regular antipsychotics over 12 months reduced by 81.7% (95% confidence interval: 72.4-89.0). Withdrawal was not accompanied by drug substitution or a significant increase in pro-re-nata antipsychotic or benzodiazepine administration. There was no change in BPSD or in adverse outcomes.

Conclusion: In a selected sample of older adults living in long-term residential care, sustained reduction in regular antipsychotic use is feasible without an increase of BPSD.

Keywords: Antipsychotic withdrawal; behavioral and psychological symptoms of dementia; dementia.

Publication types

  • Clinical Trial
  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Accidental Falls / statistics & numerical data
  • Aged
  • Aged, 80 and over
  • Antipsychotic Agents / administration & dosage*
  • Australia
  • Dementia / drug therapy*
  • Dementia / psychology*
  • Deprescriptions*
  • Drug Utilization / statistics & numerical data
  • Female
  • Health Personnel / education
  • Hospitalization / statistics & numerical data
  • Humans
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Neuropsychological Tests
  • Nursing Homes*


  • Antipsychotic Agents