The risk-benefit balance of antipsychotic use in dementia is precarious. While evidence supports the efficacy of certain atypical antipsychotics in treating behavioral disturbances, these drugs have been found to increase the risk of death and cerebrovascular events in people with dementia. Despite these warnings, antipsychotic use in people with dementia remains common. Training providers to understand other aspects of care that impact behavioral disturbances, as well as appropriate antipsychotic selection and use, may improve antipsychotic utilization patterns and, as a result, the safety and quality of life of people with dementia. This collaboration of the University of Iowa Older Adults Center for Education and Research on Therapeutics, the Iowa Geriatric Education Center, the Iowa Foundation for Medical Care, and Iowa Health Systems proposes to adapt and disseminate the AHRQ comparative effectiveness research review and summary guide (CERSG) within a comprehensive program to guide providers in the care of patients with dementia and behavioral disturbances.
Aim 1 is to adapt the CERSG into a clinical decision aid and educational materials for providers and consumers to guide optimal use of antipsychotics in dementia. We will focus efforts on procedural learning. Adaptation products include a series of case-based presentations available in electronic formats targeted towards clinicians and direct care providers;a decision aid to guide providers in caring for patients with dementia and behavioral disturbances in print, web, and personal digital assistant formats;and products for patient families including a guide to facilitate shared decision making on antipsychotic use.
Aim 2 is to disseminate the products in Iowa then nationally. We will partner with numerous organizations to achieve this aim.
Aim 3 is to evaluate the impact of dissemination on educational outcomes, antipsychotic use patterns, and patient oriented outcomes. Antipsychotic use patterns and patient oriented outcomes will be evaluated by analyzing Minimum Data Set and Medicare data in Iowa from 2009-2012. Consenting providers and facilities who participate in the educational programs will be linked to evaluation data to compare changes in trends over time among participants with those in the rest of Iowa.

Public Health Relevance

Cognitive impairment and dementia are major public health issues for the elderly and aging population, particularly nursing home residents. Behavioral problems in dementia place undue burden on caregivers, and current drug therapies for these problems are unsafe and have limited effectiveness. This research addresses AHRQ goals of assessing and improving the effectiveness of treatment strategies for dementia.

National Institute of Health (NIH)
Agency for Healthcare Research and Quality (AHRQ)
Research Demonstration and Dissemination Projects (R18)
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Special Emphasis Panel (ZHS1-HSR-C (02))
Program Officer
Cravens, Catherine
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University of Iowa
Public Health & Prev Medicine
Schools of Public Health
Iowa City
United States
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Carnahan, Ryan M; Brown, Grant D; Letuchy, Elena M et al. (2017) Impact of programs to reduce antipsychotic and anticholinergic use in nursing homes. Alzheimers Dement (N Y) 3:553-561
Urick, Benjamin Y; Kaskie, Brian P; Carnahan, Ryan M (2016) Improving antipsychotic prescribing practices in nursing facilities: The role of surveyor methods and surveying agencies in upholding the Nursing Home Reform Act. Res Social Adm Pharm 12:91-103
Daly, Jeanette M; Bay, Camden P; Levy, Barcey T et al. (2015) Caring for people with dementia and challenging behaviors in nursing homes: A needs assessment geriatric nursing. Geriatr Nurs 36:182-91