2025 Volume 37 Issue 1 Pages 19-28
The Dementia Care Team (DCT) was established alongside the introduction of a sleeping pill formulary in a general hospital. This led to a study examining changes in sleeping pill prescriptions and their association with fall rates, physical restraint use, and delirium. The study found that prescriptions for the recommended drug, lemborexant, increased both before and after the DCT became operational. Meanwhile, prescriptions for benzodiazepines (BZ) and risperidone significantly decreased. There were no significant differences between falls and restraints and each drug group, but looking at the drugs alone, there was a trend towards increased falls with flunitrazepam and a significant increase in restraints with risperidone; the presence of DCT intervention reduced restraints without increasing falls. Of the 344 patients included, 41 (11.9%) developed delirium, but there was a significant difference in the presence or absence of delirium between lemborexant and other drugs, with a smaller proportion developing delirium in those on lemborexant and a statistically significant difference in delirium development between the other drug groups. Multivariate analysis of the incidence of delirium supported the results of the univariate analysis for the drug groups, with statistically significantly fewer cases in the lemborexant and Psychoactive Drug (PD) groups (risperidone/trazodone), while the odds ratio tended to increase with the degree of independence in daily living of older people with dementia. To reduce delirium, in addition to the presence of a multidisciplinary team that can be easily consulted, it is important that attending physicians and nursing staff other than psychiatrists become familiar with appropriate medication use and response methods, and that a systematic preventive care system is established that can be implemented by non-specialists.
