Reducing antipsychotic polypharmacy in adults 65 years and older diagnosed with dementia: a quality improvement initiative

Abstract

Background: Older adults - defined as aged 65 years and older, with mental illness, specifically dementia, experience antipsychotic polypharmacy which increases the risk for further comorbidities and adverse events. Using an algorithm to deprescribe antipsychotics can be helpful in reducing health risk. Objective: A scoping review aims to look at the existing evidence pertaining to the risk of antipsychotic polypharmacy use in older adults with dementia. In addition, this review will analyze the current deprescribing algorithms and methods used to reduce antipsychotic polypharmacy to improve patient outcomes and quality of life. Design: Online resources were used to select peer-reviewed research articles published between 2020-2025. Keywords used included "older adults", "polypharmacy", "dementia", "schizophrenia", and "antipsychotic." From the final search, a total of 21 sources were extracted and narrowed down to 12 articles used in this review. Results: Longitudinal cohort studies made up most of the literature alongside two meta-analyses. Several Scoping Reviews looking at deprescribing algorithms were analyzed as well. Evidence shows antipsychotic polypharmacy significantly affects older adults with mental illness. Deprescribing methods prove to be successful in eliminating unnecessary prescriptions though remain under-researched. Conclusion: Research yielded mixed results. While some evidence supports the use and risk of antipsychotic polypharmacy in older adults, others present valid concern and detrimental effects of antipsychotic polypharmacy. While research remains limited on effective deprescribing methods, several studies show the success of using algorithms to reduce polypharmacy, particularly the START/STOPP method.