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Wednesday, 10 April 2013

Dementia study confirms dramatic reduction in use of antipsychotics

Written by The Editorial Team
A new study of residents in specialised dementia care homes has confirmed a reduction, averaging 48 per cent, in the requirement for antipsychotic medication, together with dramatic reductions in usage of a range of other medications and a corresponding improvement in the wellbeing of participants.

Analysis of data from 16 homes in the PEARL specialised dementia care programme developed by Four Seasons Health Care found that on average across all participants, in addition to the reduction in antipsychotics use:

•    Medication to alleviate anxiety reduced by 40 per cent.
•    Depression score reduced in 30 per cent of residents while use of anti-depressant medication reduced by 19 per cent.
•    Requirement for medication to induce sleep reduced by 44 per cent.

A corresponding increase in wellbeing was measured among 46 per cent of residents.(*1)  While 42 per cent gained weight, against the expectation that people living with dementia would lose weight.

Falls reduced by 25 per cent. Fall reduction may be attributed to increased alertness as a result of reduction of antipsychotics and other medications as well as improved wellbeing.

The only medication consistently to increase in use was for pain relief, which increased 10 per cent on average. As the use of antipsychotic medication has decreased in these homes, the use of analgesics increased (following assessment utilising the Abbey Pain Scale*2). This suggests pain may be under-recognised in dementia care. Typically on nursing units 40% of residents are taking analgesic medication. By contrast on typical dementia units, with a similar population profile, 0-10% of residents are taking analgesics.

The average of 48 per cent reduction in use of antipsychotics included the highest reduction of  84 per cent in one home. This is the second study of the outcomes from Four Seasons’ specialised dementia units and it supports the findings of its initial study at eight other homes in 2010.  The average reduction in antipsychotics use is in line with a reduction of 50 per cent recorded in the earlier study. The slight variance may be accounted for by the fact that some of the homes in the second study had started putting the specialised dementia care principles into practice when the study began and so had begun to experience a reduction in the need for antipsychotics.

Caroline Baker, Head of Quality & Dementia Care for Four Seasons Health Care said, “When people with dementia are showing distress reactions this may be due to them experiencing pain or discomfort, yet too often rather than trying to identify and relieve this symptom they are needlessly given antipsychotic drugs to calm them and keep them quiet. Reducing use of these drugs is a national priority. The consistent outcomes of the two studies in our dementia care homes provide confirmation that with better understanding of how to care for people with dementia we can reduce the need for antipsychotics together with a range of other medications and at the same time improve wellbeing.”