A new study of residents in specialised dementia care homes has confirmed a dramatic reduction, averaging 48%, in the requirement for antipsychotic medication, together with a corresponding improvement in the wellbeing of participants. Analysis of data in 16 Homes done by Four Seasons Health Care in the United Kingdom supports the findings.
Summary of key study findings :
Antipsychotic medication reduced on average by 48% across the homes involved in the most recent study, with the highest reduction being 84% in one home. The average is in line with an average reduction of 50% across the earlier study involving residents of a different group of eight of the company’s homes. The slight variance between the two groups of homes may be accounted for by the fact that some of the homes in the second phase study had already started putting the PEARL specialised dementia care principles into practice when the study began and so had already begun to experience a reduction in the need for antipsychotic medication.
Wellbeing increased among 46% of residents. Wellbeing can be profiled against a set of measurement criteria including, for example, how the resident interacts; ability to communicate needs and choices; sense of purpose*1. This is based on a smaller sample of 14 homes that measured wellbeing.
“When people with dementia are showing distress reactions, this may be due to them experiencing pain or discomfort, yet too often, rather than care staff trying to identify and relieve this symptom, the residents are needlessly given antipsychotic drugs to calm them and keep them quiet.” Caroline Baker Head of Quality & Dementia Care for Four Seasons Health Care.
Reduced requirement for Anxiolytic medication to alleviate anxiety, on average by 40%.
Depression score reduced in 30% of residents.
Also use of anti-depressant medication reduced on average by 19% as wellbeing improved. Depression is often undetected in people with dementia who are routinely prescribed antipsychotics.
Reduced requirement for hypnotic medication to induce sleep, on average by 44%
Weight gain among an average of 42% of residents in the participating homes, against the tendency for people with dementia to lose weight.
Falls reduced by 32% on average. Fall reduction may be attributed to increased alertness as a result of a reduction of antipsychotics and hypnotics as well as improved wellbeing.
Pain relief medication use increased 10% on average while 17% of residents had a reduced pain score with appropriate pain relief medication.
As the use of antipsychotic medication has decreased, the use of analgesics increased, following assessment utilising the Abbey Pain Scale*2, a tool which assists in assessment of non verbal cues from people with dementia who may be unable to articulate their experience of pain. This suggests pain is 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.
“Far too many people with dementia are robbed of their wellbeing and effectively part of their lives because they are over-prescribed antipsychotic medication. Reducing use of these drugs is a national priority. The consistent outcomes of the two studies in our PEARL specialised dementia care homes, carried out two years apart, provide confirmation that with better understanding of how to care for people with dementia we can reduce the need for medication and at the same time improve the residents’ wellbeing.” Caroline Baker Head of Quality & Dementia Care for Four Seasons Health Care
Four Seasons Health Care has produced a summary report of its second dementia care study. You can download a copy of the Pearl Dementia Care Report by clicking here.
- The study was conducted over two years and involved some 480 residents. The earlier study was also conducted over two years and involved some 240 residents.
- The reality of what reducing antipsychotic medication and improving wellbeing means in human terms is illustrated by this testimony by the wife of a resident at a PEARL specialised dementia care facility. “My husband was in bed for 16 months. The home took him off night medication first; then daytime medication. In a matter of weeks he was up and about. On the next visit we sat in the lounge eating breakfast together and he is much more aware and alert. The only medication he is on now is blood pressure tablets. It is remarkable.”
- The ethos of PEARL (Positively Enriching And enhancing Residents Lives) is to see beyond the symptoms of dementia to appreciate the individuality of each resident and support them to continue to live their lives as closely as possible to the way that they always have. Care programmes are planned in consultation with the resident and key influencers of his or her care experience, including relatives, friends, staff, community clinicians and GPs. The programme uses a range of therapies in daily care including sensory rooms, music therapy, reminiscence therapy and memory. The PEARL home is designed with consideration of the impact of light, colour, contrast, texture, aroma and sound to assist the overall orientation of residents and create a balanced sensory stimulating environment.
- Staff training includes, new ways of thinking about dementia. For example, it challenges the mindset that someone with dementia may be seen as disabled or dysfunctional. Four Seasons has re-defined what the care industry has tended to term “challenging behaviour” and recognises that this often is a distress reaction. Trainees agree to spend a day experiencing how it may feel to be a resident in a care home where they may have their individuality and personality disregarded. They wear smeared glasses to impair their sight and earplugs to impair hearing. They have one arm immobilised and are left wearing wet incontinence pads. They are not addressed directly by name; are not given a choice about food or beverages; have tablets administered without explanation or warning and are ignored for long periods. Then they are given the contrasting experience of once again being treated an individual with communication needs, emotions and preferences as well as physical care needs.
Jura Care :
As I read this article my whole inside is turning with excitement! This is it! At last, this is exactly what I am fighting for! This is what dear Sharon, Buddy’s daughter, trusted me in doing with our first resident! Take him off drugs ( anti-psychotics), although carefully monitored, I must add. Did you read the part about the lady and her husband? In bed for 16 months and then off medication…..?
Our Buddy has the same story, but you can read that on the blog, and I would love to tell many more stories like that!
With all this exciting news about taking people off drugs in mind, I do have to say that I will not recommend it if you can not offer these people living with Dementia something more. If you do not have the environment like Jura Care, with the freedom to go about, to walk around in huge gardens, to breathe in the fresh air blowing in from the Ocean, the sun bathing Vit D down on their wrinkly skin, a bird cage to listen to the chirping sounds of Nature or a Tea Garden to share a piece of sweet home bake with their loved ones….. and companions to share a day with….if you can not offer them something like this, you can not take them off anything yet.
This is the beginning of really helping and understanding people living with Dementia! – click here : Marlene’s Blog – To drug or not to drug
Below a photo of Buddy helping in the garden of the Jura Care Annex