Continuous Palliative Sedation in Nursing Home Residents With Dementia and Refractory Neuropsychiatric Symptoms

ABSTRACTBackground: The goal of this study is to determine patterns of psychotropic drug use (PDU), the association with neuropsychiatric symptoms (NPS), and the variability across dementia types in nursing home residents with dementia. In addition, PDU was analyzed across multiple indications.Methods: This was a prospective cohort study over a two-year period from 2006 to 2008, which involved 14 dementia special care units in nine nursing homes. A total of 117 residents with dementia participated in the study, of whom 35% had Alzheimer's dementia (AD) and 11% vascular dementia (VaD). PDU was classified according to anatomical therapeutic chemical-classification as either “present” or “absent”.Results: The majority of residents had moderately severe to severe dementia. At all successive assessments, almost two-thirds of residents received any psychotropic drug (PD) and almost one-third continued to receive any PD. Of all PDs, antipsychotics (APs) were prescribed most frequently. Fewer residents started with antidepressants, but continued to receive antidepressants at higher percentages. Anxiolytics showed an intermittent course, but a subgroup of 9% showed two-year continuation. Once started on PDs at baseline, residents continued to use PDs at high percentages: three-quarters continued to receive APs for at least six months. Half of residents received at least one PD; one-fifth received at least two PDs simultaneously. Residents with AD received more hypnotics and antidementia drugs; residents with VaD received more antipsychotics, antidepressants, anxiolytics and anticonvulsants.Conclusions: PDs have different utilization patterns, but overall, consistently high continuation rates were found. These results warrant scrutiny of continuous PDU.

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Music therapy: A nonpharmacological approach to the care of agitation and depressive symptoms for nursing home residents with dementia

Dementia ◽

10.1177/1471301215613779 ◽

2015 ◽

Vol 16 (6) ◽

pp. 689-710 ◽

Cited By ~ 25

Author(s):

Kendra D Ray ◽

Mary S Mittelman

Keyword(s):

Nursing Home ◽

Depressive Symptoms ◽

Music Therapy ◽

Repeated Measures ◽

Neuropsychiatric Symptoms ◽

Nursing Home Residents ◽

Term Care ◽

Symptoms Of Depression

Depression, agitation, and wandering are common behaviors associated with dementia and frequently observed among nursing home residents. Even with pharmacological treatment, behaviors often persist, hindering quality of life for elders, their family, and paid caregivers. This study examined the use of music therapy for treatment of these symptoms among 132 people with moderate to severe dementia in nursing homes. Participants were evaluated for depressive symptoms, agitation, and wandering to determine their predominate behavior. There were two assessments, two weeks apart, prior to intervention, followed by a two-week intervention, and two follow-up assessments, also two weeks apart. A repeated measures ANOVA determined that after two weeks of music therapy, symptoms of depression and agitation were significantly reduced; there was no change for wandering. Multivariate analyses confirmed a relationship between music therapy and change in neuropsychiatric symptoms associated with dementia. Results suggest widespread use of music therapy in long-term care settings may be effective in reducing symptoms of depression and agitation.

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The Prevalence of and Documented Indications for Antipsychotic Prescribing in Irish Nursing Homes

Pharmacy ◽

10.3390/pharmacy9040160 ◽

2021 ◽

Vol 9 (4) ◽

pp. 160

Author(s):

Jayne E. Kelleher ◽

Peter Weedle ◽

Maria D. Donovan

Keyword(s):

Nursing Home ◽

Nursing Homes ◽

Antipsychotic Medication ◽

Psychological Symptoms ◽

Neuropsychiatric Symptoms ◽

Medication Use ◽

Nursing Home Residents ◽

Cross Sectional ◽

Home Setting ◽

Antipsychotic Prescribing

Background: Antipsychotic medications are often used ‘off-licence’ to treat neuropsychiatric symptoms and disorders of aging and to manage behavioural and psychological symptoms of dementia despite the warnings of adverse effects. Objective: To establish the prevalence of and documented indication for antipsychotic medication use in the Irish nursing home setting. Setting: This study was conducted in six nursing homes located in Co. Cork, Ireland. Method: A retrospective, cross-sectional study was employed. All patients who met the inclusion criteria (≥65 years, residing in a nursing home on a long-term basis) were eligible for inclusion. There were 120 nursing home residents recruited to the study. Main Outcome Measure: The prevalence of antipsychotic medication use in nursing home residents (with and without dementia). Results: The overall prevalence of antipsychotic prescribing was found to be 48% and patients with dementia were significantly more likely to be prescribed an antipsychotic compared to those without dementia (67% vs. 25%) (χ2 (1, N = 120) = 21.541, p < 0.001). In the cohort of patients with dementia, there was a trend approaching significance (p = 0.052) of decreasing antipsychotic use with increasing age (age 65–74 = 90%; age 75–84 = 71%; age 85 and over = 58%). An indication was documented for 84% of the antipsychotic prescriptions in this cohort. Conclusion: The findings of this study highlight that high rates of antipsychotic medication use remains an issue in Irish nursing homes. Further work should explore factors in influencing prescribing of these medications in such settings.

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Differences in neuropsychiatric symptoms between nursing home residents with young-onset dementia and late-onset dementia

Aging & Mental Health ◽

10.1080/13607863.2018.1428935 ◽

2018 ◽

Vol 23 (5) ◽

pp. 581-586 ◽

Cited By ~ 5

Author(s):

Britt Appelhof ◽

Christian Bakker ◽

Jeannette C. L. Van Duinen-van Den IJssel ◽

Sandra A. Zwijsen ◽

Martin Smalbrugge ◽

...

Keyword(s):

Nursing Home ◽

Late Onset ◽

Neuropsychiatric Symptoms ◽

Nursing Home Residents ◽

Young Onset ◽

Young Onset Dementia ◽

Late Onset Dementia

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Correction: The course of neuropsychiatric symptoms in nursing home residents from admission to 30-month follow-up

PLoS ONE ◽

10.1371/journal.pone.0209875 ◽

2018 ◽

Vol 13 (12) ◽

pp. e0209875

Author(s):

Anne-Sofie Helvik ◽

Geir Selbæk ◽

Jūratė Šaltytė Benth ◽

Irene Røen ◽

Sverre Bergh

Keyword(s):

Nursing Home ◽

Neuropsychiatric Symptoms ◽

Nursing Home Residents

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Pain, Neuropsychiatric Symptoms, and Quality of Life of Nursing Home Residents With Advanced Dementia in The Netherlands

Alzheimer Disease & Associated Disorders ◽

10.1097/wad.0000000000000197 ◽

2017 ◽

Vol 31 (4) ◽

pp. 315-321 ◽

Cited By ~ 6

Author(s):

Janine van Kooten ◽

Johannes C. van der Wouden ◽

Sietske A.M. Sikkes ◽

Martin Smalbrugge ◽

Cees M.P.M. Hertogh ◽

...

Keyword(s):

Quality Of Life ◽

Nursing Home ◽

The Netherlands ◽

Neuropsychiatric Symptoms ◽

Nursing Home Residents ◽

Advanced Dementia

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Associations between Pain and Quality of Life in Severe Dementia: A Norwegian Cross-Sectional Study

Dementia and Geriatric Cognitive Disorders Extra ◽

10.1159/000468923 ◽

2017 ◽

Vol 7 (1) ◽

pp. 109-121 ◽

Cited By ~ 8

Author(s):

Hanne Marie Rostad ◽

Martine T.E. Puts ◽

Milada Cvancarova Småstuen ◽

Ellen Karine Grov ◽

Inger Utne ◽

...

Keyword(s):

Quality Of Life ◽

Nursing Home ◽

Depressive Symptoms ◽

Daily Living ◽

Neuropsychiatric Symptoms ◽

Nursing Home Residents ◽

Severe Dementia ◽

Cross Sectional ◽

The Relationship

Background/Aims: Many variables influence the quality of life in older adults with dementia. We aim to quantify how the relationship between pain and quality of life in nursing home residents with severe dementia can be explained by neuropsychiatric symptoms, depressive symptoms, and activities of daily living. Methods: This article presents cross-sectional baseline data from a cluster randomised controlled trial. Results: The total and direct effects of pain on quality of life were statistically significant. Both neuropsychiatric and depressive symptoms partially mediated the relationship between pain and quality of life. Activities of daily living acted as a mediator only when modelled together with depressive symptoms. Conclusion: Pain, neuropsychiatric symptoms, and depressive symptoms appear to be important factors that influence the quality of life for nursing home residents with severe dementia. Therefore, multidimensional interventions may be beneficial for maintaining or improving quality of life in this population.

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The Determinants of Quality of Life of Nursing Home Residents with Young-Onset Dementia and the Differences between Dementia Subtypes

Dementia and Geriatric Cognitive Disorders ◽

10.1159/000477087 ◽

2017 ◽

Vol 43 (5-6) ◽

pp. 320-329 ◽

Cited By ~ 18

Author(s):

Britt Appelhof ◽

Christian Bakker ◽

Jeannette C.L. Van Duinen-van den Ijssel ◽

Sandra A. Zwijsen ◽

Martin Smalbrugge ◽

...

Keyword(s):

Quality Of Life ◽

Nursing Home ◽

Frontotemporal Dementia ◽

Neuropsychiatric Symptoms ◽

Nursing Home Residents ◽

Young Onset ◽

Alzheimer Dementia ◽

Young Onset Dementia ◽

Dementia Subtype

Aims: The aims of this study are to (1) explore the determinants of quality of life (QoL) in nursing home residents with young-onset dementia (YOD), (2) investigate whether there are differences between dementia subtypes (Alzheimer dementia, vascular/mixed dementia, frontotemporal dementia, other) regarding these determinants, and (3) compare QoL profiles of YOD nursing home residents across dementia subtypes. Methods: This cross-sectional study included 207 nursing home residents. Multilevel modeling was used to determine the relationships between QoL and neuropsychiatric symptoms (NPS), dementia severity, psychotropic drug use (PDU), dementia subtype, age, and gender. Additional multilevel models were used to compare aspects of QoL between dementia subtypes. Results: Residents' QoL was negatively associated with advanced dementia, PDU, and NPS. In general, the relationships between the determinants and QoL were similar across the dementia subtypes. Aspects of QoL differed by dementia subtype. Residents with frontotemporal dementia showed less negative emotions, accepted more help and experienced better quality of relationships with professional caregivers, had a more positive self-image, felt more comfortable in the nursing home environment, and experienced lower quality of social relationships. Conclusions: Considering the high rates of NPS and PDU in YOD residents and their negative associations with QoL, we recommend emphasizing services to manage and reduce NPS and PDU in nursing home residents with YOD. Furthermore, our findings suggest accounting for differences in aspects of QoL by dementia subtype to address specific needs and thereby improve QoL.

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The Effects of Individualized Music Listening on Affective, Behavioral, Cognitive, and Sundowning Symptoms of Dementia in Long-Term Care Residents

Journal of Aging and Health ◽

10.1177/08982643211033407 ◽

2021 ◽

pp. 089826432110334

Author(s):

Tara T. Lineweaver ◽

Tonya R. Bergeson ◽

Kendall Ladd ◽

Heather Johnson ◽

Donald Braid ◽

...

Keyword(s):

Nursing Home ◽

Neuropsychiatric Symptoms ◽

Nursing Home Residents ◽

Standardized Assessments ◽

Music Listening ◽

Term Care ◽

Positive Effects ◽

Direct Observations ◽

New Applications ◽

Individualized Music

Objectives This study aimed to replicate music’s positive effects on dementia-related symptoms, determine whether a 6-month intervention would lead to greater positive outcomes than typical 3- to 4-month interventions, and examine changes in sundowning symptoms after music listening. Methods 282 nursing home residents with dementia listened to personalized music playlists 1–3 times weekly for 30 minutes across 6 months. Standardized assessments of affect, behavior, and cognition and direct observations of sundowning symptoms comprised the outcomes. Results Results documented significant improvements in residents’ general neuropsychiatric symptoms, agitation, and depression across the first 3 months, but no additional improvements across the subsequent 3 months. Seven sundowning symptoms significantly improved following music listening, with some (e.g., disengagement) being more amenable to music than others (e.g., aggression). Discussion Results support short-term individualized music listening as an effective non-pharmacological approach for improving dementia-related symptoms in nursing home residents and suggest new applications of music-related interventions.

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