scholarly journals 422 - Evaluating the Clinical Impact of National Dementia Behavior Support Programs on Neuropsychiatric Outcomes in Australia

2021 ◽  
Vol 33 (S1) ◽  
pp. 44-44
Author(s):  
Atee M ◽  
Macfarlane S ◽  
Morris T ◽  
Whiting D ◽  
Healy M ◽  
...  
Keyword(s):  
Behavior Management ◽  
Psychological Symptoms ◽  
Neuropsychiatric Symptoms ◽  
Psychosocial Interventions ◽  
Aged Care ◽  
Support Programs ◽  
Residential Aged Care ◽  
Behavior Support ◽  
Average Case ◽  
The Mean

Background:People living with dementia (PLWD) in residential aged care homes (RACHs) are frequently prescribed psychotropic medications due to the high prevalence of neuropsychiatric symptoms, also known as behaviors and psychological symptoms of dementia (BPSD). However, the gold standard to support BPSD is using psychosocial/non-pharmacological therapies.Objective:This study aims to describe and evaluate services and neuropsychiatric outcomes associated with the provision of psychosocial person-centered care interventions delivered by national multidisciplinary dementia-specific behavior support programs.Methods:A 2-year retrospective pre-post study with a single-arm analysis was conducted on BPSD referrals received from Australian RACHs to the two Dementia Support Australia (DSA) programs, the Dementia Behavior Management Advisory Service (DBMAS) and the Severe Behavior Response Teams (SBRT). Neuropsychiatric outcomes were measured using the Neuropsychiatric Inventory (NPI) total scores and total distress scores. The questionnaire version “NPI-Q” was administered for DBMAS referrals whereas the nursing home version “NPI-NH” was administered for SBRT referrals. Linear mixed effects models were used for analysis, with time, baseline score, age, sex, and case length as predictors. Clinical significance was measured using Cohen’s effect size (d; ≥0.3), the mean change score (MCS; 3 points for the NPI-Q and 4 points for the NPI-NH) and the mean percent change (MPC; ≥30%) in NPI parameters.Results:A total of 5,914 referrals (55.9% female, age 82.3 ± 8.6 y) from 1,996 RACHs were eligible for analysis. The most common types of dementia were Alzheimer’s disease (37.4%) and vascular dementia (11.7%). The average case length in DSA programs was 57.2 ± 26.3 days. The NPI scores were significantly reduced as a result of DSA programs, independent of covariates. There were significant reductions in total NPI scores as a result of the DBMAS (61.4%) and SBRT (74.3%) programs. For NPI distress scores, there were 66.5% and 69.1% reductions from baseline for the DBMAS and SBRT programs, respectively. All metrics (d, MCS, MPC) were above the threshold set for determining a clinically significant effect.Conclusions:Multimodal psychosocial interventions delivered by DSA programs are clinically effective as demonstrated by positive referral outcomes, such as improved BPSD and related caregiver distress.Word count:350 words

scholarly journals Evaluating the Clinical Impact of National Dementia Behaviour Support Programs on Neuropsychiatric Outcomes in Australia

2021 ◽  
Vol 12 ◽  
Author(s):  
Stephen Macfarlane ◽  
Mustafa Atee ◽  
Thomas Morris ◽  
Daniel Whiting ◽  
Madeleine Healy ◽  
...  
Keyword(s):  
Psychological Symptoms ◽  
Neuropsychiatric Symptoms ◽  
Psychosocial Interventions ◽  
Change Score ◽  
Aged Care ◽  
Support Programs ◽  
Residential Aged Care ◽  
Average Case ◽  
Questionnaire Version ◽  
The Mean

Background/Objective: People living with dementia (PLWD) in residential aged care homes (RACHs) are frequently prescribed psychotropic medications due to the high prevalence of neuropsychiatric symptoms, also known as behaviours and psychological symptoms of dementia (BPSD). However, the gold standard to support BPSD is using psychosocial/non-pharmacological therapies. This study aims to describe and evaluate services and neuropsychiatric outcomes associated with the provision of psychosocial person-centred care interventions delivered by national multidisciplinary dementia-specific behaviour support programs.Methods: A 2-year retrospective pre-post study with a single-arm analysis was conducted on BPSD referrals received from Australian RACHs to the two Dementia Support Australia (DSA) programs, the Dementia Behaviour Management Advisory Service (DBMAS) and the Severe Behaviour Response Teams (SBRT). Neuropsychiatric outcomes were measured using the Neuropsychiatric Inventory (NPI) total scores and total distress scores. The questionnaire version “NPI-Q” was administered for DBMAS referrals whereas the nursing home version “NPI-NH” was administered for SBRT referrals. Linear mixed effects models were used for analysis, with time, baseline score, age, sex, and case length as predictors. Clinical significance was measured using Cohen's effect size (d; ≥0.3), the mean change score (MCS; 3 points for the NPI-Q and 4 points for the NPI-NH) and the mean percent change (MPC; ≥30%) in NPI parameters.Results: A total of 5,914 referrals (55.9% female, age 82.3 ± 8.6 y) from 1,996 RACHs were eligible for analysis. The most common types of dementia were Alzheimer's disease (37.4%) and vascular dementia (11.7%). The average case length in DSA programs was 57.2 ± 26.3 days. The NPI scores were significantly reduced as a result of DSA programs, independent of covariates. There were significant reductions in total NPI scores as a result of the DBMAS (61.4%) and SBRT (74.3%) programs. For NPI distress scores, there were 66.5% and 69.1% reductions from baseline for the DBMAS and SBRT programs, respectively. All metrics (d, MCS, MPC) were above the threshold set for determining a clinically significant effect.Conclusions: Multimodal psychosocial interventions delivered by DSA programs are clinically effective as demonstrated by positive referral outcomes, such as improved BPSD and related caregiver distress.

Animal-assisted therapy for dementia: a review of the literature

2006 ◽  
Vol 18 (4) ◽  
pp. 597-611 ◽  
Author(s):  
Susan L. Filan ◽  
Robert H. Llewellyn-Jones
Keyword(s):  
Psychological Symptoms ◽  
Preliminary Evidence ◽  
Aged Care ◽  
Animal Assisted Therapy ◽  
Residential Aged Care ◽  
Pet Dogs ◽  
People With Dementia ◽  
Aged Care Facilities ◽  
Residential Aged Care Facilities ◽  
Potential Benefits

Background: Animal-assisted therapy (AAT) is gaining popularity as part of therapy programs in residential aged care facilities. Humans and pet dogs respond to quiet interaction with a lowering of blood pressure and an increase in neuroche-micals associated with relaxation and bonding. These effects may be of benefit in ameliorating behavioral and psychological symptoms of dementia (BPSD).Methods: Medline, PsychInfo and CINAHL databases (1960–2005) were searched for papers on AAT or pets and dementia. Publications of controlled trials that measured the effect of AAT for dementia were reviewed.Results: Several small studies suggest that the presence of a dog reduces aggression and agitation, as well as promoting social behavior in people with dementia. One study has shown that aquaria in dining rooms of dementia care units stimulate residents to eat more of their meals and to gain weight but is limited by the small number of facilities studied. There is preliminary evidence that robotic pets may provide pleasure and interest to people with dementia.Conclusions: Current literature suggests that AAT may ameliorate BPSD, but the duration of the beneficial effect has not been explored. The relative benefits of “resident” versus “visiting” pet dogs are unclear and are confounded by the positive effect of pet interaction on staff or caregivers. Further research on the potential benefits of AAT is recommended.

Investigating the current methods of assessing behavioral and psychological symptoms in residential aged care facilities in a metropolitan city

2016 ◽  
Vol 29 (5) ◽  
pp. 855-858 ◽  
Author(s):  
Samantha M. Loi ◽  
Nicola T. Lautenschlager
Keyword(s):  
Psychological Symptoms ◽  
Aged Care ◽  
Assessment Tools ◽  
Residential Aged Care ◽  
Convenience Sample ◽  
Major Barrier ◽  
Care Facilities ◽  
Aged Care Facilities ◽  
Residential Aged Care Facilities ◽  
Behavioral And Psychological Symptoms

ABSTRACTUp to 90% of people with dementia living in residential aged care facilities (RACFs) display behavioral and psychological symptoms of dementia (BPSD), and these are associated with poorer quality of life and increased morbidity and mortality. In order to implement appropriate interventions, it is important to understand the symptoms in more detail. Despite the availability of BPSD assessment tools, it is unknown what the current practice of monitoring of BPSD in RACFs. We sought to investigate the current BPSD assessment tools being used in RACFs and explore different stakeholders’ views on current practices. A cross-sectional convenience sample of 21 clinicians were identified and administered a questionnaire.Old age psychiatrists, aged psychiatry clinicians, behavior management teams and RACF staff completed the questionnaires. Clinicians reported that objective consistent information about BPSD were important for recommending and implementing pharmacological and non-pharmacological strategies for BPSD; however, the use of validated BPSD assessments in RACFs was not a usual part of clinical practice. RACF staff stated the major barrier to assessment of BPSD was lack of time. Alternate methods of assessing BPSD which consider preferences from clinicians and RACF staff should be further investigated. Modern technology which can allow “real time” assessment may be a solution.

The use of antipsychotics among people treated with medications for dementia in residential aged care facilities

2016 ◽  
Vol 28 (6) ◽  
pp. 977-982 ◽  
Author(s):  
Hee-Young Shin ◽  
Svetla Gadzhanova ◽  
Elizabeth E. Roughead ◽  
Michael B. Ward ◽  
Lisa G. Pont
Keyword(s):  
Psychological Symptoms ◽  
Antipsychotic Agent ◽  
Antipsychotic Agents ◽  
Aged Care ◽  
Residential Aged Care ◽  
Concurrent Use ◽  
Care Facilities ◽  
Aged Care Facilities ◽  
Residential Aged Care Facilities ◽  
Unit Dose

ABSTRACTBackground:Antipsychotic agents have limited efficacy for Behavioral and Psychological Symptoms of Dementia (BPSD) and there are concerns about their safety. Despite this, they are frequently used for the management of BPSD. This study aimed to assess the use of antipsychotics among people on anti-dementia medicines in Australian residential aged care facilities.Methods:Data were obtained from an individual patient unit dose packaging database covering 40 residential aged care facilities in New South Wales, Australia. Residents supplied an anti-dementia medicine between July 2008 and June 2013 were included. Prevalence of concurrent antipsychotic use was established. Incident antipsychotic users between January 2009 and December 2011 were identified. We examined initial antipsychotic dose, maximum titrated doses, type and duration of antipsychotic use, and compared use with Australian guidelines.Results:There were 291 residents treated with anti-dementia medicines, 129 (44%) of whom received antipsychotics concomitantly with an anti-dementia medicine. Among the 59 incident antipsychotic users, risperidone (73%) was the most commonly used antipsychotic agent. Amongst the risperidone initiators, 43% of patients had initial doses greater than 0.5 mg/day and 6% of patients exceeded 2.0 mg/day for their maximum dose. 53% of concomitant users received daily treatment for greater than six months.Conclusions:Our study using records of individual patient unit dose supply, which represents the intended medication consumption schedule, shows high rates of concurrent use of antipsychotics and anti-dementia medicines and long durations of use. The use of antipsychotics in patients with dementia needs to be carefully monitored to improve patient outcomes.

scholarly journals An audit of the use of psychotropic medications over the course of admission to a specialist dementia ward

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S350-S351
Author(s):  
Sukhmeet Singh ◽  
Margaret Papworth ◽  
Concha Turrion ◽  
Shamim Ruhi
Keyword(s):  
Psychological Symptoms ◽  
Occupational Therapists ◽  
Psychosocial Interventions ◽  
Psychotropic Medications ◽  
Clinical Psychologist ◽  
First Line ◽  
Nice Guidelines ◽  
Medicines Reconciliation ◽  
The Mean ◽  
Audit Project

AimsThe aim of this audit project was to establish the practices in prescribing and de-prescribing of psychotropic medications for patients on a specialist dementia ward.BackgroundThere is a great deal of evidence demonstration high rates of polypharmacy, defined as ≥5 drugs, in older adults in general and in those with dementia more specifically. NICE guidelines recommend a structured assessment of a patient with dementia to exclude other potential causes, e.g. pain or delirium. Psychosocial interventions are recommended as first line. Antipsychotics should only be offered second line who present a risk to themselves or others. These should only be used for the shortest time possible and reassessed at least every 6 weeks.MethodData were collected for patients (n = 20) discharged from a specialist dementia ward between September 2018 and March 2019. The unit has 14 beds caring for patients with predominantly severe behavioural and psychological symptoms associated with dementia (BPSD). The team is comprised of doctors, nurses, a clinical psychologist, occupational therapists, physiotherapists and pharmacists who meet twice a week to review patients. Data were coded by drug class and counts of medication on admission, at the midpoint and at discharge were conducted. Antipsychotic and benzodiazepine dosages were converted into haloperidol and diazepam equivalence.ResultOf the 20 patients, 70% were male and 30% female. 95% of the patient (n = 19) were admitted under the Mental Health Act (1983). 20% were managed on 1 to 1 observations and 80% were on 15 min observations. In general, the results show little change in the overall rate of psychotropic prescribing. The mean number of psychotropic medications prescribed per patient on admission was 2.30, at the mid-point of admission it was 2.30 and at discharge it was 2.05. Mean benzodiazepine dosage in diazepam equivalence reduced between admission and discharge from 3.20 mg to 2.10 mg. Mean haloperidol equivalent dosages increased at the midpoint of admission from 1.11 mg to 2.27 mg before reducing to 0.78 mg at discharge.ConclusionThe results demonstrate minimal change in the overall average number and composition of drugs prescribed. There are differences in the use of regular antipsychotics and benzodiazepines between admission and discharge which are consistent with NICE guidelines. Patients had a structured assessment with regular medicines reconciliation supervised by the team pharmacist. Therefore, the ward environment did allow for detailed discussions about de-prescribing which may not be the case elsewhere.

scholarly journals The need for holistic management of behavioral disturbances in dementia

2017 ◽  
Vol 29 (7) ◽  
pp. 1055-1058 ◽  
Author(s):  
Stephen Macfarlane ◽  
Colm Cunningham
Keyword(s):  
Cause Of Death ◽  
Psychological Symptoms ◽  
Aged Care ◽  
World Health ◽  
Residential Aged Care ◽  
Behavioral Disturbances ◽  
Holistic Management ◽  
Aged Care Facilities ◽  
Residential Aged Care Facilities ◽  
Health Organization

Dementia is now the leading cause of admission to residential aged care facilities (RACF) in the developed world (Van Rensbergen and Nawrot, 2010), with prevalence rates among residents estimated to be approximately 70% (Zimmermanet al., 2014). In addition, dementia is now the 4th leading cause of death in high-income countries with this expected to rise to the 3rd leading cause of death by 2030 (World health Organization, 2015). Despite the prevalence of the condition, the amount of teaching time devoted to dementia in medical school curricula remains low and does not adequately prepare graduates for their work as doctors (Tullo and Allan, 2011; Tullo and Gordon, 2013). As a consequence, many general practitioners feel their level of confidence in managing behavioral and psychological symptoms of dementia (BPSD) is very low (Buhagiaret al., 2011).

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