Medication Monitoring for People with Dementia in Care Homes: The Feasibility and Clinical Impact of Nurse-Led Monitoring

Objectives. People with dementia are susceptible to adverse effects of medicines. However, they are not always closely monitored. We explored (1) feasibility and (2) clinical impact of nurse-led medication monitoring.Design. Feasibility “before-and-after” intervention study.Setting. Three care homes in Wales.Participants. Eleven service users diagnosed with dementia, taking at least one antipsychotic, antidepressant, or antiepileptic medicine.Intervention. West Wales Adverse Drug Reaction (ADR) Profile for Mental Health Medicines.Outcome Measures. (1) Feasibility: recruitment, retention, and implementation. (2) Clinical impact: previously undocumented problems identified and ameliorated, as recorded in participants’ records before and after introduction of the profile, and one month later.Results. Nurses recruited and retained 11 of 29 eligible service users. The profile took 20–25 minutes to implement, caused no harm, and supplemented usual care. Initially, the profile identified previously undocumented problems for all participants (mean 12.7 (SD 4.7)). One month later, some problems had been ameliorated (mean 4.9 (3.6)). Clinical gains included new prescriptions to manage pain (2 participants), psoriasis (1), Parkinsonian symptoms (1), rash (1), dose reduction of benzodiazepines (1), new care plans for oral hygiene, skin problems, and constipation.Conclusions. Participants benefited from structured nurse-led medication monitoring. Clinical trials of our ADR Profile are feasible and necessary.

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Non-pharmacological interventions in care homes, with particular emphasis on the treatment of people with dementia

Oxford Textbook of Old Age Psychiatry ◽

10.1093/med/9780198807292.003.0019 ◽

2020 ◽

pp. 265-280

Author(s):

Ian A. James ◽

Alan Howarth

Keyword(s):

Psychosocial Interventions ◽

Care Homes ◽

Future Research ◽

Pharmacological Interventions ◽

Cognitive Health ◽

Care Plans ◽

People With Dementia ◽

The Individual ◽

The Uk ◽

Preventative Interventions

In the UK there are over 22,000 care homes, largely run by the private and charitable sectors, caring for 416,000 people. The residents in care homes present with a range of needs linked to physical health, cognitive health, and mental health. A large proportion of residents in care homes have dementia and many of them exhibit Behaviours that Challenge (BtC). This chapter focuses on the non-pharmacological interventions available in care homes to help treat BtC that occur in the context of dementia. It discusses preventative interventions designed to promote the wellbeing of people with dementia, and reviews the evidence. Formulation-led interventions identify the needs of the individual and lead to the development of person-centred care plans and the evidence strongly supports that these are needed to deliver effective psychosocial interventions in care homes. Finally, the chapter discusses the implications for future research.

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Cross-national comparative mixed-methods case study of recovery-focused mental health care planning and co-ordination: Collaborative Care Planning Project (COCAPP)

Health Services and Delivery Research ◽

10.3310/hsdr04050 ◽

2016 ◽

Vol 4 (5) ◽

pp. 1-190 ◽

Cited By ~ 15

Author(s):

Alan Simpson ◽

Ben Hannigan ◽

Michael Coffey ◽

Aled Jones ◽

Sally Barlow ◽

...

Keyword(s):

Mental Health ◽

Health Care ◽

Community Mental Health ◽

Mental Health Care ◽

Risk Assessments ◽

Service Users ◽

Care Planning ◽

Community Mental Health Care ◽

Care Plans ◽

Cross National

BackgroundConcerns about fragmented community mental health care have led to the development of the care programme approach in England and care and treatment planning in Wales. These systems require those people receiving mental health services to have a care co-ordinator, a written care plan and regular reviews of their care. Care planning and co-ordination should be recovery-focused and personalised, with people taking more control over their own support and treatment.Objective(s)We aimed to obtain the views and experiences of various stakeholders involved in community mental health care; to identify factors that facilitated, or acted as barriers to, personalised, collaborative and recovery-focused care planning and co-ordination; and to make suggestions for future research.DesignA cross-national comparative mixed-methods study involving six NHS sites in England and Wales, including a meta-narrative synthesis of relevant policies and literature; a survey of recovery, empowerment and therapeutic relationships in service users (n = 449) and recovery in care co-ordinators (n = 201); embedded case studies involving interviews with service providers, service users and carers (n = 117); and a review of care plans (n = 33).Review methodsA meta-narrative mapping method.ResultsQuantitative and qualitative data were analysed within and across sites using inferential statistics, correlations and the framework method. Our study found significant differences for scores on therapeutic relationships related to positive collaboration and clinician input. We also found significant differences between sites on recovery scores for care co-ordinators related to diversity of treatment options and life goals. This suggests that perceptions relating to how recovery-focused care planning works in practice are variable across sites. Interviews found great variance in the experiences of care planning and the understanding of recovery and personalisation within and across sites, with some differences between England and Wales. Care plans were seen as largely irrelevant by service users, who rarely consulted them. Care co-ordinators saw them as both useful records and also an inflexible administrative burden that restricted time with service users. Service users valued their relationships with care co-ordinators and saw this as being central to their recovery. Carers reported varying levels of involvement in care planning. Risk was a significant concern for workers but this appeared to be rarely discussed with service users, who were often unaware of the content of risk assessments.LimitationsLimitations include a relatively low response rate of between 9% and 19% for the survey and a moderate level of missing data on one measure. For the interviews, there may have been an element of self-selection or inherent biases that were not immediately apparent to the researchers.ConclusionsThe administrative elements of care co-ordination reduce opportunities for recovery-focused and personalised work. There were few shared understandings of recovery, which may limit shared goals. Conversations on risk appeared to be neglected and assessments kept from service users. A reluctance to engage in dialogue about risk management may work against opportunities for positive risk-taking as part of recovery-focused work.Future workResearch should be commissioned to investigate innovative approaches to maximising staff contact time with service users and carers; enabling shared decision-making in risk assessments; and promoting training designed to enable personalised, recovery-focused care co-ordination.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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The impact of the first UK Covid-19 lockdown on carers and people living with low prevalence dementia: results from the Rare Dementia Support survey

10.1101/2020.12.18.20248455 ◽

2020 ◽

Author(s):

Aida Suárez-González ◽

Emma Harding ◽

Nikki Zimmerman ◽

Zoe Hoare ◽

Emilie Brotherhood ◽

...

Keyword(s):

Mental Health ◽

Well Being ◽

Care Homes ◽

Cognitive Symptoms ◽

Family Carers ◽

People With Dementia ◽

The Uk ◽

Low Prevalence ◽

Person With Dementia ◽

The Impact

AbstractIntroductionThe public health measures imposed to contain Covid-19 during the first UK lockdown resulted in significant changes in the provision of community support and care for people with dementia. People with low prevalence and young-onset dementias often experience non-memory, behavioural or neuropsychiatric symptoms that require specialised support.ObjectiveWe explored the impact of the first Covid-19 lockdown on people living with low prevalence and young-onset dementia and their carers in the UK.MethodAn online survey, including eleven questions about the impact of the lockdown on both the person with dementia and their family caregivers was conducted. Participants were people living with dementia and caregivers who are members of the UK national-reach organisation Rare Dementia Support.Results184 carers and 24 people with dementia completed the survey. People with dementia experienced worsening of cognitive symptoms (70%), ability to do things (62%) and well-being (57%) according to their carers. Carers also reported a reduction in the support received for caring (55%). 93% of carers of people living in care homes reported a reduction in their ability to provide care. 26% of carers reported changes in the medication of the person with dementia during the lockdown. 74% of people with dementia reported decreased ability to connect with people socially.ConclusionsPeople with dementia experienced a worsening of dementia symptoms, removal of support and increased difficulty to connect with other people socially during the 1st wave of Covid-19. Carers encountered barriers to both receiving and providing support and a decline in their own mental health and well-being.Key points70 % of carers reported cognitive symptoms getting worse during the lockdown (e.g., the person with dementia being more disoriented and finding it more difficult to communicate).26 % of carers reported a change (initiation or increase) in medication in the person with dementia during the lockdown.79 % carers reported their own physical or mental health getting worse due to the lockdown. This increased to 93% when considering responses only from family carers of people living in care homes.93 % of family carers of people living in care homes found it harder to continue providing care and support for their relative due to Covid-19.

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Micro-skills of group formulations in care settings: Working with expressions of staff distress

Dementia ◽

10.1177/1471301215596495 ◽

2015 ◽

Vol 16 (4) ◽

pp. 523-536

Author(s):

Louisa Jackman ◽

Amy Fielden ◽

Steven Pearson

Keyword(s):

Nursing Care ◽

Group Processes ◽

Care Staff ◽

Care Homes ◽

Care Plans ◽

People With Dementia ◽

Effective Care ◽

Collaborative Working

The help of specialist clinicians is often sought to advise staff in residential and nursing care homes about how to work with people with dementia whose behaviour is challenging. The Newcastle Model ( James, 2011 ) is a framework and a process developed to help care staff understand and improve their care of this group. The model emphasises the use of sharing information with staff to develop effective care plans. In the Shared Formulation Sessions characteristic of the Newcastle Model, clinicians take the role of a group facilitator, helping the staff reach a consensus about what needs to change. These sessions can be difficult to manage as intra and inter-group processes emerge and the group express their anxieties. This paper aims to explore the processes that might be in play Shared Formulation Sessions and to suggest ways in which the facilitator might approach this to manage effective collaborative working.

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The social support, mental health, psychiatric symptoms, and functioning of persons with schizophrenia participating in peer co-delivered vocational rehabilitation: a pilot study in Taiwan

10.21203/rs.3.rs-50709/v1 ◽

2020 ◽

Author(s):

Kan-Yuan Cheng ◽

Chia-Feng Yen

Keyword(s):

Mental Health ◽

Social Support ◽

Vocational Rehabilitation ◽

Psychiatric Symptoms ◽

Service Users ◽

Pilot Program ◽

Western Countries ◽

The Social ◽

Before And After ◽

Persons With Schizophrenia

Abstract Background A consensual understanding of the effect of vocational peer support (VPS) on the functioning of persons with schizophrenia still eludes researchers. There are also few VPS services found in non-Western countries. Hence, a pilot program of peer co-delivered vocational rehabilitation to support persons with schizophrenia in Taiwan was proposed and evaluated. Methods Six peers were trained and were willing to co-lead and assist workplace problem-solving and care skills training in an extended vocational rehabilitation program. A total of 46 persons with schizophrenia participated in such services from August 2017 to December 2018. The social support, mental health, psychiatric symptoms, and functioning of service users were assessed before and after peer co-delivered services, based on the following: Social Support Scale (SSS), Chinese Health Questionnaire-12 (CHQ-12), Brief Psychiatric Rating Scale (BPRS), Global Assessment of Function (GAF), and the Chinese version of the Social Functioning Scale (C-SFS). Results Most service users were middle-aged (49.1 ± 9.8), with 27 being male (58.7%). Forty-two service users who completed the program scored as follows before and after the intervention: 149.1 ± 31.8 vs. 161.2 ± 35.0, df = 41, t = 2.70, p = 0.01 (total SSS), and 44.4 ± 12.0 vs. 53.2 ± 13.2, df = 41, t = 4.72, p < 0.001 (subscale of friend-peer dimension); 69.8 ± 9.8 vs. 72.6 ± 8.8, df = 41, t = 3.50, p = 0.001 (GAF); 75.2 ± 8.8 vs. 78.1 ± 9.5, df = 41, t = 2.59, p = 0.01 (C-SFS); and 37.5 ± 35.5 vs. 43.6 ± 38.0, df = 41, t = 2.57, p = 0.01 (weekly wage). The BPRS-18 score decreased significantly after the intervention (31.2 ± 6.7 vs. 29.3 ± 5.0, df = 41, t = -2.83, p = 0.007). Conclusions Peer co-delivered vocational rehabilitation services can enhance the social support received by persons with schizophrenia and improve their occupational function (as evidenced in the wage increase). The pilot program proposed can thus be a model for non-Western countries with limited resources allocated from the government to support persons with schizophrenia.

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Feasibility study of an optimised person-centred intervention to improve mental health and reduce antipsychotics amongst people with dementia in care homes: study protocol for a randomised controlled trial

Trials ◽

10.1186/1745-6215-14-13 ◽

2013 ◽

Vol 14 (1) ◽

pp. 13 ◽

Cited By ~ 11

Author(s):

Rhiannon Whitaker ◽

Clive Ballard ◽

Jane Stafford ◽

Martin Orrell ◽

Esme Moniz-Cook ◽

...

Keyword(s):

Mental Health ◽

Randomised Controlled Trial ◽

Feasibility Study ◽

Study Protocol ◽

Controlled Trial ◽

Care Homes ◽

People With Dementia ◽

Randomised Controlled

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Nurse-led medicines’ monitoring in care homes study protocol: a process evaluation of the impact and sustainability of the adverse drug reaction (ADRe) profile for mental health medicines

BMJ Open ◽

10.1136/bmjopen-2018-023377 ◽

2018 ◽

Vol 8 (9) ◽

pp. e023377 ◽

Cited By ~ 5

Author(s):

Sue Jordan ◽

Timothy Banner ◽

Marie Gabe-Walters ◽

Jane M Mikhail ◽

Jeff Round ◽

...

Keyword(s):

Mental Health ◽

Adverse Drug Reaction ◽

Drug Reaction ◽

Process Evaluation ◽

Comparative Method ◽

Signs And Symptoms ◽

Care Homes ◽

Routine Practice ◽

Ethical Approval ◽

The Impact

IntroductionImproved medicines’ management could lead to real and sustainable improvements to the care of older adults. The overuse of mental health medicines has featured in many reports, and insufficient patient monitoring has been identified as an important cause of medicine-related harms. Nurse-led monitoring using the structured adverse drug reaction (ADRe) profile identifies and addresses the adverse effects of mental health medicines. Our study investigates clinical impact and what is needed to sustain utilisation in routine practice in care homes.Methods and analysisThis process evaluation will use interviews and observations with the participants of all five homes involved in earlier research, and five newly recruited homes caring for people prescribed mental health medicines. The ADRe profile is implemented by nurses, within existing resources, to check for signs and symptoms of ADRs, initiate amelioration and share findings with pharmacists and prescribers for medication review. Outcome measures are the numbers and nature of problems addressed and understanding of changes needed to optimise clinical gain and sustain implementation. Data will be collected by 30 observations and 30 semistructured interviews. Clinical gains will be described and narrated. Interview analysis will be based on the constant comparative method.Ethics and disseminationEthical approval was conferred by the National Health Service Wales Research Ethics Committee. If the ADRe profile can be sustained in routine practice, it has potential to (1) improve the lives of patients, for example, by reducing pain and sedation, and (2) assist in early identification of problems caused by ADRs. Therefore, in addition to peer-reviewed publications and conferences, we shall communicate our findings to healthcare professionals, policy-makers and sector regulators.Trial registration numberNCT03110471.

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Mental health recovery narratives: their impact on service users and other stakeholder groups

Mental Health and Social Inclusion ◽

10.1108/mhsi-08-2019-0021 ◽

2019 ◽

Vol 23 (4) ◽

pp. 173-184 ◽

Cited By ~ 1

Author(s):

Myra Piat ◽

Jessica Spagnolo ◽

Suzanne Thibodeau-Gervais ◽

Catherine Deschamps ◽

Yves Gosselin

Keyword(s):

Mental Health ◽

Mental Health Recovery ◽

Service Users ◽

Cross Sectional ◽

Content Type ◽

Positive Effects ◽

Stakeholder Groups ◽

Before And After ◽

Recovery Narratives ◽

The Impact

Purpose The purpose of this paper is twofold: first, assess the effects of the peers’ recovery narratives on service users’ perceived mental health recovery; and second, explore various stakeholders’ perspectives on the program, specifically its facilitators and barriers. Design/methodology/approach The study used a convergent mixed-method design. First, a pre-test post-test design was used with service users to evaluate the peer recovery narrative program. They completed the Recovery Assessment Scale (RAS) and participated in qualitative interviews that explored perspectives on their mental health recovery before and after the program. Second, a cross-sectional design was used to explore stakeholder groups’ perspectives on the recovery narrative program immediately after listening to the narratives. Findings While findings show that there was no statistical difference between scores on the RAS before and after the peer narratives, thematic analysis revealed a change in service users’ understanding of recovery post-narratives. Other stakeholder groups confirmed this change. However, some healthcare professionals questioned the universal positive effects of the peer recovery narrative program on service users. Stakeholders agreed that beyond effects of the peer recovery narrative program on service users, there were also positive effects among the peers themselves. Originality/value To the authors’ knowledge, this is the first Canadian study, and one of the first studies to rely on mixed-methods and various stakeholder groups to evaluate the impact of peer recovery narratives on service users. The research, thus, fills a knowledge gap on peer recovery narratives.

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