scholarly journals Antipsychotic Use in Dementia

2016 ◽  
Vol 62 (3) ◽  
pp. 170-181 ◽  
Author(s):  
Julia Kirkham ◽  
Chelsea Sherman ◽  
Clive Velkers ◽  
Colleen Maxwell ◽  
Sudeep Gill ◽  
...  
Keyword(s):  
Psychiatric Symptoms ◽  
Clinical Care ◽  
Neuropsychiatric Symptoms ◽  
Mental Illnesses ◽  
Educational Outreach ◽  
Term Care ◽  
Inappropriate Use ◽  
Regulatory Changes ◽  
Current Controversy

Antipsychotics are necessary for many older adults to treat major mental illnesses or reduce distressing psychiatric symptoms. Current controversy exists over the role of antipsychotics in the management of neuropsychiatric symptoms (NPS) in persons with dementia. Although some NPS may be appropriately and safely treated with antipsychotics, a fine balance must be achieved between the benefits of these medications, which are often modest, and adverse events, which may have significant consequences. Approximately one-third of all persons with dementia are currently prescribed antipsychotic medications, and there is significant variation in the use of antipsychotics across care settings and providers. Reducing the inappropriate or unnecessary use of antipsychotics among persons with dementia has been the focus of increasing attention owing to better awareness of the potential problems associated with these medications. Several approaches can be used to curb the use of antipsychotics among persons with dementia, including policy or regulatory changes, public reporting, and educational outreach. Recently, there has been encouraging evidence of a downward trend in the use of antipsychotics in many long-term care settings, although prescribing rates are still higher than what is likely optimal. Although reducing the inappropriate use of antipsychotics is a complex task, psychiatrists can play an important role via the provision of clinical care and research evidence, contributing to improved care of persons with dementia in Canada and elsewhere.

The TAPS Project. 3: Predicting the Community Costs of Closing Psychiatric Hospitals

1990 ◽  
Vol 157 (5) ◽  
pp. 661-670 ◽  
Author(s):  
Martin Knapp ◽  
Jeni Beecham ◽  
Jeremy Anderson ◽  
David Dayson ◽  
Julian Leff ◽  
...  
Keyword(s):  
Psychiatric Symptoms ◽  
Hospital Costs ◽  
Psychiatric Hospitals ◽  
Prediction Equation ◽  
Behavioural Problems ◽  
Accurate Information ◽  
Term Care ◽  
Resource Requirements ◽  
Baseline Characteristics

The planning of long-term care in the community as an alternative to in-patient care requires accurate information on the likely expense of altering the balance of provision. Unfortunately, as very few long-stay psychiatric hospitals have yet closed, the planning of these resource requirements has had to proceed in a vacuum. By examining the costs of community reprovision for the first 136 people to leave Claybury and Friern Hospitals, a prediction equation has been estimated from existing data which links the hospital-assessed characteristics (including psychiatric symptoms and behavioural problems) of these people to the subsequent cost of community care. About a third of the observed variation in these costs can be explained statistically by these ‘baseline’ characteristics. However, the first cohorts exhibit fewer behavioural problems and other symptoms of mental illness, they have been in hospital for shorter lengths of time, and they are younger. The prediction equation for the leavers is thus used to extrapolate community costs for those hospital residents yet to leave. It is found that community costs are lower than hospital costs, not just for the first cohorts of leavers, but for the full populations of the two hospitals scheduled to close.

The Practice of Community Psychiatric Nursing and Mental Health Social Work in Salford Some Implications for Community Care

1988 ◽  
Vol 152 (6) ◽  
pp. 783-792 ◽  
Author(s):  
K. Wooff ◽  
D. P. Goldberg ◽  
T. Fryers
Keyword(s):  
Mental Health ◽  
Psychiatric Symptoms ◽  
Psychiatric Patients ◽  
Psychiatric Nurses ◽  
Health Staff ◽  
Mental Health Staff ◽  
Term Care ◽  
Community Psychiatric ◽  
Wide Range

The context and content of work undertaken with individual clients by community psychiatric nurses (CPNs) and mental health social workers (MHSWs) in Salford were found to be significantly different. Although there were some areas of overlap, the ways in which the two professions worked were quite distinct. MHSWs discussed a wide range of topics and were as concerned with clients' interactions with family and community networks as they were with symptoms. Their interviews with schizophrenic clients followed a similar pattern to those with other groups, and they worked closely with psychiatrists and other mental health staff. CPNs, on the other hand, focused mainly on psychiatric symptoms, treatment arrangements, and medications, and spent significantly less time with individual psychotic clients than they did with patients suffering from neuroses. They were as likely to be in contact with general practitioners as they were with psychiatrists, and had fewer contacts with other mental health staff than the MHSWs. There was evidence that the long-term care of chronic psychiatric patients living outside hospital required more co-ordinated long-term multidisciplinary input.

scholarly journals Characteristics Associated with Quality of Life in Long-Term Care Residents with Dementia: A Cross-Sectional Study

2016 ◽  
Vol 42 (3-4) ◽  
pp. 186-197 ◽  
Author(s):  
Maartje S. Klapwijk ◽  
Monique A.A. Caljouw ◽  
Marjoleine J.C. Pieper ◽  
Jenny T. van der Steen ◽  
Wilco P. Achterberg
Keyword(s):  
Quality Of Life ◽  
Social Relations ◽  
Long Term Care ◽  
Neuropsychiatric Symptoms ◽  
Pulmonary Diseases ◽  
Severe Dementia ◽  
Cross Sectional ◽  
Term Care

Background: To determine which characteristics are associated with quality of life (QOL) in residents with moderate to very severe dementia in long-term care facilities (LTCFs). Material and Methods: This was a cross-sectional analysis of a cluster randomized controlled study in 12 Dutch LTCFs that enrolled 288 residents, with moderate to severe dementia assessed with the Reisberg Global Deterioration Scale (Reisberg GDS) and QOL with the QUALIDEM. Characteristics that were hypothesized to be associated with the six domains of QOL (applicable to very severe dementia) included demographic variables, activities of daily living (Katz ADL), cognitive performance (Cognitive Performance Scale; CPS), pain (Pain Assessment Checklist for Seniors with Limited Ability to Communicate; PACSLAC-D), neuropsychiatric symptoms (Neuropsychiatric Inventory-Nursing Home Version; NPI-NH) and comorbidities. Results: Multivariate logistic regression modelling showed associations with age in the domain Social isolation [odds ratio, OR, 0.95 (95% confidence interval, CI, 0.91-0.99)], ADL level in the domain Positive affect [OR 0.89 (95% CI 0.83-0.95)] and the domain Social relations [OR 0.87 (95% CI 0.81-0.93)], severity of dementia in the domain Social relations [OR 0.28 (95% CI 0.12-0.62)] and in the domain Social isolation [OR 2.10 (95% CI 1.17-3.78)], psychiatric disorders in the domain Positive affect [OR 0.39 (95% CI 0.17-0.87)] and pulmonary diseases in the domain Negative affect [OR 0.14 (95% CI 0.03-0.61)] of the QUALIDEM. Neuropsychiatric symptoms were independently associated with all six domains of the QUALIDEM [OR 0.93 (95% CI 0.90-0.96) to OR 0.97 (95% CI 0.95-0.99)]. Pain was associated with the domains Care relationship [OR 0.92 (95% CI 0.84-1.00)] and Negative affect [OR 0.92 (95% CI 0.85-1.00)]. Conclusion: QOL in dementia is independently associated with age, ADL, dementia severity, pain, psychiatric disorders, pulmonary diseases and neuropsychiatric symptoms. It is possible to detect persons with dementia at risk for a lower QOL. This information is important for developing personalized interventions to improve QOL in persons with dementia in LTCFs.

Effect of Relocation on Neuropsychiatric Symptoms in Elderly Adults Living in Long-Term Care

2018 ◽  
Vol 66 (11) ◽  
pp. 2183-2187 ◽  
Author(s):  
Kamal El Haddad ◽  
Philipe de Souto Barreto ◽  
Stephane Gerard ◽  
Aurelie Prouff ◽  
Bruno Vellas ◽  
...  
Keyword(s):  
Long Term Care ◽  
Neuropsychiatric Symptoms ◽  
Elderly Adults ◽  
Term Care

scholarly journals The Impact of the Long-term Care Homes Act and Public Reporting on Physical Restraint and Potentially Inappropriate Antipsychotic Use in Ontario’s Long-term Care Homes

2019 ◽  
Author(s):  
Kevin Walker ◽  
Sara Shearkhani ◽  
Yu Qing Bai ◽  
Katherine S McGilton ◽  
Whitney B Berta ◽  
...  
Keyword(s):  
Long Term Care ◽  
Physical Restraint ◽  
Public Reporting ◽  
Care Homes ◽  
Term Care ◽  
Early Adopters ◽  
Inappropriate Use ◽  
Restraint Use ◽  
The Impact

Abstract Background We report on the impact of two system-level policy interventions (the Long-Term Care Homes Act [LTCHA] and Public Reporting) on publicly reported physical restraint use and non-publicly reported potentially inappropriate use of antipsychotics in Ontario, Canada. Methods We used interrupted time series analysis to model changes in the risk-adjusted use of restraints and antipsychotics before and after implementation of the interventions. Separate analyses were completed for early ([a] volunteered 2010/2011) and late ([b] volunteered March 2012; [c] mandated September 2012) adopting groups of Public Reporting. Outcomes were measured using Resident Assessment Instrument Minimum Data Set (RAI-MDS) data from January 1, 2008 to December 31, 2014. Results For early adopters, enactment of the LTCHA in 2010 was not associated with changes in physical restraint use, while Public Reporting was associated with an increase in the rate (slope) of decline in physical restraint use. By contrast, for the late-adopters of Public Reporting, the LTCHA was associated with significant decreases in physical restraint use over time, but there was no significant increase in the rate of decline associated with Public Reporting. As the LTCHA was enacted, potentially inappropriate use of antipsychotics underwent a rapid short-term increase in the early volunteer group, but, over the longer term, their use decreased for all three groups of homes. Conclusions Public Reporting had the largest impact on voluntary early adopters while legislation and regulations had a more substantive positive effect upon homes that delayed public reporting.

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

Dementia ◽  
2015 ◽  
Vol 16 (6) ◽  
pp. 689-710 ◽  
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.

Management of Neuropsychiatric Symptoms in Long-Term Care Residents with Parkinson’s Disease

Drugs & Aging ◽  
2012 ◽  
Vol 30 (1) ◽  
pp. 19-22 ◽  
Author(s):  
Nathan Herrmann ◽  
Connie Marras ◽  
Hadas D. Fischer ◽  
Xuesong Wang ◽  
Geoff M. Anderson ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Long Term Care ◽  
Neuropsychiatric Symptoms ◽  
Term Care

scholarly journals The Prescription of Drug Ontology 2.0 (PDRO): More Than the Sum of Its Parts

2021 ◽  
Vol 18 (22) ◽  
pp. 12025
Author(s):  
Jean-François Ethier ◽  
François Goyer ◽  
Paul Fabry ◽  
Adrien Barton
Keyword(s):  
Information Integration ◽  
Drug Product ◽  
Medical Outcomes ◽  
Term Care ◽  
Multiple Systems ◽  
Inappropriate Use ◽  
Knowledge Models ◽  
Lack Of Information ◽  
Geographical Scale

While drugs and related products have profoundly changed the lives of people around the world, ongoing challenges remain, including inappropriate use of a drug product. Inappropriate uses can be explained in part by ambiguous or incomplete information, for example, missing reasons for treatments, ambiguous information on how to take a medication, or lack of information on medication-related events outside the health care system. In order to fully assess the situation, data from multiple systems (electronic medical records, pharmacy and radiology information systems, laboratory management systems, etc.) from multiple organizations (outpatient clinics, hospitals, long-term care facilities, laboratories, pharmacies, registries, governments) on a large geographical scale is needed. Formal knowledge models like ontologies can help address such an information integration challenge. Existing approaches like the Observational Medical Outcomes Partnership are discussed and contrasted with the use of ontologies and systems using them for data integration. The PRescription Drug Ontology 2.0 (PDRO 2.0) is then presented and entities that are paramount in addressing this problematic are described. Finally, the benefits of using PDRO are discussed through a series of exemplar situation.

One province, one healthcare system: A decade of healthcare transformation in Alberta

2018 ◽  
Vol 31 (5) ◽  
pp. 167-171 ◽  
Author(s):  
David Veitch
Keyword(s):  
Cost Savings ◽  
Stroke Care ◽  
Term Care ◽  
Inappropriate Use ◽  
System A ◽  
Health Authorities ◽  
Enhance Patient Safety ◽  
Integration Of Services ◽  
Regional Health Authorities

Nearly a decade has passed since Alberta folded nine regional health authorities and three government agencies into one province-wide health system: Alberta Health Services (AHS). Deemed a reckless experiment by some at the time, there is now mounting evidence province-wide integration of services across the healthcare continuum is an enabler of improved quality, safety, and financial sustainability. The article highlights specific examples of how AHS is strengthening partnerships, standardizing best practices, and driving innovation, making Alberta a national and international leader in areas such as stroke care and potentially inappropriate use of antipsychotics in long-term care. It also shows how province-wide integration is being leveraged to build workplace culture, enhance patient safety, and find operational efficiencies that result in cost savings and cost avoidance.

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