A Randomized Trial of Dementia Care in Nursing Homes

Rovner, Barry W.; Steele, Cynthia D.; Shmuely, Yochi; Folstein, Marshal F.

doi:10.1111/j.1532-5415.1996.tb05631.x

Cited by 189 publications

(172 citation statements)

References 29 publications

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“…In light of the known side-effects and rather serious risks associated with antipsychotic drug use (Brodaty et al, 2003;Katz, 2004), this is an important ethical question, especially because there are alternative ways of managing the behavioral disturbances that might occur in dementia. Non-pharmacological approaches have been used successfully to reduce behavioral disturbances (Rovner et al, 1996;Sloane et al, 2004). Furthermore, most studies proving the effectiveness of antipsychotics have been performed over shorter periods of time, while studies lasting over a whole year (Ballard et al, 2001) and discontinuation studies Thapa et al, 1994) have found no benefits from ongoing antipsychotic medication for a majority of patients.…”

Section: Discussionmentioning

confidence: 99%

Relationship between antipsychotic drug use and behavioral and psychological symptoms of dementia in old people with cognitive impairment living in geriatric care

Lövheim

Sandman

Kallin

et al. 2006

Int. Psychogeriatr.

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Relationship between antipsychotic drug use and behavioral and psychological symptoms of dementia in old people with cognitive impairment living in geriatric care.. International psychogeriatrics, ABSTRACTBackground: Behavioral and psychological symptoms of dementia (BPSD) commonly occur among cognitively impaired people in geriatric care. BPSD are often managed with antipsychotic drugs, despite the associated serious health risks. The aim of the present study was to discover factors associated with the use of antipsychotics.

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Section: Discussionmentioning

confidence: 99%

Relationship between antipsychotic drug use and behavioral and psychological symptoms of dementia in old people with cognitive impairment living in geriatric care

Lövheim

Sandman

Kallin

et al. 2006

Int. Psychogeriatr.

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“…Although the limited evidence of efficacy does limit the potential value of quetiapine, this is probably helpful in indicating that atypical agents have a less detrimental impact on quality of life than typical antipsychotics. Important studies have highlighted the potential of specific non-pharmacological intervention programs to improve key outcomes such as the use of unnecessary antipsychotic drugs (Rovner et al 1996;Fossey et al, 2006), mood (Teri et al, 1997;2003) and behavioral symptoms (Cohen-Mansfield et al, 2007) with person-centered training for care staff, or structured approaches such as exercise, social interaction, pleasant events or assessment of needs, but disappointingly few studies have directly evaluated the impact of these interventions on quality of life directly, or the impact of stopping antipsychotics on quality of life amongst care home residents with dementia. The Focused Intervention Training and Support (FITS) study, in a cluster randomized trial, demonstrated the capacity of a training program focused on person-centered care to significantly reduce the use of antipsychotic drugs in care homes (Fossey et al, 2006).…”

Section: Antipsychotics and Quality Of Lifementioning

confidence: 99%

TOP CITED PAPERS IN INTERNATIONAL PSYCHOGERIATRICS: 6a. QUALITY OF LIFE FOR PEOPLE WITH DEMENTIA LIVING IN RESIDENTIAL AND NURSING HOME CARE: THE IMPACT OF PERFORMANCE ON ACTIVITIES OF DAILY LIVING, BEHAVIORAL AND PSYCHOLOGICAL SYMPTOMS, LANGUAGE SKILLS, AND PSYCHOTROPIC DRUGS

Ballard

Margallo-Lana

O’Brien

et al. 2009

Int. Psychogeriatr.

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The majority of people with dementia develop behavioral and psychological symptoms of dementia (BPSD) at some point during their illness (Jeste et al., 2008). These symptoms, which are especially common among care home residents, are frequently distressing for the patients who experience them (Gilley et al., 2006; Jeste et al., 2008) and problematic for their professional and/or family caregivers. The starting point for our paper “Quality of life for people with dementia living in residential and nursing home care: the impact of performance on activities of daily living, behavioral and psychological symptoms, language skills, and psychotropic drugs” (Ballard et al., 2001) was to try and understand the impact of BPSD, function and language skills on quality of life in care home residents with dementia. Although there were frequent statements in previous work referring to the capacity of psychiatric and behavioral symptoms to reduce quality of life, we had been unable to identify any empirical evidence to support this clinical impression in a thorough literature review. The parallel validation of Dementia Care Mapping (DCM), predominantly a practice development tool, as an observational measure of well-being/quality of life (Kitwood and Bredin, 1997; Fossey et al., 2002) provided an excellent opportunity to examine this issue in a care home setting. The study focused on 209 people with dementia living in residential and nursing home care in north-east England in the U.K., who received a detailed assessment of BPSD, function and cognition. A DCM evaluation was completed for 112 of these individuals, providing a detailed observational measure of well-being, activities and social withdrawal as indices of quality of life over a six-hour daytime period. To our surprise, there was actually no association between well-being, social withdrawal or activities and BPSD. In contrast, there was a significant association between antipsychotic medication and reduced well-being, social withdrawal and activities respectively, even after controlling for the severity of behavioral disturbance. Using an arbitrary definition of “ill-being”, defined as a well-being score of less than zero, 5% of people not taking antipsychotics, 10% of people taking atypical antipsychotics and 22% of people taking typical antipsychotics were defined as having ill-being. Lower levels of functional ability were also associated with significantly lower well-being, less activities and more social withdrawal. At first this latter finding appears to be contrary to one of the central principles of DCM – namely, that the assessment should be independent of dementia severity. Although high levels of well-being and engagement are possible for people with severe dementia, this probably requires higher staff numbers and a workforce with more specialized skills in order to achieve this.

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“…While subjects in both groups received psychotropics, controls were more than twice as likely to receive antipsychotics or be physically restrained compared with subjects in the treatment group. 48 Changes to the level of stimulation can have varying effects on patients with dementia and disturbed behaviour. While studies examining methods to increase stimulation by use of activity groups, exercise and social interaction have demonstrated positive results, 43,48 other studies suggest reduced stimulation may decrease agitation and other problematic behaviours.…”

Section: The Canadian Journal Of Neurological Sciencesmentioning

confidence: 99%

“…48 Changes to the level of stimulation can have varying effects on patients with dementia and disturbed behaviour. While studies examining methods to increase stimulation by use of activity groups, exercise and social interaction have demonstrated positive results, 43,48 other studies suggest reduced stimulation may decrease agitation and other problematic behaviours. 49 Increasing the level of stimulation may occasionally have adverse effects.…”

Section: The Canadian Journal Of Neurological Sciencesmentioning

confidence: 99%

Recommendations for the Management of Behavioral and Psychological Symptoms of Dementia

Herrmann

2001

Can. J. Neurol. Sci.

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Suppl. 1 -S96 serious problem that they encountered, rating it more frequently as a serious problem than the memory disturbance itself. The significance of BPSD was recently endorsed by both the United States A l z h e i m e r's A s s o c i a t i o n 6 and the International Psychogeriatric Association 1 as research priorities. The phenomenology and prevalence of BPSD have beenThe behavioral and psychological symptoms of dementia (BPSD) include delusions, hallucinations, misidentifications, agitation, wandering, pacing, restlessness, disinhibition, apathy, negativism, emotional lability, depression, anxiety, sleep disturbance and sexually inappropriate behaviours.1 While not included as diagnostic criteria for dementia by DSM-IV 2 or the NINCDS-ADRDA, 3 behaviours such as paranoia, depression, euphoria and apathy were recognized by Alzheimer in the initial description of the illness that bears his name. 4 Historically, the focus on BPSD began only recently, prompted by an early study by Rabins et al,5 who interviewed caregivers of patients with dementia. While these behaviours were noted in 50-90% of patients, caregivers considered physical aggression the most ABSTRACT: Background: The behavioral and psychological symptoms of dementia (BPSD) are common, serious problems that impair the quality of life for both patient and caregiver. In order to provide recommendations based upon the best available evidence, a qualitative literature review was performed. Methods: A search of the English language medical literature published between 1966 and 2000 was performed. The quality of the studies was assessed by considering the subjects, trial design, analysis and results. Final recommendations were based upon the quality of available evidence. Results: The management of BPSD begins with a thorough assessment to search for underlying causes of behaviour change. Concomitant medical illness should be treated and sensory impairment ameliorated. Nonpharmacological approaches should be instituted prior to medication use. These interventions include music, light, changes in level of stimulation and specific behavioral techniques. Antipsychotics are the best studied pharmacological intervention for agitation and aggression and have demonstrated modest but consistent efficacy. Antidepressants such as trazodone and selective serotonin re-uptake inhibitors, as well as anticonvulsants such as carbamazepine and valproic acid have also demonstrated efficacy. Benzodiazepines can be used for short-term treatment as p.r.n. agents when necessary. Pharmacotherapy must be monitored closely for both effectiveness and side effects, with consideration of medication withdrawal when appropriate. Conclusion: The management of BPSD can significantly improve the quality of life for the patient and caregiver. Their assessment and management are essential components of the treatment of dementia.RÉSUMÉ: Recommandations pour la prise en charge des symptômes comportementaux et psychologiques de la démence. Introduction: L e s symptômes comportementaux et ...

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A Randomized Trial of Dementia Care in Nursing Homes

Abstract: The A.G.E. program reduces the prevalence of behavior disorders and the use of antipsychotic drugs and restraints. It is practical, feasible, and appears to improve the lives of patients with dementia in nursing homes.

Cited by 189 publications

References 29 publications

Relationship between antipsychotic drug use and behavioral and psychological symptoms of dementia in old people with cognitive impairment living in geriatric care

Relationship between antipsychotic drug use and behavioral and psychological symptoms of dementia in old people with cognitive impairment living in geriatric care

TOP CITED PAPERS IN INTERNATIONAL PSYCHOGERIATRICS: 6a. QUALITY OF LIFE FOR PEOPLE WITH DEMENTIA LIVING IN RESIDENTIAL AND NURSING HOME CARE: THE IMPACT OF PERFORMANCE ON ACTIVITIES OF DAILY LIVING, BEHAVIORAL AND PSYCHOLOGICAL SYMPTOMS, LANGUAGE SKILLS, AND PSYCHOTROPIC DRUGS

Recommendations for the Management of Behavioral and Psychological Symptoms of Dementia

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