Advances in the treatment of psychiatric disorders in long-term care homes

Conn, David; Seitz, Dallas

doi:10.1097/yco.0b013e32833efe56

Cited by 20 publications

(19 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Although the proportion of teams providing some form of education or training to care home staff was higher than previously reported (Challis et al ., ; Tucker et al ., ), a systematic literature review found many such initiatives are piecemeal and arbitrary (Nolan et al ., ). Furthermore, although research indicates that extensive interventions with ongoing support can lead to the sustained implementation of new knowledge, there is little or no evidence for the efficacy of simpler, less intensive interventions (Moniz‐Cook, ; Moniz‐Cook et al ., ; Conn and Seitz, ). Meanwhile, other structured arrangements for detecting mental illness or supporting care home staff remained relatively uncommon, which, given CMHTs' concerns about existing capacity, and the number of teams that carried vacancies, raises questions about whether the necessary staff are available.…”

Section: Discussionmentioning

confidence: 99%

All things to all people? The provision of outreach by community mental health teams for older people in England: findings from a national survey

Tucker

Wilberforce

Brand

et al. 2013

Int J Geriat Psychiatry

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 99%

All things to all people? The provision of outreach by community mental health teams for older people in England: findings from a national survey

Tucker

Wilberforce

Brand

et al. 2013

Int J Geriat Psychiatry

View full text Add to dashboard Cite

show abstract

“…The selection process for studies is summarised in Figure 1. Further details of the Namaste Care studies are listed in additional file 3 of Bunn et al 32 With respect to research design, the 86 papers reported: l 17 evidence reviews (not Namaste Care) [51][52][53][54][55][56][57][58][59][60][61][62][63][64][65][66][67][68] l 59 papers reporting 51 primary studies (not Namaste Care) l 10 papers reporting 8 Namaste Care studies. 22,27,29,[44][45][46][47][48]50,130 REALIST REVIEW OF NAMASTE CARE AND OTHER MULTISENSORY INTERVENTIONS NIHR Journals Library www.journalslibrary.nihr.ac.uk…”

Section: Phasementioning

confidence: 99%

A group intervention to improve quality of life for people with advanced dementia living in care homes: the Namaste feasibility cluster RCT

Froggatt

Best

Bunn

et al. 2020

Health Technol Assess

View full text Add to dashboard Cite

Background People with advanced dementia who live and die in nursing homes experience variable quality of life, care and dying. There is a need to identify appropriate, cost-effective interventions that facilitate high-quality end-of-life care provision. Objectives To establish the feasibility and acceptability to staff and family of conducting a cluster randomised controlled trial of the Namaste Care intervention for people with advanced dementia in nursing homes. Design The study had three phases: (1) realist review and (2) intervention refinement to inform the design of (3) a feasibility cluster randomised controlled trial with a process evaluation and economic analysis. Clusters (nursing homes) were randomised in a 3 : 1 ratio to intervention or control (usual care). The nature of the intervention meant that blinding was not possible. Setting Nursing homes in England providing care for people with dementia. Participants Residents with advanced dementia (assessed as having a Functional Assessment Staging Test score of 6 or 7), their informal carers and nursing home staff. Intervention Namaste Care is a complex group intervention that provides structured personalised care in a dedicated space, focusing on enhancements to the physical environment, comfort management and sensory engagement. Main outcome measures The two contender primary outcome measures were Comfort Assessment in Dying – End of Life Care in Dementia for quality of dying (dementia) and Quality of Life in Late Stage Dementia for quality of life. The secondary outcomes were as follows: person with dementia, sleep/activity (actigraphy), neuropsychiatric symptoms, agitation and pain; informal carers, satisfaction with care at the end of life; staff members, person-centred care assessment, satisfaction with care at the end of life and readiness for change; and other data – health economic outcomes, medication/service use and intervention activity. Results Phase 1 (realist review; 86 papers) identified that a key intervention component was the activities enabling the development of moments of connection. In phase 2, refinement of the intervention enabled the production of a user-friendly 16-page A4 booklet. In phase 3, eight nursing homes were recruited. Two homes withdrew before the intervention commenced; four intervention and two control homes completed the study. Residents with advanced dementia (n = 32) were recruited in intervention (n = 18) and control (n = 14) homes. Informal carers (total, n = 12: intervention, n = 5; control, n = 7) and 97 staff from eight sites (intervention, n = 75; control, n = 22) were recruited over a 6-month period. Recruitment is feasible. Completion rates of the primary outcome questionnaires were high at baseline (100%) and at 4 weeks (96.8%). The Quality of Life in Late Stage Dementia was more responsive to change over 24 weeks. Even where economic data were missing, these could be collected in a full trial. The intervention was acceptable; the dose varied depending on the staffing and physical environment of each care home. Staff and informal carers reported changes for the person with dementia in two ways: increased social engagement and greater calm. No adverse events related to the intervention were reported. Conclusions A subsequent definitive trial is feasible if there are amendments to the recruitment process, outcome measure choice and intervention specification. Future work In a full trial, consideration is needed of the appropriate outcome measure that is sensitive to different participant responses, and of clear implementation principles for this person-centred intervention in a nursing home context. Trial registration Current Controlled Trials ISRCTN14948133. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 6. See the NIHR Journals Library website for further project information.

show abstract

“…Although there are previous reviews on the use of psychotropic medications for the management of NPS (Schneider et al ., 1990; 2006a; Borson and Raskind, 1997; Lanctot et al ., 1998; Sutor et al ., 2001; Kindermann et al ., 2002; Snowden et al ., 2003; Alexopoulos et al ., 2005; Bharani and Snowden, 2005; Sink et al ., 2005; Ballard and Howard, 2006; Kozman et al ., 2006; Herrmann and Lanctot, 2007; Konavalov et al ., 2007; Saddichha and Pandey, 2008; Ballard et al ., 2009a; 2009b; Conn and Seitz, 2010; Gauthier et al ., 2010), few have focused exclusively on studies conducted in LTC settings (Snowden et al ., 2003; Bharani and Snowden, 2005). Residents of LTC facilities with dementia may be particularly susceptible to adverse events associated with psychotropics when compared with community or hospital-based populations.…”

Section: Introductionmentioning

confidence: 99%

Pharmacological treatments for neuropsychiatric symptoms of dementia in long-term care: a systematic review

Seitz

Gill

Herrmann

et al. 2012

Int. Psychogeriatr.

109

View full text Add to dashboard Cite

Background: Medications are frequently prescribed for neuropsychiatric symptoms (NPS) associated with dementia, although information on the efficacy and safety of medications for NPS specifically in long-term care (LTC) settings is limited. The objective of this study was to provide a current review of the efficacy and safety of pharmacological treatments for NPS in LTC.Methods: We searched MEDLINE, EMBASE, PsychINFO, and the Cochrane Library for randomized controlled trials comparing medications with either placebo or other interventions in LTC. Study quality was described using the Cochrane collaboration risk of bias tool. The efficacy of medications was evaluated using NPS symptom rating scales. Safety was evaluated through rates of trial withdrawals, trial withdrawals due to adverse events, and mortality.Results: A total of 29 studies met inclusion criteria. The most common medications evaluated in studies were atypical antipsychotics (N = 15), typical antipsychotics (N = 7), anticonvulsants (N = 4), and cholinesterase inhibitors (N = 3). Statistically significant improvements in NPS were noted in some studies evaluating risperidone, olanzapine, and single studies of aripiprazole, carbamazepine, estrogen, cyproterone, propranolol, and prazosin. Study quality was difficult to rate in many cases due to incomplete reporting of details. Some studies reported higher rates of trial withdrawals, adverse events, and mortality associated with medications.Conclusions: We conclude that there is limited evidence to support the use of some atypical antipsychotics and other medications for NPS in LTC populations. However, the generally modest efficacy and risks of adverse events highlight the need for the development of safe and effective pharmacological and non-pharmacological interventions for this population.

show abstract

Advances in the treatment of psychiatric disorders in long-term care homes

Cited by 20 publications

References 26 publications

All things to all people? The provision of outreach by community mental health teams for older people in England: findings from a national survey

All things to all people? The provision of outreach by community mental health teams for older people in England: findings from a national survey

A group intervention to improve quality of life for people with advanced dementia living in care homes: the Namaste feasibility cluster RCT

Pharmacological treatments for neuropsychiatric symptoms of dementia in long-term care: a systematic review

Contact Info

Product

Resources

About