Analgesics in the management of behavioral and psychological symptoms of dementia: a perspective review

Tampi, Rajesh R.; Hassell, Corey; Joshi, Pallavi; Tampi, Deena J.

doi:10.7573/dic.212508

Cited by 10 publications

(5 citation statements)

References 22 publications

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“…In line with other studies, the overall consumption of analgesics and anti-psychotic drugs is high (Tampi, Hassell, Joshi, & Tampi, 2017;Shah, Carey, Harris, DeWilde, & Cook, 2011) and did not change over time. As cultural and environmental factors are associated with the prescription rates of these drug (van der Putten, Wetzels, Bor, Zuidema, & Koopmans, 2014) and psychosocial interventions are effective for reducing the use of antipsychotics (Birkenh€ ager-Gillesse et al, 2018), we expected a reduction of antipsychotic drugs among residents moving to a small-scaled SCU.…”

Section: Discussionsupporting

confidence: 90%

Psychotropic drug use in residents with dementia living in small-scaled special care facilities; a longitudinal study

Kok

Voshaar

Scherder

2019

Aging & Mental Health

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Objectives: Over the past decade, a trend has been noticed in the Netherlands to replace largescaled special care units (SCUs) caring for 20-30 residents with dementia by small-scaled SCUs caring for up to 8 residents. Systematic evaluations, however, have yielded a differentiated picture of the effects. As the impact on psychotropic drug use has hardly been addressed thus far, we examined the (potential) impact of psychotropic drug use when moving residents with dementia from large-scaled to small-scaled SCUs. Methods: We conducted a non-randomized, controlled study with a six-month follow-up. Among 145 residents with dementia living a large-scaled SCUs for dementia caring for 20-30 residents per unit, a total of 77 residents were moved to small-scaled SCUs caring for up to 8 residents per unit. Psychotropic drug use, classified according to the Anatomical Therapeutic Chemical Classification (ATC) system was monitored at 2 months before replacement, as well as at 3 and 6 months thereafter. Repeated measures ANOVAs were conducted for the mean Defined Daily Doses (DDDs) of both groups. Results: No significant differences between both groups in psychotropic medication use were found over a period of 8 months. Conclusion: Prescription of psychotropic drugs does not change after a transfer from a largescaled SCU to a small-scaled SCU of patients with moderate to severe dementia. Current Controlled Trials: ISRCTN11151241.

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Section: Discussionsupporting

confidence: 90%

Psychotropic drug use in residents with dementia living in small-scaled special care facilities; a longitudinal study

Kok

Voshaar

Scherder

2019

Aging & Mental Health

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“…Pain is a trigger of distress, yet often overlooked as a contributing factor, and the person is not only left to suffer unnecessarily in pain, but also to be prescribed psychotropic agents to manage their behaviors (28). It has been demonstrated that systematic use of observational pain assessment tools can improve the identification of pain in people with dementia, positively impacting the use of non-pharmacological pain interventions and analgesics (1,29,30) As a result of the program analgesic use improved, with fewer people receiving no analgesics (from 15 to 6%) and more receiving regular plus as-needed analgesics (from 24 to 43%). These changes in analgesic use were associated with improvements in pain relief (31).…”

Section: Discussionmentioning

confidence: 99%

“…Tampi et al (30), in their review reported that that the use of analgesics appeared be well tolerated and their use was associated with reduction of BPSD. Improvements were observed in social as well as verbal and physical behaviors.…”

Section: Discussionmentioning

confidence: 99%

Clinical impact of a multifaceted intervention aimed at decreasing distress in people living with dementia: evaluating the Reconnect program

Baird,

Miller,

Hoti

et al. 2023

Front. Psychiatry

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BackgroundTo better meet the needs of people living with advanced dementia, Orchard Care Homes, United Kingdom have established an enhanced person focused program, namely the Reconnect program, which provides an enriched psycho-social care to enhance peoples’ quality of life and well-being. Here we aimed to review the impact of this program on people living with dementia.MethodsIn this study the implementation of the Reconnect program was evaluated for two six-month periods (April–September 2020 and April–September 2021). The focus of this evaluation was on three key interventions: increasing meaningful occupation and engagement; improving pain identification and management, and reducing constipation. The Reconnect program was conducted in a single for-profit care home. It involved residents with complex dementia needs who previously not responded to support in alternative settings or found previous care ineffective in relieving their distress and reducing risks they pose to themselves or others.ResultsA total of 24 people participated in the program during this evaluation. We observed a substantial increase in engagement in meaningful activity per person, including an increase of outdoor access to fresh air. Pain management improved as evidenced by more standardized pain assessments using the PainChek system and coverage of people with either regular and/or “when required” pain management. Constipation relief also improved. For the two comparison periods, distress responses per resident reduced from 14.5 to 10.6 events and use of regular pain relief increased from 21.7 to 48.1%. Use of “when required” benzodiazepine halved from 6 months average of 46 to 23.2 doses given. Benzodiazepine dose reductions increased from 13.3 to 31.8%, while cessations increased from 20 to 50%. We also observed a reduction from 76.3 to 56.3% in antipsychotic use. Their dose reductions increased from 8.3 to 40% and drug cessation was made in 30% of people using antipsychotics (compared to the first period in which no medication cessation was observed). A 91.7% reduction (i.e., from 36 to 3 events) in safeguarding events related to behaviors was also observed.ConclusionIntroduction of the Reconnect program, through its interventions focused on meaningful activity engagement, pain management and constipation relief resulted in substantial improvements related to people’s distress, safeguarding and psychotropic use.

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“…Inappropriate use of analgesia and psychotropic increases the risk of delirium and further deteriorating cognitive function in the elderly (Alagiakrishnan & Wiens, 2004), who represent most people living with dementia. Furthermore, in people living with dementia, the effect of analgesic pain management is often viewed in line with the change in their pain‐related behaviours or the behavioural psychological symptoms of dementia (Tampi et al., 2017). In this review, while the use of analgesia for treating pain has its beneficial effects in reducing pain‐related behaviours of dementia, dementia‐related agitation has not changed (Chen & Lin, 2016).…”

Section: Discussionmentioning

confidence: 99%

The effectiveness of interventions to improve pain assessment and management in people living with dementia: A systematic review and meta‐analyses

Tsai

Browne

Inder

2020

Journal of Advanced Nursing

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Aims To synthesize and evaluate the effectiveness of interventions for nurses to improve the assessment and management of pain in people living with dementia. Design Systematic review and meta‐analyses of randomized controlled trials. Data sources CINAHL, Joanna Briggs Institute (JBI) EBP, Cochrane Library, PubMed, and Scopus databases were searched for all journal articles published between 2009 ‐2019. Review methods Papers were included under population intervention comparator outcome (PICO) framework for: (a) people living with dementia aged 65 years and over; (b) interventions developed for nurses or other health professionals; (c) comparison group of standard care or control; and (d) outcome that measures the intervention effects on nurses and people living with dementia. Independent reviewers undertook critical appraisal, data abstraction, and synthesis. Meta‐analyses were performed to determine the effectiveness of interventions. Results Of 2099 titles and abstracts screened, six interventions with low‐to‐moderate risk of bias met inclusion criteria. Studies that implemented a routine pain assessment tool showed no effect on nurses’ analgesic management. Studies that developed a comprehensive pain model involving multidisciplinary health professionals showed overall effects on pain assessment and management in dementia care. Physician involvement had an impact on analgesic management. Conclusion Comprehensive pain models improve nurses’ pain assessment and management. A lack of balance between analgesia use and non‐pharmacological pain management in dementia care is evident. Multidisciplinary health professionals’ involvement is essential for effective intervention design for pain management in dementia. Impact Various pain assessment tools have been considered to assist identification and management of pain in people living with dementia. Nevertheless, challenges exist when caring for people living with dementia in pain. These findings support the development of a comprehensive pain model, which may be a more effective strategy than routine use of a pain tool alone for nurses to improve pain management in dementia care.

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Analgesics in the management of behavioral and psychological symptoms of dementia: a perspective review

Cited by 10 publications

References 22 publications

Psychotropic drug use in residents with dementia living in small-scaled special care facilities; a longitudinal study

Psychotropic drug use in residents with dementia living in small-scaled special care facilities; a longitudinal study

Clinical impact of a multifaceted intervention aimed at decreasing distress in people living with dementia: evaluating the Reconnect program

The effectiveness of interventions to improve pain assessment and management in people living with dementia: A systematic review and meta‐analyses

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