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

Abstract

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.

A systematic review of specialty dementia care units in long‐term care settings

“…However, The Educating Nursing Staff Effectively ( TENSE) program had no significant effect on outcomes (e.g., stress, personal accomplishment) 30 . Results regarding environmental design and small‐scale homelike settings housing 7‐8 residents were inconclusive but trended towards positive associations 31–33 …”

“…Of the 54 selected international studies, five intervention studies were conducted in the Netherlands, including three cluster randomized controlled trials, [26][27][28][29][30] one non-randomized controlled trial, [31][32][33] and one pre-post comparison study. 34 Interventions were designed to address resident challenging behavior (Grip on Challenging Behavior), [26][27][28] sleep (caffeine reductions), 34 psychotropic drug use (web-based tool), 29 staff education programs (TENSE), 30 and environmental design (DSCU size) [31][32][33] (Table 2). Findings from studies examining resident outcomes are generally positive (e.g., improved sleep with caffeine reduction 34 and behavioral functioning in smaller home-like settings, [31][32][33] decreased use of psychoactive drugs 29 ).…”

“…regarding environmental design and small-scale homelike settings housing 7-8 residents were inconclusive but trended towards positive associations. [31][32][33] Studies from eight other international countries examined resident quality of life, [35][36][37][38][39] behavior, 40,41 social connectedness, 42 neuropsychiatric symptoms, 43 and staff transfer behaviors 44 and learning outcomes 45,46 Acupressure and Montessori-based methods, 41 and companion clowns were used to examine associations with resident behaviors. 40 Physically nonaggressive behaviors, agitated behaviors, and aggressive behaviors were improved among residents with dementia receiving acupressure and Montessori-based methods, as were easeof-care ratings and affect.…”

“…34 Interventions were designed to address resident challenging behavior (Grip on Challenging Behavior), [26][27][28] sleep (caffeine reductions), 34 psychotropic drug use (web-based tool), 29 staff education programs (TENSE), 30 and environmental design (DSCU size) [31][32][33] (Table 2). Findings from studies examining resident outcomes are generally positive (e.g., improved sleep with caffeine reduction 34 and behavioral functioning in smaller home-like settings, [31][32][33] decreased use of psychoactive drugs 29 ).…”

The Small House Model to Support Older Adults in Long-Term Care

“…Objective 3: Outcomes A total of 31 publications provided study data or commentary related to resident outcomes. This included qualitative (n = 10), 2,6,7,[21][22][23]31,42,48,49 quantitative (n = 16), [13][14][15]17,19,26,44,45,[50][51][52][53][54][55][56][57] and mixed (n = 1) 4 study designs, as well as reviews (n = 4). 11,18,41,58,59 Interviews with staff were the most common instrument used for the qualitative studies, while the quantitative studies typically used validated quality of life (QoL) instruments.…”