Abstract
BackgroundPeople living with dementia in care homes frequently exhibit “behaviour that challenges”. Anti-psychotics are used to treat such behaviour, but are associated with significant morbidity. This study researched the feasibility of conducting a trial of a full clinical medication review for care home residents with behaviour that challenges, combined with staff training. This paper focusses on the feasibility of measuring clinical outcomes and intervention costs.MethodsPeople living with moderate to severe dementia, receiving psychotropics for behaviour that challenges, in care homes were recruited for a medication review by a specialist pharmacist. Care home and primary care staff received training on the management of challenging behaviour.Data were collected at 8 weeks, and 3 and 6 months. Measures were Neuropsychiatric Inventory-Nursing Home version (NPI-NH), cognition (sMMSE), quality of life (EQ-5D-5 L/DEMQoL) and costs (Client Services Receipt Inventory).Response rates, for clinical, quality of life and health economic measures, including the levels of resource-use associated with the medication review and other non-intervention costs were calculated.ResultsTwenty-nine of 34 participants recruited received a medication review. It was feasible to measure the effects of the complex intervention on the management of behaviour that challenges with the NPI-NH. There was valid NPI-NH data at each time point (response rate = 100%). The sMMSE response rate was 18.2%. Levels of resource-use associated with the medication review were estimated for all 29 participants who received a medication review. Good response levels were achieved for other non-intervention costs (100% completion rate), and the EQ-5D-5 L and DEMQoL (≥88% at each of the time points where data was collected).ConclusionsIt is feasible to measure the clinical and cost effectiveness of a complex intervention for behaviour that challenges using the NPI-NH and quality of life measures.Trial registrationISRCTN58330068. Retrospectively registered, 15 October 2017.
Highlights
People living with dementia in care homes frequently exhibit “behaviour that challenges”
The management of “behaviour that challenges” - the behavioural and psychological symptoms of dementia (BPSD) - which includes symptoms such as agitation, aggression, pacing, depression and hallucinations is a key challenge in dementia care pathways [2] [3]
The Banerjee Report found that antipsychotics were implicated in the death of 1800 people living with dementia; they potentially worsen quality of life [3]
Summary
People living with dementia in care homes frequently exhibit “behaviour that challenges”. This study researched the feasibility of conducting a trial of a full clinical medication review for care home residents with behaviour that challenges, combined with staff training. The management of “behaviour that challenges” - the behavioural and psychological symptoms of dementia (BPSD) - which includes symptoms such as agitation, aggression, pacing, depression and hallucinations is a key challenge in dementia care pathways [2] [3]. The Banerjee Report found that antipsychotics were implicated in the death of 1800 people living with dementia; they potentially worsen quality of life [3]. Antipsychotics were frequently used as a first-line treatment for behaviour that challenges that could be managed by other approaches and two thirds of their use may be inappropriate [3] [6]. Research should test interventions to limit the use of all psychotropics [10] [11]
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