Antipsychotics in dementia: prevalence and quality of antipsychotic drug prescribing in UK mental health services

Barnes, Thomas R. E.; Banerjee, Sube; Collins, Noel; Treloar, Adrian; McIntyre, Samantha; Paton, Carol

doi:10.1192/bjp.bp.111.107631

Cited by 74 publications

(64 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This may be because participants had been managed in primary care prior to referral to specialist services for CB, and primary care physicians may be less confident about withdrawing patients from antipsychotics than their colleagues in secondary care. 269 Similar to other studies, a large number of participants with dementia (i.e. around 20%) were prescribed at least one antidepressant, but our data note a low likelihood of discontinuing in 3 months, despite evidence indicating limited or no benefit in the management of depression in dementia.…”

Section: Main Outcomes Over Timesupporting

confidence: 62%

“…This is lower than the 25% estimates by Banerjee,112 and similar to the value for care homes (but not the overall data which included family care settings), which was noted by Barnes et al 269 However, disappointingly, in this subsample of participants in receipt of one or more antipsychotic,…”

Section: Antipsychoticscontrasting

confidence: 46%

“…In March 2011, the Prescribing Observatory for Mental Health (POMH-UK) programme conducted an audit-based quality improvement programme of prescribing in dementia care within 54 specialist NHS organisations. 269 This noted that 64% of people with dementia lived at home and, of this group, 9.6% were prescribed an antipsychotic. Our data, which were taken from patient prescriptions rather than from audits carried out by staff within their organisation -and where some but not all NHS organisations had participated in the POMH-UK audit -show that 91% of our sample were not prescribed an antipsychotic and thus concur with the POMH-UK data.…”

Section: Main Outcomes Over Timementioning

confidence: 99%

“…314 Suboptimal quality of prescribing practices was also noted in the POMH-UK audit of quality improvement. 269 …”

Section: Overview Of Key Findings From Challenge Demcarementioning

confidence: 99%

See 3 more Smart Citations

Challenge Demcare: management of challenging behaviour in dementia at home and in care homes – development, evaluation and implementation of an online individualised intervention for care homes; and a cohort study of specialist community mental health care for families

Moniz–Cook

Hart

Woods

et al. 2017

Programme Grants Appl Res

View full text Add to dashboard Cite

BackgroundDementia with challenging behaviour (CB) causes significant distress for caregivers and the person with dementia. It is associated with breakdown of care at home and disruption in care homes. Challenge Demcare aimed to assist care home staff and mental health practitioners who support families at home to respond effectively to CB.ObjectivesTo study the management of CB in care homes (ResCare) and in family care (FamCare). Following a conceptual overview, two systematic reviews and scrutiny of clinical guidelines, we (1) developed and tested a computerised intervention; (2) conducted a cluster randomised trial (CRT) of the intervention for dementia with CB in care homes; (3) conducted a process evaluation of implementation of the intervention; and (4) conducted a longitudinal observational cohort study of the management of people with dementia with CB living at home, and their carers.Review methodsCochrane review of randomised controlled trials; systematic meta-ethnographic review of quantitative and qualitative studies.DesignResCare – survey, CRT, process evaluation and stakeholder consultations. FamCare – survey, longitudinal cohort study, participatory development design process and stakeholder consultations. Comparative examination of baseline levels of CB in the ResCare trial and the FamCare study participants.SettingsResCare – 63 care homes in Yorkshire. FamCare – 33 community mental health teams for older people (CMHTsOP) in seven NHS organisations across England.ParticipantsResCare – 2386 residents and 861 staff screened for eligibility; 555 residents with dementia and CB; 277 ‘other’ residents; 632 care staff; and 92 staff champions. FamCare – every new referral (n = 5360) reviewed for eligibility; 157 patients with dementia and CB, with their carer; and 26 mental health practitioners. Stakeholder consultations – initial workshops with 83 practitioners and managers from participating organisations; and 70 additional stakeholders using eight group discussions and nine individual interviews.InterventionAn online application for case-specific action plans to reduce CB in dementia, consisting of e-learning and bespoke decision support care home and family care e-tools.Main outcome measuresResCare – survey with the Challenging Behaviour Scale; measurement of CB with the Neuropsychiatric Inventory (NPI) and medications taken from prescriptions; implementation with thematic views from participants and stakeholders. FamCare – case identification from all referrals to CMHTsOP; measurement of CB with the Revised Memory and Behaviour Problems Checklist and NPI; medications taken from prescriptions; and thematic views from stakeholders. Costs of care calculated for both settings. Comparison of the ResCare trial and FamCare study participants used the NPI, Clinical Dementia Rating and prescribed medications.ResultsResCare – training with group discussion and decision support for individualised interventions did not change practice enough to have an impact on CB in dementia. Worksite e-learning opportunities were not readily taken up by care home staff. Smaller homes with a less hierarchical management appear more ready than others to engage in innovation. FamCare – home-dwelling people with dementia and CB are referred to specialist NHS services, but treatment over 6 months, averaging nine contacts per family, had no overall impact on CB. Over 60% of people with CB had mild dementia. Families bear the majority of the care costs of dementia with CB. A care gap in the delivery of post-diagnostic help for families supporting relatives with dementia and significant CB at home has emerged. Higher levels of CB were recorded in family settings; and prescribing practices were suboptimal in both care home and family settings.LimitationsFunctionality of the software was unreliable, resulting in delays. This compromised the feasibility studies and undermined delivery of the intervention in care homes. A planned FamCare CRT could not proceed because of insufficient referrals.ConclusionsA Cochrane review of individualised functional analysis-based interventions suggests that these show promise, although delivery requires a trained dementia care workforce. Like many staff training interventions, our interactive e-learning course was well received by staff when delivered in groups with facilitated discussion. Our e-learning and decision support e-tool intervention in care homes, in its current form, without ongoing review of implementation of recommended action plans, is not effective at reducing CB when compared with usual care. This may also be true for staff training in general. A shift in priorities from early diagnosis to early recognition of dementia with clinically significant CB could bridge the emerging gap and inequities of care to families. Formalised service improvements in the NHS, to co-ordinate such interventions, may stimulate better opportunities for practice models and pathways. Separate services for care homes and family care may enhance the efficiency of delivery and the quality of research on implementation into routine care.Future workThere is scope for extending functional analysis-based interventions with communication and interaction training for carers. Our clinical workbooks, video material of real-life episodes of CB and process evaluation tool resources require further testing. There is an urgent need for evaluation of interventions for home-dwelling people with dementia with clinically significant CB, delivered by trained dementia practitioners. Realist evaluation designs may illuminate how the intervention might work, and for whom, within varying service contexts.Trial registrationCurrent Controlled Trials ISRCTN02553381 (the ResCare trial) and ISRCTN58876649 (the FamCare study).FundingThis project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 5, No. 15. See the NIHR Journals Library website for further project information.

show abstract

Section: Main Outcomes Over Timesupporting

confidence: 62%

Section: Antipsychoticscontrasting

confidence: 46%

Section: Main Outcomes Over Timementioning

confidence: 99%

“…314 Suboptimal quality of prescribing practices was also noted in the POMH-UK audit of quality improvement. 269 …”

Section: Overview Of Key Findings From Challenge Demcarementioning

confidence: 99%

See 2 more Smart Citations

Challenge Demcare: management of challenging behaviour in dementia at home and in care homes – development, evaluation and implementation of an online individualised intervention for care homes; and a cohort study of specialist community mental health care for families

Moniz–Cook

Hart

Woods

et al. 2017

Programme Grants Appl Res

View full text Add to dashboard Cite

show abstract

“…This was lower than the 25% overall population rate estimated by the Department of Health in 2009. 14 …”

Section: Point Prevalence Of Antipsychotic Prescribingmentioning

confidence: 99%

Association between antipsychotics and adverse outcomes in dementia

Bangash¹,

Stubbs²,

Khan³

et al. 2017

Prog Neurol Psychiatry

View full text Add to dashboard Cite

Prolonged use of antipsychotics continues to be a controversial subject area, especially in the older adult population due to age‐related changes in pharmacokinetic and pharmacodynamics parameters. Best practice guidelines recommends that they should be used at their lowest dosage for no longer than 6–12 weeks. Here, the authors discuss the prevalence of antipsychotic use to treat the behavioural and psychological symptoms of dementia in the older adult population and the dilemma it poses.

show abstract

Associations between risk of mortality and atypical antipsychotic use in vascular dementia: a clinical cohort study

Sultana

Chang²,

Hayes³

et al. 2014

Int J Geriat Psychiatry

View full text Add to dashboard Cite

The absence of a significant increase in mortality risk associated with atypical antipsychotics in people with VaD indicates that a clinical trial of antipsychotics focussing on the treatment of aggression and agitation in this patient group will be justified and feasible following further consideration of possible confounders, which will be critical to determine the role of antipsychotics in treatment of VaD.

show abstract

Antipsychotics in dementia: prevalence and quality of antipsychotic drug prescribing in UK mental health services

Cited by 74 publications

References 27 publications

Challenge Demcare: management of challenging behaviour in dementia at home and in care homes – development, evaluation and implementation of an online individualised intervention for care homes; and a cohort study of specialist community mental health care for families

Challenge Demcare: management of challenging behaviour in dementia at home and in care homes – development, evaluation and implementation of an online individualised intervention for care homes; and a cohort study of specialist community mental health care for families

Association between antipsychotics and adverse outcomes in dementia

Associations between risk of mortality and atypical antipsychotic use in vascular dementia: a clinical cohort study

Contact Info

Product

Resources

About