Dementia experts at a leading care home group have halved the use of antipsychotic drugs in an approach they say could apply nationally to save thousands of lives.
The team at Colten Care have challenged, reviewed and cut down on typically powerful medications that can so readily be chosen as a first-line response for residents with or without dementia.
They wanted to try more alternatives to help those who are experiencing distress, anxiety, aggression, apathy, nausea, low moods or other complex behaviour that carers can find challenging.
Acting on continual clinical audits and reviews, nurses and carers have steadily introduced more ‘psychosocial’ interventions in such situations so that medications become a last, rather than first, resort.
At the start of the three-month trial, 64 residents were being prescribed antipsychotics among nearly 260 people living in five dementia-specific care settings. Now, just 32 of these residents – exactly half – are receiving the drugs.
Across Colten Care’s entire family of 20 nursing homes, caring for a full range of age-related conditions, there were 97 residents using the medicines. That figure has dropped to just 65.
“The results have been truly spectacular,” said Admiral Nurse Kay Gibson, who has led the initiative. “By taking a non-pharmacological approach, we have cut the use of antipsychotics by half in our dementia-specific settings and by a third across the whole group.
“I initially worked with colleagues to check the evidence base for intervention, clinical supervision and monitoring of nurses, and devised a short observational inspection framework.
“Instead of saying ‘here’s a tablet that will help’, we have put much more store on personal interaction, activities, talking and working one-to-one with the resident to encourage feelings of wellbeing and purpose.”
Despite widely known risk factors, around 180,000 people in England with dementia are treated with antipsychotics every year.
While tens of thousands derive benefit, use at this level is thought to equate to an additional 1,800 deaths a year plus 1,620 other adverse brain conditions, including strokes.
Colten Care’s findings reflect those of a new study by Exeter University, Kings College London and Oxford Health which found that additional dementia training for care home staff, increased social interaction for residents and reviewing the use of antipsychotics could reduce resident mortality by an estimated 36%, saving up to 20,000 lives a year.
Emphasising the rationale for Colten Care’s new approach, Kay said: “We of course recognise that antipsychotic drugs have their place, for example in end-of-life or palliative care, but we wanted to see how far they could safely be made a last resort rather than a first-line response for people with symptoms or features of dementia.
“In our audit we looked in depth at the prevalence of antipsychotic prescriptions and introduced a new system fully in line with Department of Health guidance and the National Dementia Strategy.
“The aim was to gather good quality information about the instances where medications were being recommended and identify those symptoms and features of dementia they were genuinely needed for and, on the other hand, where an alternative approach could be taken.
“The review of ongoing medication has been a large part of our initiative.
“Even though an antipsychotic may have been necessary at a particular time, if treatment is not reviewed appropriately then someone could remain on an antipsychotic prescription for a long time.
“This can be problematic as someone living with dementia might only receive therapeutic benefit in treating or managing these symptoms for a limited period and, even worse, go on to experience potentially harmful side effects.
“I’m really proud that through our auditing, monitoring and alternative approaches, we have safely reduced the use of antipsychotic medicines in our homes.
“Nationally, the number of antipsychotic prescriptions that could be reduced with appropriate support will obviously vary by setting but, based on our experience, alternative approaches can make a big difference and potentially save thousands of lives.”
Colten Care partnered with Dementia UK to employ Kay as the provider’s first Admiral Nurse and is recruiting two others to start later this year.
The company has a stated promise to help families overcome the challenges of dementia and live well.
The range of psychosocial therapies it offers includes the input of a dedicated Music and Arts Partner who stimulates residents’ creativity and imagination through singing, playing music, drama, poetry, storytelling, dance and active listening.
Colten Care has also rolled out a multi-level dementia awareness training programme for staff with more than 80% of its 1,800 employees becoming Dementia Friends.
In recent inspections, three Colten Care homes, including a dementia-specific setting, have been rated Outstanding by care sector regulator the Care Quality Commission.
Kay is to present a paper on Colten Care’s antipsychotic initiative to more than 200 nursing professionals at Dementia UK’s annual Admiral Nurse Forum. The event takes place at Nottingham University on 17-18 September, 2018.