Specialist dementia programme reduces antipsychotic medication in dementia care homes by nearly half

Use of antipsychotic medication in specialised dementia care homes run by Four Seasons Health Care Group has dropped by nearly a half, due to its PEARL dementia care programme.

Data from 16 homes on the programme was analysed and revealed a 48 per cent drop in use of antipsychotic medication plus a reduction in use of a range of other medications. There was also a corresponding improvement in the well-being of care home residents.

The analysis revealed that medication to alleviate anxiety fell by 40 per cent, the depression score fell in 30 per cent of residents while use of anti-depressant medication reduced by 19 per cent. Requirement for medication to induce sleep fell by 44 per cent.

A corresponding increase in well-being was measured among 46 per cent of residents. While 42 per cent gained weight, against the expectation that people living with dementia would lose weight.

This is the second study of the outcomes from Four Seasons’ specialised dementia units and it supports the findings of its initial study at eight other homes in 2010.

Caroline Baker, head of quality and dementia care for Four Seasons Health Care said: “When people with dementia are showing distress reactions this may be due to them experiencing pain or discomfort, yet too often rather than trying to identify and relieve this symptom they are needlessly given antipsychotic drugs to calm them and keep them quiet.

“Reducing use of these drugs is a national priority. The consistent outcomes of the two studies in our dementia care homes provide confirmation that with better understanding of how to care for people with dementia we can reduce the need for antipsychotics together with a range of other medications and at the same time improve well-being.”

The study also found falls among residents dropped by 25 per cent. This may be attributed to increased alertness as a result of reduction of antipsychotics and other medications as well as improved well-being.

A wife of a resident at a PEARL specialised dementia care facility has seen a marked change in her husband: “My husband was in bed for 16 months. The home took him off night medication first; then daytime medication. In a matter of weeks he was up and about. On the next visit we sat in the lounge eating breakfast together and he is much more aware and alert. The only medication he is on now is blood pressure tablets. It is remarkable.”

The ethos of PEARL (Positively Enriching And enhancing Residents Lives) is to see beyond the symptoms of dementia to appreciate the individuality of each resident and support them to continue to live their lives as closely as possible to the way that they always have.

Putting person centred care into practice can be as simple as addressing people by their name rather than ‘dear’ or ‘pet’ to knowing which toiletries they like to use and what side their hair is normally parted.

Lynda Hodgkinson, home manager at Ashcroft Care Home, said: “We have a resident who used to be a station master who tells us to all walk one way around the corridors and organises certain things for us – like which way the chairs are facing. Another resident used to be a head teacher and from time to time will communicate with authority and tell everyone to sit down and listen. We understand their behaviour and respect this is their reality.”

Care programmes are planned in consultation with the resident and key people, including relatives, friends, staff, community clinicians and GPs.

The programme uses a range of therapies in daily care including sensory rooms, music therapy, reminiscence therapy and memory.

The PEARL home is designed with consideration of the impact of light, colour, contrast, texture, aroma and sound to assist the overall orientation of residents and create a balanced sensory stimulating environment.

Staff training includes new ways of thinking about dementia, such as challenging the mindset that someone with dementia may be seen as disabled or dysfunctional and realising what is often seen as ‘challenging behaviour’ can often be a distress reaction.

Trainees spend a day experiencing how it may feel to be a resident in a care home where they may have their individuality and personality disregarded. They wear smeared glasses to impair their sight and earplugs to impair hearing. They have one arm immobilised and are left wearing wet incontinence pads. They are not addressed directly by name; are not given a choice about food or beverages; have tablets administered without explanation or warning and are ignored for long periods.

Then they are given the contrasting experience of once again being treated an individual with communication needs, emotions and preferences as well as physical care needs.

The study found the only medication that consistently increased in use in the care homes was for pain relief, which increased 10 per cent on average.

As the use of antipsychotic medication has decreased in these homes, the use of analgesics increased, suggesting pain may be under-recognised in dementia care.

Typically on nursing units, 40 per cent of residents are taking analgesic medication. By contrast on typical dementia units, with a similar population profile, up to 10 per cent of residents are taking analgesics.

After two years in development, the pilot of the PEARL specialised dementia programme was launched early in 2008. It came about after Dr Pete Calveley, a former GP and Primary Care Trust director, who is now chief executive of Four Seasons Health Care, was dissatisfied with what he saw happening as then accepted practice in dementia care and in particular, the routine use of antipsychotic medication to keep patients quiet and compliant. He believed there was a better way and wanted to challenge the status quo.

He assembled a team and with them developed his concept of creating a specialised approach to dementia care. That was the beginning of the PEARL dementia programme.

Today, Four Seasons Health Care has 56 homes that are accredited as PEARL specialist dementia care centres with another 70 undertaking the demanding pathway to accreditation.

The study was conducted over two years and involved 480 residents. The earlier study was also conducted over two years and involved 240 residents.

Four Seasons Health Care has produced a summary report of its second dementia care study that can be seen on its website www.fshc.co.uk

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