Introduction

Stress and Distress in Dementia Reducing and Reviewing Antipsychotic MedicationDr Deborah Cunningham, Holburn Medical Group, Aberdeen 2013

Results (so far)

Aim

Conclusions

References

•antipsychotics often useful in dealing with stress and distress in dementia

• however, can be risky

• sometimes not reviewed and reduced if appropriate

• 93% of prescription in Scotland become repeats (1)

• 15% of care home residents in Aberdeen on these drugs (2)

• non pharmacological approaches can be used in dealing with stress and distress

To review and perhaps reduce antipsychotic prescriptions in dementia patients in Torry Nursing Home, in conjunction with improving training of care home staff and GPs in methods of managing patients with stress and distress in dementia

Project still ongoing so this is an account of what I’ve been involved in up to this point.

1.Questionnaires for staff in home and GPs to assess knowledge of stress and distress2. Ttraining sessions for staff (4) and GPs (1)• given by Clinical Psychologist and CPN for the care home staff and consultant, and clinical psychologist for GPs1.Reviw of notes of 14 patients on antipsychotics by GP, CPN and Associate Specialist in Old Age Psych (3-5 per month for 3-4 months) with the aim to reduce/stop2. Completion of ABC charts, behaviour charts +/- sleep charts by care home staff prior to reduction if appropriate and thereafter to monitor any behaviour change

• only a handful of the 80 questionnaires given to care home staff were completed

• a couple of care home training sessions carried out - sadly not well attended

• first round of notes were reviewed but problems met in getting charts completed

• however, successful training session to GPs

• project work postponed for the time being

• Why?•big changes in home - high turnover of staff, new agency staff and management changes - project not high priority

• hopefully will recommence in August when more stability in the home

• staff will undoubtedly benefit from training

• more work is needed to look at non pharmacological methods in managing stress and distress in dementia

Why Torry Nursing Home?

• Second highest number of dementia patients on antipsychotics in Aberdeen (2)

• Only one of 4 or 5 homes which agreed to participate Learning Points

From this project...• the training I received on stress and distress has made me more aware of what to consider when reviewing such patients• I will consider reviewing and perhaps reducing antipsychotics at an earlier stage

From the scholarship...• all areas of management of dementia improved• in particular, increased confidence in dealing with earlier diagnosis and helping advise patients on legal issues• also, greater knowledge of local resources available to patients and carers

I am glad that my colleagues have also benefitted from my participation in the project and hopefully as time goes on, from my increased knowledge overall in dementia care.

1.The burden of psychotropic drug prescribing in people with dementia: a population database study. Bruce Guthrie, Stella Clark, Colin McCowan. Age and Ageing 2010; 39: 637-642

2.Aberdeen City CHP: Review of antipsychotic prescribing within care homes for patients with dementia

Methods

Questionnaires Training sessions

Review of Notes Completion of charts