Posted in Caregiving, Dementia, International Policies, Therapeutic Activities

Needless treatments: antipsychotic drugs are rarely effective in ‘calming’ dementia patients

 

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People with dementia often experience a range of psychological symptoms and behaviour changes.
from shutterstock.com

Juanita Westbury, University of Tasmania and Carmelle Peisah, University of Sydney

From time to time, we hear or read about medical procedures or treatments that can be ineffective and needlessly drive up the nation’s health-care costs. This occasional series explores such procedures individually and explains why they could cause more harm than good in particular circumstances.


Antipsychotic medications were initially developed to treat schizophrenia, a mental health condition characterised by psychotic symptoms such as delusions and hallucinations. Because of their sedative effects, antipsychotic medications (such as risperidone, olanzapine, quetiapine and haloperidol) are often used to “manage” people with dementia.

People with dementia often experience a range of psychological symptoms and behaviour changes. These can include anxiety, sleep disturbance, pacing, wandering, crying out, agitation, delusions and hallucinations.

These are referred to as “behavioural and psychological symptoms of dementia” (BPSD) though the term “responsive behaviours” has also been adopted to help explain their cause, signalling that there are often reasons behind the behaviours. Understanding and treating these reasons is the best way to approach these behaviours.




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Antipsychotic medications are known as psychotropic medications. These are drugs that alter a person’s mental state and include antipsychotics, antidepressants, benzodiazepines and anticonvulsants, which are also used to sedate patients in nursing homes. These come with significant and serious risks. Clinical guidelines recommend such medications be used only as a last resort.

Psychotropic medicines should only be considered when non-pharmacological interventions have failed and the patient has symptoms that are distressing for them, their family or fellow residents.

Responsive behaviours

Dementia is not just a single disease. It’s a term describing symptoms associated with more than 70 separate diseases, including Alzheimer’s disease and Lewy body dementia. The condition affects many brain functions including language, personality and reasoning skills, not just memory, which is usually associated with the condition.




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Responsive behaviours in people with dementia vary according to the type and severity of their disease. They also fluctuate over time. A Canadian study of 146 aged care residents assessed these behaviours monthly for six months, revealing a wide variation in their duration and frequency. Results showed most responsive behaviours lasted for less than three months with usual care.

Dementia affects many brain functions including langugage, personality and reasoning skills.
from shutterstock.com

Many responsive behaviours in people with dementia are thought to result from, or be worsened by, unmet needs (pain, hunger), the environment (over- or under-stimulation), social needs (loneliness or need for intimacy) and approaches of carers or others. Sometimes these behaviours are caused by an acute medical illness on top of the dementia, such as an infection. Other times the behaviours arise from the disease process of dementia itself.

Each cause requires different treatment. For example, an infection shouldn’t be missed, nor should pain, each requiring different strategies. So, the first step for those around the person, both health care professionals and family carers, is to work out why they are behaving a certain way rather than reaching for a script pad.

Psychotropic use in aged care

Psychotropic medications are often over-used. The main evidence for excessive use of psychotropics such as antipsychotics in dementia in Australia has been collected in aged care homes. A recent study, that one of the authors was involved in, examined antipsychotic use in 139 homes across all six states and the ACT during 2014-2015. It assessed the use of antipsychotics in more than 11,500 residents.

We found that 22% of residents were taking an antipsychotic medication every day. And concerningly, more than 10% of residents were charted for a “when required” antipsychotic. This means they could be given an antipsychotic dose when a behaviour occurred that their carer decided was necessary to medicate, or a top-up dose in addition to their regular dose.




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Excessive use of antipsychotics in older people does not appear to be confined to the residential aged care sector. A 2013 district nursing study of 221 people with dementia living in their own homes found that 18% were prescribed these medications.

Many trials have examined the effectiveness of antipsychotics to treat agitation in people with dementia. These studies show they only offer benefit to about 20% of people with these symptoms and appear to offer no benefit for other responsive behaviours such as wandering, crying out or anxiety.

Antipsychotics don’t benefit symptoms such as wandering, crying out or anxiety.
from shutterstock.com

But what’s worse is that use is associated with severe adverse effects including stroke, early death, infections, Parkinson’s-like movement disturbances, falls and over-sedation.

There are times when behaviours can be severe and disabling and impact the quality of life for the person with dementia. Sometimes the behaviours may put the person or others at risk. In these cases, careful prescribing is recommended. When needed for responsive behaviours, antipsychotics should be taken at the lowest effective dose for a maximum of three-months.

If people are in pain, it is absolutely essential that this is treated. One study showed using increasingly strong analgesia was as effective in treating agitation in dementia as antipsychotics.

Advice for family members

Family members need to understand and be aware of these symptoms and behaviours, their treatment and alternatives and be part of finding out why they are happening as well as the solution.

This includes being aware that legally, psychotropics must be prescribed with consent, either from the person themselves or from their substitute decision-maker. Families should not just be finding out about use of medications when they receive the pharmacy bill.

Skilled advice for nursing homes is available across Australia, 24-hours a day from the Dementia Behaviour Management Advisory Service and the Severe Behaviour Response Teams. They support aged-care providers in improving care for people with dementia and related behaviours.

Families need to make sure that the facility their loved one resides is in is aware of and uses this service, so they don’t have to resort to using drugs first. The 24-hour helpline number is 1800 699 799.


For more information about your rights, visit empoweredproject.org.auThe Conversation

Juanita Westbury, Senior Lecturer in Dementia Care, University of Tasmania and Carmelle Peisah, Clinical Associate Professor, University of Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Posted in Caregiving, Therapeutic Activities

Empathetic dogs lend a helping paw

News Release
July 2018 | Heidelberg – Empathetic dogs lend a helping paw

Study shows that dogs that remain calm and show empathy during their owner’s distress help out faster

man wearing black and brown fur hoodie jacket and blue pants holding dog leash beside white short coat dog
Photo by Pixabay on Pexels.com

Many dogs show empathy if their owner is in distress and will also try to help rescue them. This is according to Emily M. Sanford, formerly of Macalester College and now at Johns Hopkins University in the US. She is the lead author of a study in Springer’s journal Learning and Behavior that tested whether there is truth in the notion that dogs have a prosocial and empathetic nature. Interesting to note, the study found that dogs specially trained for visitations as therapy dogs are just as likely to help as other dogs.

In one of their experiments, Sanford and her colleagues instructed the owners of 34 dogs to either give distressed cries or to hum while sitting behind a see-through closed door. Sixteen of these dogs were registered therapy dogs. The researchers watched what the dogs did, and also measured their heart rate variability to see how they physically reacted to the situation. In another part of the experiment, the researchers examined how these same dogs gazed at their owners to measure the strength of their relationship.

Dogs that heard distress calls were no more likely to open a door than dogs that heard someone humming. However, they opened the door much faster if their owner was crying. Based on their physiological and behavioural responses, dogs who opened the door were, in fact, less stressed than they were during baseline measurements, indicating that those who could suppress their own distress were the ones who could jump into action.

The study therefore provides evidence that dogs not only feel empathy towards people, but in some cases also act on this empathy. This happens especially when they are able to suppress their own feelings of distress and can focus on those of the human involved. According to Sanford, this is similar to what is seen when children need to help others. They are only able to do so when they can suppress their own feelings of personal distress.

“It appears that adopting another’s emotional state through emotional contagion alone is not sufficient to motivate an empathetic helping response; otherwise, the most stressed dogs could have also opened the door,” explains co-author Julia Meyers-Manor of Ripon College in the US. “The extent of this empathetic response and under what conditions it can be elicited deserve further investigation, especially as it can improve our understanding of the shared evolutionary history of humans and dogs.”

Contrary to expectation, the sixteen therapy dogs in the study performed as well as the other dogs when tested on opening the door. According to Meyers-Manor this may be because registered therapy dogs, despite what people may think, do not possess traits that make them more attentive or responsive to human emotional states. She says that therapy dog certification tests involve skills based more on obedience rather than on human-animal bonding.

“It might be beneficial for therapy organizations to consider more traits important for therapeutic improvement, such as empathy, in their testing protocols,” adds Meyers-Manor. “It would also be interesting to determine whether service dogs show a different pattern of results given their extensive training in attentiveness to their human companions.”

Reference: Sanford, E.M. et al (2018). Timmy’s in the well: Empathy and prosocial helping in dogs, Learning & Behavior DOI: 10.3758/s13420-018-0332-3

Posted in Caregiving, Research & Best Practice, Therapeutic Activities

Dementia coaching program offers chance to live well

News Release
August 8, 2018 | Australia, Dementia coaching program offers chance to live well

Support available for Sydney residents diagnosed with dementia
A new University of Sydney trial offers coaching and peer support to help people newly diagnosed with dementia cope with their prognosis and stay active and involved in their lives and community.

“I want to try and help people see they can fight back…you can’t just give into it.”

Bobby Redman, Peer supporter living with dementia

Lead researcher Associate Professor Lee-Fay Low said the pilot study has the potential to fill a vital service gap with the latest research suggesting keeping the mind and body active could slow the progression of dementia.

“Following a dementia diagnosis many people withdraw from their friends and family for fear they will deteriorate quickly and can suffer immense grief or depression,” said Low, Associate Professor in Ageing and Health at the University of Sydney.

“There are over 400 000 Australians currently living with dementia and with a cure still some way off it’s essential that we help people with early dementia to live well.

“We hope that giving people the right support, tools and strategies from the onset could help achieve this.”

The Dementia Lifestyle Coach pilot study is a collaboration between the University’s Faculty of Health Sciences and Brain and Mind Centre.

Participants will receive 14 counselling and coaching sessions from a registered psychologist over a six-month period and will also have a regular phone or skype catch ups with a peer supporter who lives with dementia.


Retired psychologist Bobby Redman is one of the peer supporters involved in the study.

Photo of peer supporter Bobby Redman

Bobby was diagnosed with frontotemporal dementia two and half years ago at age 66 after she noticed problems remembering the names of close friends and an inability to find the right words to express herself.

“My story is a bit different because with my psychology background I knew something was definitely wrong – but a dementia diagnosis is still a shock for anyone,” said Bobby.

“And what’s probably hardest is that, like in my experience, many people with early dementia are just told to come back when things get worse or to get their things in order.

“But I’ve learnt that there are tools and strategies you can put in place to help manage the impact of dementia. Even simple things like using my phone to set daily reminders to drink water and stay hydrated.

“What I’d like to see is more clinicians trained to provide these strategies to people to help them overcome simple issues.

“I want to try and help people see they can fight back. I think that’s the key….you can’t just give into it.”

The pilot study will run over a 12-month period, with researchers aiming to assess the impact the coaching program has on participants’ mood, independence, activity levels and quality of life.

Participant information

The University of Sydney is trialling a counselling and coaching program for people living at home recently diagnosed with early dementia. To be eligible you must have received a diagnosis of early dementia within the past 6 months. Read more information about the Dementia lifestyle coaching study or contact Dr Annica Barcenilla on +61 2 9351 9837 or annica.barcenilla@sydney.edu.au

 

Posted in Caregiving, Dementia, International Campaigns, Research & Best Practice, The Built Environment, Therapeutic Activities

What good dementia design looks like – A case study on Dementia Training Australia’s work with Scalabrini Village

DTA and Scalabrini Village case study profiled at Alzheimer’s International Conference in Chicago from Dementia Training Australia on Vimeo.

 

A case study on Dementia Training Australia’s work with Scalabrini Village is featured in the program Every Three Seconds, a collaboration between ADI and ITN Productions which highlights the fact that someone in the world is diagnosed with dementia every three seconds.

Source: https://www.dta.com.au/case-studies-dementia-training-australia/

Posted in Ageing & Culture, Caregiving, Research & Best Practice, Therapeutic Activities

Just ten minutes of social interaction a day improves wellbeing in dementia care

News Release
July 2018 | United Kingdom – Just ten minutes of social interaction a day improves wellbeing in dementia care

An e-learning programme that trains care home staff to engage in meaningful social interaction with people who have dementia improves wellbeing and has sustained benefits.

couple elderly man old
Photo by Pixabay on Pexels.com

The average person with dementia in a care home experiences just two minutes of social interaction each day, researchers found. They also showed that out of 170 available training programmes for nursing home staff, only three are evidence-based – none of which improve quality of life.

The Wellbeing and Health for people with Dementia (WHELD) programme trained care home staff to increase social interaction from two minutes a day to ten, combined with a programme of personalised care. It involves simple measures such as talking to residents about their interests and involving them in decisions around their care.

The Improving Staff Attitudes and Care for People with Dementia e-Learning (tEACH) study, conducted by the University of Exeter Medical School and King’s College London in partnership with the Social Care Institute for Excellence (SCIE), was presented at the Alzheimer’s Association International Conference 2018. The study involved 280 residents and care staff in 24 care homes over nine months.

Carers took part in an e-learning programme based on the WHELD training, with or without Skype supervision. They compared outcomes to usual care. Both treatment arms improved resident wellbeing and staff attitudes to person-centred care. The Skype supported arm continued to deliver improved resident wellbeing four months after the trial was completed.

Joanne McDermid, of King’s College London, who presented the research, said: “Care home staff are under a lot of pressure – it’s a really tough job. It’s a challenging environment for both residents living with dementia and staff. Our programme moved care staff to see dementia through the eyes of those who are living it. We found a simple approach, delivered as e-learning, improves staff attitudes to care and residents’ wellbeing, ultimately improving lives for people with dementia.

“In a traditionally task -focussed work environment, our programme reminds us of the human side; of the full life experience of those living with dementia in care.”

Professor Clive Ballard, of the University of Exeter Medical School, who led the research, said: “Just take a moment to imagine life with just two minutes of social interaction each day. To accept this is discrimination against people with dementia. We urgently need to do better. Most care home training programmes are not evidence-based. We know our programme works over the long term, and we now know it can be delivered remotely. We now need to roll this out to care homes.”

Watch carers talk about their experience of the WHELD training. To find out more about our world-leading dementia research, follow #ExeterDementia and @Clive_Ballard on Twitter, or visit the Exeter Dementia website.

Posted in International Campaigns, Therapeutic Activities

How poetry influences illness and health

News Release
May 1, 2018 | Chicago – How poetry influences illness and health

by Marla Paul

How can poetry influence our experience of illness? How can the lyric form disrupt and reshape our understanding of illness and health care?

These and other provocative questions at the intersection of poetry and medicine will be discussed at the ninth Annual Hippocrates Poetry and Medicine Symposium on Thursday and Friday, May 10 and 11.

This is the first time the international conference will be held in Chicago. It is co-sponsored by Northwestern University’s Center for Bioethics and Medical Humanities, the Hippocrates Initiative for Poetry and Medicine, the Poetry Foundation and Harvard Medical School.

“Poetry can have a powerful influence on how we experience and understand illness,” said symposium organizer Dr. Kelly Michelson, director of the Center for Bioethics and Medical Humanities at Northwestern University Feinberg School of Medicine. “Very creative people are integrating poetry into clinical care, but we need a broader conversation to understand what that looks like and what its impact could be for patients, families and health care providers.”

The symposium will kick off at 7 p.m. Thursday, May 10, with a reading by poet Mark Doty at the Poetry Foundation, 61 W. Superior St., Chicago.

The conference’s academic program begins at 8:15 a.m. Friday morning, May 11, at the Feinberg School of Medicine at the Robert H. Lurie Research Center in the Baldwin auditorium, 303 E. Superior St., on the Chicago campus.

Panels of the day will explore how poetry can influence the illness experience; how a body’s physiology and a poem’s language speak to each other; how poetry frames the witnessing of cultural differences and disparities; and how lyric form can disrupt and reconstitute our understanding and teaching of illness and health care. The day will also feature a keynote conversation between poet Mark Doty and physician-poet Rafael Campo and a lunchtime poster session.

At 4 p.m., the award ceremony and reading of winning entries of the Hippocrates Prize for Poetry and Medicine will be held at the Poetry Foundation.

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