TY - JOUR

T1 - Impact of antipsychotic review and non-pharmacological intervention on health-related quality of life in people with dementia living in care homes

T2 - WHELD—a factorial cluster randomised controlled trial

AU - Ballard, Clive

AU - Orrell, Martin

AU - Sun, Yongzhong

AU - Moniz-Cook, Esme

AU - Stafford, Jane

AU - Whitaker, Rhiannon

AU - Woods, Robert

AU - Corbett, Anne

AU - Banerjee, Sube

AU - Testad, Ingelin

AU - Garrod, Lucy

AU - Khan, Zunera

AU - Woodward-Carlton, B.

AU - Wenborn, Jennifer

AU - Fossey, Jane

N1 - National Institute for Health Research (UK). Grant Number: RP-PG-0608-10133

PY - 2017/10

Y1 - 2017/10

N2 - BackgroundVery few interventional studies have directly examined the impact of treatment approaches on health-related quality of life (HRQL) in people with dementia. This is of particular importance in therapies to address behavioural symptoms, where HRQL is often severely affected.MethodsAnalysis within the WHELD cluster randomised factorial study in 16 UK care homes examining the impact of person-centred care in combination with antipsychotic review, social interaction and exercise interventions. This study analysed impact on HRQL through the DEMQOL-Proxy.ResultsData on HRQL were available for 187 participants. People receiving antipsychotic review showed a significant worsening in two DEMQOL-Proxy domains (negative emotion: p = 0.02; appearance: p = 0.04). A best-case scenario analysis showed significant worsening for total DEMQOL-Proxy score. Social interaction intervention resulted in a significant benefit to HRQL (p = 0.04). There was no deterioration in HRQL in groups receiving both antipsychotic review and social interaction (p = 0.62).ConclusionsThis demonstrates an important detrimental impact of discontinuation of antipsychotics in dementia on HRQL, highlighting the need for careful review of best practice guidelines regarding antipsychotic use and emphasising the importance of providing evidence-based non-pharmacological interventions in conjunction with antipsychotic review

AB - BackgroundVery few interventional studies have directly examined the impact of treatment approaches on health-related quality of life (HRQL) in people with dementia. This is of particular importance in therapies to address behavioural symptoms, where HRQL is often severely affected.MethodsAnalysis within the WHELD cluster randomised factorial study in 16 UK care homes examining the impact of person-centred care in combination with antipsychotic review, social interaction and exercise interventions. This study analysed impact on HRQL through the DEMQOL-Proxy.ResultsData on HRQL were available for 187 participants. People receiving antipsychotic review showed a significant worsening in two DEMQOL-Proxy domains (negative emotion: p = 0.02; appearance: p = 0.04). A best-case scenario analysis showed significant worsening for total DEMQOL-Proxy score. Social interaction intervention resulted in a significant benefit to HRQL (p = 0.04). There was no deterioration in HRQL in groups receiving both antipsychotic review and social interaction (p = 0.62).ConclusionsThis demonstrates an important detrimental impact of discontinuation of antipsychotics in dementia on HRQL, highlighting the need for careful review of best practice guidelines regarding antipsychotic use and emphasising the importance of providing evidence-based non-pharmacological interventions in conjunction with antipsychotic review

KW - Dementia

KW - Care homes

KW - Antipsychotic review

KW - Psychosocial

KW - Quality of Life

U2 - 10.1002/gps.4572

DO - 10.1002/gps.4572

M3 - Article

VL - 32

SP - 1094

EP - 1103

JO - International Journal of Geriatric Psychiatry

JF - International Journal of Geriatric Psychiatry

SN - 0885-6230

IS - 10

ER -