Anto P. Rajkumar
Apathy and its response to antipsychotic review and non-pharmacological interventions in people with dementia living in nursing homes : WHELD, A factorial cluster randomised controlled trial
Rajkumar, Anto P.; Ballard, Clive; Fossey, Jane; Corbett, Anne; Woods, Bob; Orrell, Martin; Prakash, Rohan; Moniz-Cook, Esme; Testad, Ingelin
Authors
Clive Ballard
Jane Fossey
Anne Corbett
Bob Woods
Martin Orrell
Rohan Prakash
Professor Esme Moniz-Cook E.D.Moniz-Cook@hull.ac.uk
Emeritus Professor of Clinical Psychology of Ageing and Dementia Care Research / Dementia Research Work Group Lead
Ingelin Testad
Abstract
Objectives: Apathy is common, impactful, and difficult to manage in people with dementia. We evaluated the efficacy of non-pharmacological interventions, exercise and social interaction, in combination with antipsychotic review, to reduce apathy in people with dementia living in nursing homes in a cluster randomised controlled trial (RCT). Methods: Well-being and health for people with dementia (WHELD) programme included a 2X2X2 factorial cluster RCT involving people with dementia living in 16 nursing homes in UK. All homes received training in person-centred care, and were randomised to receive antipsychotic review, social interaction, and exercise, either alone or in combinations. Apathy was one of the secondary outcomes of the WHELD trial, and it was measured by the Neuropsychiatric Inventory-nursing home version at baseline and nine months (N=273). We employed multilevel mixed effects linear regression models to assess the impact of the interventions on apathy. Results: Prevalence of apathy was 44.0% (n=120; 95% CI 38.1-49.9%) at baseline. Severity of apathy had significant positive correlations with dementia severity, neuropsychiatric symptoms, depressive symptoms, agitation, and the needs of the people with dementia (p<0.001). Antipsychotic review reduced antipsychotic use, but it significantly increased apathy (β=5.37; SE=0.91; p<0.001). However, antipsychotic review in combination with either social interaction (β=-5.84; SE=1.15; p<0.001) or exercise (β=-7.54; SE=0.93; p<0.001) significantly reduced apathy. Conclusions: Antipsychotic review can play a significant role in improving apathy in people with dementia living in nursing homes, when combined with psychosocial interventions such as social interaction and exercise. Guidance must be adapted to reflect this subtlety in care.
Citation
Rajkumar, A. P., Ballard, C., Fossey, J., Corbett, A., Woods, B., Orrell, M., Prakash, R., Moniz-Cook, E., & Testad, I. (2016). Apathy and its response to antipsychotic review and non-pharmacological interventions in people with dementia living in nursing homes : WHELD, A factorial cluster randomised controlled trial. Journal of the American Medical Directors Association, 17(8), 741-747. https://doi.org/10.1016/j.jamda.2016.04.006
Acceptance Date | May 12, 2016 |
---|---|
Publication Date | 2016-08 |
Deposit Date | May 23, 2016 |
Publicly Available Date | Aug 31, 2016 |
Journal | Journal of the American Medical Directors Association |
Print ISSN | 1525-8610 |
Publisher | Elsevier |
Peer Reviewed | Peer Reviewed |
Volume | 17 |
Issue | 8 |
Pages | 741-747 |
DOI | https://doi.org/10.1016/j.jamda.2016.04.006 |
Keywords | Apathy; Dementia; Randomized controlled trial |
Public URL | https://hull-repository.worktribe.com/output/438495 |
Publisher URL | http://www.jamda.com/article/S1525-8610(16)30091-3/abstract |
Additional Information | Authors' accepted manuscript of article published in: Journal of the American Medical Directors Association, 2016, v.17, issue 8. |
Contract Date | May 23, 2016 |
Files
Article.pdf
(651 Kb)
PDF
Copyright Statement
© 2017. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/
You might also like
Downloadable Citations
About Repository@Hull
Administrator e-mail: repository@hull.ac.uk
This application uses the following open-source libraries:
SheetJS Community Edition
Apache License Version 2.0 (http://www.apache.org/licenses/)
PDF.js
Apache License Version 2.0 (http://www.apache.org/licenses/)
Font Awesome
SIL OFL 1.1 (http://scripts.sil.org/OFL)
MIT License (http://opensource.org/licenses/mit-license.html)
CC BY 3.0 ( http://creativecommons.org/licenses/by/3.0/)
Powered by Worktribe © 2025
Advanced Search