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Impact of antipsychotic review and non‐pharmacological intervention on health‐related quality of life in people with dementia living in care homes: WHELD—a factorial cluster randomised controlled trial

Ballard, Clive; Orrell, Martin; Sun, Yongzhong; Moniz-Cook, Esme; Stafford, Jane; Whitaker, Rhiannon; Woods, Bob; Corbett, Anne; Banerjee, Sube; Testad, Ingelin; Garrod, Lucy; Khan, Zunera; Woodward-Carlton, Barbara; Wenborn, Jennifer; Fossey, Jane

Authors

Clive Ballard

Martin Orrell

Yongzhong Sun

Professor Esme Moniz-Cook E.D.Moniz-Cook@hull.ac.uk
Professor of Clinical Psychology of Ageing and Dementia Care Research/ Dementia Research Work Group Lead

Jane Stafford

Rhiannon Whitaker

Bob Woods

Anne Corbett

Sube Banerjee

Ingelin Testad

Lucy Garrod

Zunera Khan

Barbara Woodward-Carlton

Jennifer Wenborn

Jane Fossey



Abstract

Background: Very 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. Methods: Analysis 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. Results: Data 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) Conclusions: This 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 emphasizing the importance of providing evidence-based non-pharmacological interventions in conjunction with antipsychotic review.

Publication Date 2017-10
Journal International journal of geriatric psychiatry
Print ISSN 0885-6230
Electronic ISSN 1099-1166
Publisher Wiley
Peer Reviewed Peer Reviewed
Volume 32
Issue 10
Pages 1094-1103
APA6 Citation Ballard, C., Orrell, M., Sun, Y., Moniz-Cook, E., Stafford, J., Whitaker, R., …Fossey, J. (2017). Impact of antipsychotic review and non‐pharmacological intervention on health‐related quality of life in people with dementia living in care homes: WHELD—a factorial cluster randomised controlled trial. International journal of geriatric psychiatry, 32(10), 1094-1103. https://doi.org/10.1002/gps.4572
DOI https://doi.org/10.1002/gps.4572
Keywords Antipsychotic review
Publisher URL http://onlinelibrary.wiley.com/doi/10.1002/gps.4572/abstract;jsessionid=F918453788DF1BB2E3B40084EE2B35E0.f03t02
Copyright Statement ©2017 University of Hull
Additional Information This is the peer reviewed version of the following article: Ballard, C., Orrell, M., Sun, Y., Moniz-Cook, E., Stafford, J., Whitaker, R., Woods, B., Corbett, A., Banerjee, S., Testad, I., Garrod, L., Khan, Z., Woodward-Carlton, B., Wenborn, J., and Fossey, J. (2016) Impact of antipsychotic review and non-pharmacological intervention on health-related quality of life in people with dementia living in care homes: WHELD—a factorial cluster randomised controlled trial. Int J Geriatr Psychiatry, which has been published in final form at doi: 10.1002/gps.4572. This article may be used for non-commercial purposes in accordance With Wiley Terms and Conditions for self-archiving.

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