Clive Ballard1, Martin Orrell2, Yongzhong Sun3, Esme Moniz-Cook4, Jane Stafford5, Rhiannon Whitaker6, Bob Woods7, Anne Corbett1, Sube Banerjee8, Ingelin Testad9, Lucy Garrod10, Zunera Khan1, Barbara Woodward-Carlton11, Jennifer Wenborn12, Jane Fossey10. 1. Wolfson Centre for Age-Related Diseases, King's College London, London, UK. 2. Institute of Mental Health, University of Nottingham, Nottingham, UK. 3. North Wales Organisation for Randomised Trials in Health, Bangor University, Bangor, UK. 4. Faculty of Health and Social Sciences, University of Hull, Hull, UK. 5. NIHR CLAHRC South London, King's College London, London, UK. 6. Whitaker Research Ltd., Bangor, UK. 7. DSDC Wales, Bangor University, Bangor, UK. 8. Centre for Dementia Studies, Brighton and Sussex Medical School, Brighton, UK. 9. Centre for Age-Related Medicine (SESAM), Stavanger University, Stavanger, Norway. 10. Oxford Health NHS Foundation Trust, Oxford, UK. 11. Alzheimer's Society Research Network, Alzheimer's Society, London, UK. 12. Division of Psychiatry, University College London, London, UK.
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 withantipsychotic 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 emphasising the importance of providing evidence-based non-pharmacological interventions in conjunction with antipsychotic review.
RCT Entities:
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 emphasising the importance of providing evidence-based non-pharmacological interventions in conjunction with antipsychotic review.
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