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How do people with dementia make sense of their medications? An interpretative phenomenological analysis study
- Authors:
- LIM Rosemary H. M., SHARMEEN Taniya, DONYAI Parastou
- Journal article citation:
- International Journal of Geriatric Psychiatry, 37(2), 2022,
- Publisher:
- Wiley
Background: Managing medication is complex and multifaceted for people with dementia and their family carers. Despite efforts to support medication management, medication errors and medication-related hospital admissions still occur. This study investigated how people with dementia viewed and talked about their different medications and their medication taking. Methods: An interpretative phenomenological analysis (IPA) qualitative research design combining photo elicitation and in-depth interviews was used. People with a diagnosis of mild or moderate dementia took photographs of anything they viewed to be related to medication, with or without the help of family carers, over any two-day period. The photographs were then used as cues for subsequent in-depth interviews, which were analysed using IPA. Results: Twelve people with dementia were interviewed. Four themes encapsulated the experiences: (1) Medication as a lifeline, (2) Managing medications dominates daily lives and plans, (3) Struggling with uncertainty about the effectiveness of dementia medication and (4) Sense of ‘being’ and being in control. People with dementia viewed medication as a lifeline, especially donepezil, giving it preference over other daily medication they were using. Managing medications dominated the daily lives and plans of people with dementia and changed the way they viewed themselves and their life. People with dementia continually struggled with the imperceptible benefits of donepezil on their dementia, but despite such uncertainties, continued to take donepezil. Conclusions: This study provided unique insights into how people with dementia made sense of their medication. Healthcare professionals can use these insights to shape their practice around medication prescribing and advice in dementia. The findings are also useful to researchers looking to develop interventions to support medication management within the home setting. (Edited publisher abstract)
Predictors of depression among older adults with dementia
- Authors:
- STROUD Jason M., STEINER Victoria, IWUAGWA Cletus
- Journal article citation:
- Dementia: the International Journal of Social Research and Practice, 7(1), February 2008, pp.127-138.
- Publisher:
- Sage
Dementia and depression are common disorders among elderly populations. Their frequent co-morbidity and similar presentations create a complex clinical scenario for the health care professional. The objective of this study was to determine common characteristics of older adults with dementia that were associated with depression. Data from a retrospective chart review of 242 patients visiting an outpatient geriatric clinic were analyzed to determine the potential relationship between depression and several social- and health-related variables. Results from regression analysis show that taking greater numbers of medications and living in a less independent environment were both associated with greater depression, while using alcohol was associated with less depression. This information could be easily obtained during an office visit and used to help identify patients who suffer from dementia and are at risk for depression and require further evaluation.
Communal confusion
- Authors:
- POWER-SMITH Parsley, EVANS Mary
- Journal article citation:
- Nursing Times, 8.9.93, 1993, pp.26-28.
- Publisher:
- Nursing Times
Highlights some of the difficulties in ensuring that older people with dementia living in the community take their medications properly.
Added responsibility
- Authors:
- POWER-SMITH Parsley, EVANS Mary
- Journal article citation:
- Community Care, 20.8.92, 1992, p.21,23.
- Publisher:
- Reed Business Information
Home care workers often have to give drugs to elderly people with dementia. Looks at the authors' survey of current practices in two home care areas of Sheffield to see if they could improve anything.
Pharmacist‐led medication reviews in aged care residents with dementia: a systematic review
- Authors:
- McDERBY Nicole, et al
- Journal article citation:
- Australasian Journal on Ageing, 39(4), 2020, Online only
- Publisher:
- John Wiley and Sons
Objectives: To evaluate outcomes associated with pharmacist‐led medication reviews in residential aged care facility (RACF) residents with dementia. Methods: Six scientific databases were searched. All study designs investigating pharmacist‐led medication reviews in RACF residents with dementia were considered. The protocol was registered with PROSPERO (CRD42019121681). Results: One randomised controlled trial (RCT) and five observational studies were identified. Two studies reported reductions in medication usage per resident, and one study reported improved appropriateness of psychotropic use following reviews as part of multi‐faceted, collaborative interventions. In three studies, reviews undertaken as an isolated intervention or by a visiting pharmacist with minimal collaboration with physicians were associated with low implementation rates of recommendations to alter therapy. Conclusion: Pharmacist‐led medication reviews, when conducted collaboratively, may improve the use of medicines in RACF residents with dementia. However, robust conclusions cannot be drawn, largely due to the low quality of evidence available, including only one RCT. (Edited publisher abstract)
Exploring the prevalence of and factors associated with pain: a cross-sectional study of community-dwelling people with dementia
- Authors:
- BARRY Heather E., et al
- Journal article citation:
- Health and Social Care in the Community, 24(3), 2016, pp.270-282.
- Publisher:
- Wiley
The aim of this study was to determine the prevalence of pain among this community-dwelling people with dementia (PWD) and to explore medication use. It also sought to investigate patient and caregiver variables associated with the presence of pain. Community-dwelling PWD and their caregivers were recruited between May 2009 and July 2012 from outpatient memory clinics in Northern Ireland to take part in a face-to-face structured interview with a researcher. Patients' cognitive status and presence of depression were established. A full medication history was taken. Both patients and caregivers were asked to rate patients' pain, at the time of the interview and on an average day, using a 7-point verbal descriptor scale. From the 206 patients who were eligible to take part, 75 patient–caregiver dyads participated in the study (participation rate = 36.4%). The majority of patients (92.0%) had dementia classed as mild or moderate. Pain was commonly reported among the sample, with 57.3% of patients and 70.7% of caregivers reporting patient pain on an average day. Significant differences were found between patients' and caregivers' reports of pain. Two-fifths of patients (40.0%) were prescribed analgesia. Antipsychotic, hypnotic and anxiolytic drug use was low, whereas antidepressant drugs were prescribed more commonly. Presence of pain was unaffected by dementia severity; however, the use of prescribed analgesic medication was a significant predictor of the presence of pain in these patients, whether reported by the patient or their caregiver ‘right now’ or ‘on an average day’. Patient and caregiver recruitment was challenging, and remains a barrier to research in this area in the future. (Edited publisher abstract)
Creating a community-based memory clinic for older people
- Authors:
- GRIZZELL Moganeswari, et al
- Journal article citation:
- Nursing Times, 11.07.06, 2006, pp.32-34.
- Publisher:
- Nursing Times
This article describes the development of a multi-disciplinary, nurse-led memory clinic. The clinic has grown out of research activity to become an important component of a community service for older people with dementia and other mental health problems. A detailed analysis of the interaction between the clinic and the community mental health team, as practised in this model of care, is presented for consideration.
Voyage of discovery
- Authors:
- McGREGOR Iain, BELL Janet
- Journal article citation:
- Nursing Times, 8.9.93, 1993, pp.29-31.
- Publisher:
- Nursing Times
Argues that people with dementia retain their basic personalities and should be allowed to 'rediscover' themselves without being constantly sedated.
Fact Box decision support tools reduce decisional conflict about antibiotics for pneumonia and artificial hydration in advanced dementia: a randomized controlled trail
- Authors:
- LOIZEAU Andrea J., et al
- Journal article citation:
- Age and Ageing, 48(1), 2019, pp.67-74.
- Publisher:
- Oxford University Press
Background: Fact Boxes are decision support tools that can inform about treatment effects. Objectives: To test whether Fact Box decision support tools impacted decisional conflict, knowledge and preferences about the use of antibiotics and artificial hydration in advanced dementia. Design: Randomized controlled trial. Setting: Swiss-German region of Switzerland. Subjects: Two hundred thirty-two participants (64 physicians, 100 relatives of dementia patients, 68 professional guardians) randomly allocated to intervention (N = 114) or control (N = 118). Intervention: Two-page Fact Box decision support tools on antibiotics for pneumonia and artificial hydration in advanced dementia (at 1-month). Methods: Participants were mailed questionnaires at baseline and one month later that asked questions about treatments based on hypothetical scenarios. The primary outcome was change in decisional conflict (DCS-D; range 0 < 100) about treatment decisions. Secondary outcomes included knowledge about treatments (range 0 < 7) and preferences to forego treatments. Results: Participants were: mean age, 55.6 years; female, 62.8%. Relative to control participants, intervention participants experienced less decisional conflict about using antibiotics (unstandardized beta (b) = −8.35, 95% Confidence Interval (CI), −12.43, −4.28) and artificial hydration (b = −6.02, 95% CI, −9.84, −2.20) at 1-month compared to baseline. Intervention participants displayed greater knowledge about the use of antibiotics (b = 2.24, 95% CI, 1.79, 2.68) and artificial hydration (b = 3.01, 95% CI, 2.53, 3.49), and were significantly more likely to prefer to forego antibiotics (odds ratio, 2.29, 95% CI, 1.08, 4.84) but not artificial hydration. Conclusions: Fact Box decision support tools reduced decisional conflict, increased knowledge and promoted preferences to forego antibiotics in advanced dementia among various decision-makers. (Publisher abstract)
Reducing antipschotic drugs in care homes
- Authors:
- PRENTICE Aileen, WRIGHT David
- Journal article citation:
- Nursing Times, 110(23), 2014, pp.12-15.
- Publisher:
- Nursing Times
Anti-psychotic medication should be used in people with dementia only when there is an identified need ad the benefits outweigh the risks. An audit-based service provided by pharmacists, working with nursing and care staff in residential home, resulted in antipsychotic doses reductions of 20% and drug discontinuation in 17% of residents with dementia. (Publisher abstract)