Improving skilled care means less medication
It is estimated that as few as 36,000 of the 180,000 people with dementia prescribed antipsychotics in the UK actually receive any benefit from them, while inappropriate prescribing leads to up to 1,800 extra deaths each year.
Much of this medication is given to people living in care homes, so it is important that care homes have the necessary skills and knowledge to deliver good quality care without excess sedation.
Based on research funded by the Big Lottery and conducted by Professors Ballard and Howard at King’s College London with Dr Jane Fossey of the University of Oxford and Oxford Health Foundation NHS Trust and Dr Ian James of Newcastle University, the FITS (Focussed Intervention Training and Support) programme was developed to enable care home staff to deliver effective care for people with dementia in place of inappropriate medication, providing instead person-centred approaches and evidenced- based psychosocial interventions.
The researchers ran a cluster randomised controlled trial and found that using the FITS programme meant a 40% reduction in prescribing of antipsychotics for people with dementia. They published a manual for practice and provided the basis for much of the advice in the Alzheimer’s Society Guidance (2011) on helping people with Behavioural and Psychological Symptoms of Dementia. The findings also influenced the development of the British Psychological Society guidance on alternatives to antipsychotic medication.
Alzheimer’s Society subsequently funded the researchers to work with Professor Dawn Brooker and her team at the University of Worcester to develop the FITS into Practice Programme to deliver the programme across a large number of care homes. Staff designated as Dementia Care Coaches (DCCs), who were responsible for implementing interventions in 1 or 2 care homes, participated in an in depth ten-day education course in person-centred care over a three-month period, followed by 6 supervision sessions.
The researchers evaluated the interventions by monitoring prescriptions of anti-psychotic drugs, knowledge, attitudes and how well the techniques were being implemented. They also produced some case studies and looked at reflective journals kept by some of those taking part.
Participants demonstrated better knowledge and improved attitudes to dementia, resulting in 31% less inappropriate anti- psychotic prescribing.
The National Institute for Health Research (NIHR) funded the Oxford and King’s College London teams to optimise and update the FITS methods in two randomised control trials (WHELD study). The initial findings show a 50% reduction in prescribing and a 36% reduction in mortality for those people who received a combined package of drug review and social intervention.
As a result the 2011 Alzheimer’s Society guidelines have been revised and new ones will be available in 2016.