This study measured the sedative load and use of sedative and psychotropic medications in older people with dementia living in six UK residential care homes. The sedative load model has been used previously to determine the sedative load for residents of long-term care wards, but this study is unique in using the model in settings where there is no clinician on-site.
Medication data were obtained concerning residents of care homes participating in the EVIDEM-End Of Life (EOL) study. Regular prescriptions were classified using the Anatomical Therapeutic Chemical classification system and individual sedative loads were calculated using the sedative load model.
Approximately one-third of residents were not given medications with sedative properties, and a significant proportion of residents had a low sedative load score. More than 10% of residents had a high sedative load score, and approximately two-thirds of residents were regularly prescribed one or more psychotropic medication(s). Antidepressants, predominantly SSRIs, were prescribed most frequently.
Sedative load scores were similar in all six care homes. Scores were lower than have been previously reported in studies of long-term care wards with on-site clinical support. The authors suggest that strategies to optimise drug therapy are required for residents with dementia in care homes that rely on clinicians external to the care home for support and medication review.
This study found a lack of standardised diagnosis and staging of dementia in residential care home residents. One-quarter of patients did not have a diagnosis of dementia in their care home notes, although demonstrating cognitive impairment indicative of dementia. None of the six care homes recorded the severity of dementia in residents’ care notes. Accurate and standardised diagnosis and staging of dementia is recommended by the authors of this study for residential care homes, to help ensure residents will receive appropriate and timely care.
Parsons, C. Haydock, J. [and] Mathie, E. [et al] (2011). Sedative load of medications prescribed for older people with dementia in care homes. BMC Geriatrics, September 30th 2011, Vol.11(1), pp.1-3356. (Click here to view the PubMed abstract).