PEARL Person-Centered Care Phase 2 report

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A new study of residents in specialised dementia care homes has confirmed a reduction, averaging 48 per cent, in the requirement for antipsychotic medication, together with dramatic reductions in usage of a range of other medications and a corresponding improvement in the wellbeing of participants.

Analysis of data from 16 homes in the PEARL specialised dementia care programme developed by Four Seasons Health Care found that on average across all participants, in addition to the reduction in antipsychotics use:

Medication to alleviate anxiety reduced by 40 per cent.
Depression score reduced in 30 per cent of residents while use of anti-depressant medication reduced by 19 per cent.
Requirement for medication to induce sleep reduced by 44 per cent.


A corresponding increase in wellbeing was measured among 46 per cent of residents.(*1) While 42 per cent gained weight, against the expectation that people living with dementia would lose weight.

Falls reduced by 25 per cent. Fall reduction may be attributed to increased alertness as a result of reduction of antipsychotics and other medications as well as improved wellbeing.

The only medication consistently to increase in use was for pain relief, which increased 10 per cent on average. As the use of antipsychotic medication has decreased in these homes, the use of analgesics increased (following assessment utilising the Abbey Pain Scale*2). This suggests pain may be under-recognised in dementia care. Typically on nursing units 40% of residents are taking analgesic medication. By contrast on typical dementia units, with a similar population profile, 0-10% of residents are taking analgesics.

The average of 48 per cent reduction in use of antipsychotics included the highest reduction of 84 per cent in one home. This is the second study of the outcomes from Four Seasons' specialised dementia units and it supports the findings of its initial study at eight other homes in 2010. The average reduction in antipsychotics use is in line with a reduction of 50 per cent recorded in the earlier study. The slight variance may be accounted for by the fact that some of the homes in the second study had started putting the specialised dementia care principles into practice when the study began and so had begun to experience a reduction in the need for antipsychotics.

Caroline Baker, Head of Quality & Dementia Care for Four Seasons Health Care said, "When people with dementia are showing distress reactions this may be due to them experiencing pain or discomfort, yet too often rather than trying to identify and relieve this symptom they are needlessly given antipsychotic drugs to calm them and keep them quiet. Reducing use of these drugs is a national priority. The consistent outcomes of the two studies in our dementia care homes provide confirmation that with better understanding of how to care for people with dementia we can reduce the need for antipsychotics together with a range of other medications and at the same time improve wellbeing."

A summary report , that includes details about the care that is provided to the patients, the training that the staff receive, and even the design of the facilities, can be download at: http://www.fshc.co.uk/binary/CFh.pdf


Notes:

* The study was conducted over two years and involved some 480 residents. The earlier study was also conducted over two years and involved some 240 residents.

* The reality of what reducing antipsychotic medication and improving wellbeing means in human terms is illustrated by this testimony by the wife of a resident at a PEARL specialised dementia care facility. "My husband was in bed for 16 months. The home took him off night medication first; then daytime medication. In a matter of weeks he was up and about. On the next visit we sat in the lounge eating breakfast together and he is much more aware and alert. The only medication he is on now is blood pressure tablets. It is remarkable."

* The ethos of PEARL (Positively Enriching And enhancing Residents Lives) is to see beyond the symptoms of dementia to appreciate the individuality of each resident and support them to continue to live their lives as closely as possible to the way that they always have. Care programmes are planned in consultation with the resident and key influencers of his or her care experience, including relatives, friends, staff, community clinicians and GPs. The programme uses a range of therapies in daily care including sensory rooms, music therapy, reminiscence therapy and memory. The PEARL home is designed with consideration of the impact of light, colour, contrast, texture, aroma and sound to assist the overall orientation of residents and create a balanced sensory stimulating environment.

* Staff training includes, new ways of thinking about dementia. For example, it challenges the mindset that someone with dementia may be seen as disabled or dysfunctional. Four Seasons has re-defined what the care industry has tended to term "challenging behaviour" and recognises that this often is a distress reaction. Trainees agree to spend a day experiencing how it may feel to be a resident in a care home where they may have their individuality and personality disregarded. They wear smeared glasses to impair their sight and earplugs to impair hearing. They have one arm immobilised and are left wearing wet incontinence pads. They are not addressed directly by name; are not given a choice about food or beverages; have tablets administered without explanation or warning and are ignored for long periods. Then they are given the contrasting experience of once again being treated an individual with communication needs, emotions and preferences as well as physical care needs.


*1 Wellbeing can be profiled against a set of measurement criteria including, for example, how the resident interacts; ability to communicate needs and choices; sense of purpose. Ref. Well-being – University of Bradford. The data for wellbeing is based on a smaller sample of 14 homes that measured wellbeing. However the findings are consistent with the earlier study.

*2 Abbey Pain Scale, ref.Abbey J; De Bellis, A; Piller, N; Esterman, A; Giles, L; Parker, D & Lowcay, B funded by the JH & JD Gunn Medical Research Foundation 1998-2002