Dementia Beyond Drugs - Almacasa · If 70-80% of adults living with dementia are outside of care...
Transcript of Dementia Beyond Drugs - Almacasa · If 70-80% of adults living with dementia are outside of care...
![Page 1: Dementia Beyond Drugs - Almacasa · If 70-80% of adults living with dementia are outside of care homes, there are probably over 500,000 Americans with dementia taking antipsychotics](https://reader033.fdocuments.us/reader033/viewer/2022042920/5f656605ebe7eb40010985eb/html5/thumbnails/1.jpg)
Dementia Beyond Drugs Supporting Well-Being for People with Changing Cognitive Abilities
G. Allen Power, MD, FACPDemenz Symposium
16 April, 2019
![Page 2: Dementia Beyond Drugs - Almacasa · If 70-80% of adults living with dementia are outside of care homes, there are probably over 500,000 Americans with dementia taking antipsychotics](https://reader033.fdocuments.us/reader033/viewer/2022042920/5f656605ebe7eb40010985eb/html5/thumbnails/2.jpg)
Perspectives
„Die einzig wahre Entdeckungsreise. . . wäre nicht, fremde Länder zu besuchen, sondern andere Augen zu haben, das Universum durch die Augen eines anderen zu sehen, von hundert anderen, um die hundert Universen zu sehen, die jeder von ihnen sieht, die jeder von ihnen ist. . . ”
- Marcel Proust
![Page 3: Dementia Beyond Drugs - Almacasa · If 70-80% of adults living with dementia are outside of care homes, there are probably over 500,000 Americans with dementia taking antipsychotics](https://reader033.fdocuments.us/reader033/viewer/2022042920/5f656605ebe7eb40010985eb/html5/thumbnails/3.jpg)
Meine Geschichte
![Page 4: Dementia Beyond Drugs - Almacasa · If 70-80% of adults living with dementia are outside of care homes, there are probably over 500,000 Americans with dementia taking antipsychotics](https://reader033.fdocuments.us/reader033/viewer/2022042920/5f656605ebe7eb40010985eb/html5/thumbnails/4.jpg)
My Entry into this Work:Reducing Antipsychotic
DrugsØ U.S. sales, (20002014): $5.4 billion
~$20 billion (60 million prescriptions) Ø #2 drug sold in the US in 2015 was Abilify
(aripiprazole): US$7.2BØ 29% of US prescriptions dispensed by
long-term care pharmacies in 2011Ø Overall, 14.6% of all people in US care
homes are taking antipsychotics—down
from (23.9%) at beginning of initiative in
2012Ø This still means 20 - 25% of those with a
diagnosis of dementia are being given
antipsychotic meds (maybe more, due to
labelling and “drug diversion”).
![Page 5: Dementia Beyond Drugs - Almacasa · If 70-80% of adults living with dementia are outside of care homes, there are probably over 500,000 Americans with dementia taking antipsychotics](https://reader033.fdocuments.us/reader033/viewer/2022042920/5f656605ebe7eb40010985eb/html5/thumbnails/5.jpg)
Global Perspective on Antipsychotics in Care Homes
Australia (2010, 2011): ~33%
NZ (Hawkes Bay 2005, BUPA 2009): residential
care—17/15%, private hospital—30/24%,
‘dementia unit’—60/54%
Survey of care homes in eight European
countries (2014): avg. 32% (Range 12% - 54%)
Health Quality Ontario (2015): 28.8% (Range 0%
– 67.2%)
Worldwide, in most industrialised nations, with a
diagnosis of dementia: ~25-35%
![Page 6: Dementia Beyond Drugs - Almacasa · If 70-80% of adults living with dementia are outside of care homes, there are probably over 500,000 Americans with dementia taking antipsychotics](https://reader033.fdocuments.us/reader033/viewer/2022042920/5f656605ebe7eb40010985eb/html5/thumbnails/6.jpg)
THE “BIG SECRET”:
Antipsychotic overuse is not a residential care problem!
![Page 7: Dementia Beyond Drugs - Almacasa · If 70-80% of adults living with dementia are outside of care homes, there are probably over 500,000 Americans with dementia taking antipsychotics](https://reader033.fdocuments.us/reader033/viewer/2022042920/5f656605ebe7eb40010985eb/html5/thumbnails/7.jpg)
Antipsychotic overuse outside of residential care
Care home data can be tracked, so they get all the attention
Limited data suggests the problem may be even greater in the community (US-HHS report: 14% of 1 million community-dwelling Medicare beneficiaries with dementia)
If 70-80% of adults living with dementia are outside of care homes, there are probably over 500,000 Americans with dementia taking antipsychotics in the community (vs. ~180,000 in nursing homes)
This pattern is likely true in other industrialised countries as well
Our approach to dementia reflects more universal societal attitudes
![Page 8: Dementia Beyond Drugs - Almacasa · If 70-80% of adults living with dementia are outside of care homes, there are probably over 500,000 Americans with dementia taking antipsychotics](https://reader033.fdocuments.us/reader033/viewer/2022042920/5f656605ebe7eb40010985eb/html5/thumbnails/8.jpg)
The ‘Pill Paradigm’
This comes from deep-seated societal patterns and beliefs:
- Stigma
- Ageism and able-ism
- Desire for the ‘quick fix’
- Relentless marketing of pharmaceuticals as the answer to our needs
. . . All fueled by a narrow biomedical view of dementia
![Page 9: Dementia Beyond Drugs - Almacasa · If 70-80% of adults living with dementia are outside of care homes, there are probably over 500,000 Americans with dementia taking antipsychotics](https://reader033.fdocuments.us/reader033/viewer/2022042920/5f656605ebe7eb40010985eb/html5/thumbnails/9.jpg)
The Biomedical Model of Dementia
![Page 10: Dementia Beyond Drugs - Almacasa · If 70-80% of adults living with dementia are outside of care homes, there are probably over 500,000 Americans with dementia taking antipsychotics](https://reader033.fdocuments.us/reader033/viewer/2022042920/5f656605ebe7eb40010985eb/html5/thumbnails/10.jpg)
Fallout from a Narrow Biomedical View
Looking to pills for well-being
Stigma Disempowerment
“Dementia Care”“BPSD”
![Page 11: Dementia Beyond Drugs - Almacasa · If 70-80% of adults living with dementia are outside of care homes, there are probably over 500,000 Americans with dementia taking antipsychotics](https://reader033.fdocuments.us/reader033/viewer/2022042920/5f656605ebe7eb40010985eb/html5/thumbnails/11.jpg)
An example of stigma:
Ed Voris’ story
![Page 12: Dementia Beyond Drugs - Almacasa · If 70-80% of adults living with dementia are outside of care homes, there are probably over 500,000 Americans with dementia taking antipsychotics](https://reader033.fdocuments.us/reader033/viewer/2022042920/5f656605ebe7eb40010985eb/html5/thumbnails/12.jpg)
Biggest Danger of Stigma
Self-Fulfilling Prophecies
Kate Swaffer
![Page 13: Dementia Beyond Drugs - Almacasa · If 70-80% of adults living with dementia are outside of care homes, there are probably over 500,000 Americans with dementia taking antipsychotics](https://reader033.fdocuments.us/reader033/viewer/2022042920/5f656605ebe7eb40010985eb/html5/thumbnails/13.jpg)
Old Thorazine Ad
How much have things really changed since then??
![Page 14: Dementia Beyond Drugs - Almacasa · If 70-80% of adults living with dementia are outside of care homes, there are probably over 500,000 Americans with dementia taking antipsychotics](https://reader033.fdocuments.us/reader033/viewer/2022042920/5f656605ebe7eb40010985eb/html5/thumbnails/14.jpg)
Do We Hold People Living with Dementia to a Higher Emotional Standard than
Ourselves??You and I People with Dementia
Walk, explore, do our “steps,” get bored and leave
“Wander,” “elope,” “exit-seek”
Get restless when forced into others’ rhythms
“Sundown”
Shop in bulk “Hoard”
Get angry, sad, anxious or frustrated
Exhibit “challenging behaviours”
Don’t like being locked up, bossed around or touched by strangers
Are “resistive,” “agitated,” or “aggressive”
![Page 15: Dementia Beyond Drugs - Almacasa · If 70-80% of adults living with dementia are outside of care homes, there are probably over 500,000 Americans with dementia taking antipsychotics](https://reader033.fdocuments.us/reader033/viewer/2022042920/5f656605ebe7eb40010985eb/html5/thumbnails/15.jpg)
The Problem with ‘BPSD’ Relegates people’s expressions to brain disease
Ignores relational, environmental, and historical factors
Pathologises normal expressions
Uses flawed systems of categorisation
Creates a slippery slope to drug use
Does not explain how drug use has been successfully eliminated in many care homes
Misapplies psychiatric labels, such as psychosis, delusions and hallucinations
Has led to inappropriate drug approvals in some countries
![Page 16: Dementia Beyond Drugs - Almacasa · If 70-80% of adults living with dementia are outside of care homes, there are probably over 500,000 Americans with dementia taking antipsychotics](https://reader033.fdocuments.us/reader033/viewer/2022042920/5f656605ebe7eb40010985eb/html5/thumbnails/16.jpg)
Words and Actions Usually Represent…
Unmet needs / Challenges to well-being*
Sensory Challenges*
New communication pathways*
Expressions of choice and preference*
New methods of interpreting and problem solving*
Response to physical or relational aspects of environment*
May be perfectly normal reactions, considering the circumstances!*
Expressions that threaten one’s dignity and personhood* (D. Greenwood: “Dignity distress”)
(*NO medication will help these!)
![Page 17: Dementia Beyond Drugs - Almacasa · If 70-80% of adults living with dementia are outside of care homes, there are probably over 500,000 Americans with dementia taking antipsychotics](https://reader033.fdocuments.us/reader033/viewer/2022042920/5f656605ebe7eb40010985eb/html5/thumbnails/17.jpg)
Shifting ParadigmsHow would you respond if you
were told:“Over 90% of people living with dementia will experience a BPSD during the course of their
illness.”
VS
“Over 90% of people living will dementia will find themselves in a situation in which their well-
being is not adequately supported.”
![Page 18: Dementia Beyond Drugs - Almacasa · If 70-80% of adults living with dementia are outside of care homes, there are probably over 500,000 Americans with dementia taking antipsychotics](https://reader033.fdocuments.us/reader033/viewer/2022042920/5f656605ebe7eb40010985eb/html5/thumbnails/18.jpg)
A New Model(Inspired by the “True Experts”…)
![Page 19: Dementia Beyond Drugs - Almacasa · If 70-80% of adults living with dementia are outside of care homes, there are probably over 500,000 Americans with dementia taking antipsychotics](https://reader033.fdocuments.us/reader033/viewer/2022042920/5f656605ebe7eb40010985eb/html5/thumbnails/19.jpg)
A New Approach Rests upon Three Pillars
‘Experiential model of dementia’
Well-being as a primary outcome
Transformation of the living/care environment
![Page 20: Dementia Beyond Drugs - Almacasa · If 70-80% of adults living with dementia are outside of care homes, there are probably over 500,000 Americans with dementia taking antipsychotics](https://reader033.fdocuments.us/reader033/viewer/2022042920/5f656605ebe7eb40010985eb/html5/thumbnails/20.jpg)
A New Definition
“Dementia is a shift in the way a person
experiences the world around her/him.”
![Page 21: Dementia Beyond Drugs - Almacasa · If 70-80% of adults living with dementia are outside of care homes, there are probably over 500,000 Americans with dementia taking antipsychotics](https://reader033.fdocuments.us/reader033/viewer/2022042920/5f656605ebe7eb40010985eb/html5/thumbnails/21.jpg)
Where This “Road” Leads…
From fatal disease to changing abilities From psychotropic medications to ‘ramps’ A path to continued growth An acceptance of the ‘new normal’ A directive to help fulfill universal human needs A challenge to our interpretations of distress A challenge to many of our long-accepted care
practices
![Page 22: Dementia Beyond Drugs - Almacasa · If 70-80% of adults living with dementia are outside of care homes, there are probably over 500,000 Americans with dementia taking antipsychotics](https://reader033.fdocuments.us/reader033/viewer/2022042920/5f656605ebe7eb40010985eb/html5/thumbnails/22.jpg)
A New Primary Goal:
Enhance Well-being
![Page 23: Dementia Beyond Drugs - Almacasa · If 70-80% of adults living with dementia are outside of care homes, there are probably over 500,000 Americans with dementia taking antipsychotics](https://reader033.fdocuments.us/reader033/viewer/2022042920/5f656605ebe7eb40010985eb/html5/thumbnails/23.jpg)
One Framework for ViewingWell-being
Identity (Identität) Connectedness (Beziehung) Security (Geborgenheit) Autonomy (Autonomie) Meaning (Zinn) Growth (Wachstum) Joy (Freude)
“The Eden Alternative Domains of Well-Being ”,℠Adapted by Power (2014)
![Page 24: Dementia Beyond Drugs - Almacasa · If 70-80% of adults living with dementia are outside of care homes, there are probably over 500,000 Americans with dementia taking antipsychotics](https://reader033.fdocuments.us/reader033/viewer/2022042920/5f656605ebe7eb40010985eb/html5/thumbnails/24.jpg)
Advantages of Focusing on
Well-Being
![Page 25: Dementia Beyond Drugs - Almacasa · If 70-80% of adults living with dementia are outside of care homes, there are probably over 500,000 Americans with dementia taking antipsychotics](https://reader033.fdocuments.us/reader033/viewer/2022042920/5f656605ebe7eb40010985eb/html5/thumbnails/25.jpg)
Helping Restore Well-Being for People Living with Dementia
![Page 26: Dementia Beyond Drugs - Almacasa · If 70-80% of adults living with dementia are outside of care homes, there are probably over 500,000 Americans with dementia taking antipsychotics](https://reader033.fdocuments.us/reader033/viewer/2022042920/5f656605ebe7eb40010985eb/html5/thumbnails/26.jpg)
So what does this have to do with “culture change”?
Everything!!
![Page 27: Dementia Beyond Drugs - Almacasa · If 70-80% of adults living with dementia are outside of care homes, there are probably over 500,000 Americans with dementia taking antipsychotics](https://reader033.fdocuments.us/reader033/viewer/2022042920/5f656605ebe7eb40010985eb/html5/thumbnails/27.jpg)
Why it matters…
No matter what new philosophy of care we embrace, if you bring it into an institutional system, the system will kill it, every time!
We need a pathway to operationalise the philosophy—to weave it into the fabric of our daily processes, policies and procedures.
That pathway is culture change.
![Page 28: Dementia Beyond Drugs - Almacasa · If 70-80% of adults living with dementia are outside of care homes, there are probably over 500,000 Americans with dementia taking antipsychotics](https://reader033.fdocuments.us/reader033/viewer/2022042920/5f656605ebe7eb40010985eb/html5/thumbnails/28.jpg)
Transformational Models of Care
Structural Operational
* Personal *
![Page 29: Dementia Beyond Drugs - Almacasa · If 70-80% of adults living with dementia are outside of care homes, there are probably over 500,000 Americans with dementia taking antipsychotics](https://reader033.fdocuments.us/reader033/viewer/2022042920/5f656605ebe7eb40010985eb/html5/thumbnails/29.jpg)
Checking the CowsWhy ‘Nonpharmacological
Interventions’ Do not Work!!
![Page 30: Dementia Beyond Drugs - Almacasa · If 70-80% of adults living with dementia are outside of care homes, there are probably over 500,000 Americans with dementia taking antipsychotics](https://reader033.fdocuments.us/reader033/viewer/2022042920/5f656605ebe7eb40010985eb/html5/thumbnails/30.jpg)
Why ‘Nonpharmacological Interventions’ Do not Work!
The typical “nonpharmacological intervention” is an attempt to provide person-centred care with a
biomedical mindset
Reactive, not proactive Discrete activities, often without underlying
meaning for the individual Not person-directed Not tied into domains of well-being Treated like doses of pills Superimposed upon the usual care
environment
![Page 31: Dementia Beyond Drugs - Almacasa · If 70-80% of adults living with dementia are outside of care homes, there are probably over 500,000 Americans with dementia taking antipsychotics](https://reader033.fdocuments.us/reader033/viewer/2022042920/5f656605ebe7eb40010985eb/html5/thumbnails/31.jpg)
One’s own home can be an institution…
Stigma Lack of education Lack of community / financial support Care partner stress and burnout Inability to flex rhythms to meet
individual needs Social isolation Overmedication in the home
![Page 32: Dementia Beyond Drugs - Almacasa · If 70-80% of adults living with dementia are outside of care homes, there are probably over 500,000 Americans with dementia taking antipsychotics](https://reader033.fdocuments.us/reader033/viewer/2022042920/5f656605ebe7eb40010985eb/html5/thumbnails/32.jpg)
Operationalising Domains of Well-Being:
A few simple (and not-so-simple) examples…
![Page 33: Dementia Beyond Drugs - Almacasa · If 70-80% of adults living with dementia are outside of care homes, there are probably over 500,000 Americans with dementia taking antipsychotics](https://reader033.fdocuments.us/reader033/viewer/2022042920/5f656605ebe7eb40010985eb/html5/thumbnails/33.jpg)
Example:Identity
‘Sundowning’, ‘Elopement’, and natural rhythms and activity patterns
![Page 34: Dementia Beyond Drugs - Almacasa · If 70-80% of adults living with dementia are outside of care homes, there are probably over 500,000 Americans with dementia taking antipsychotics](https://reader033.fdocuments.us/reader033/viewer/2022042920/5f656605ebe7eb40010985eb/html5/thumbnails/34.jpg)
Connectedness
Dedicated Staff Assignments
“It Takes A Community - A relationship-
centred approach to celebrating and
supporting old age”
(https://www.youtube.com/watch?v=IUJWFWXz-
wY)
Daniella Greenwood
(Former Strategy and
Innovation Manager)
![Page 35: Dementia Beyond Drugs - Almacasa · If 70-80% of adults living with dementia are outside of care homes, there are probably over 500,000 Americans with dementia taking antipsychotics](https://reader033.fdocuments.us/reader033/viewer/2022042920/5f656605ebe7eb40010985eb/html5/thumbnails/35.jpg)
Arcare Aged Care
36 residential care communities in Victoria, Queensland, and NSW
Some “sensitive care” areas for people living with dementia
Daniella Greenwood (former Strategy and Innovation Manager) – appreciative inquiry retreat with elders, staff and family members
Identified four main categories, including “connections”
Many comments highlighted the importance of continuous relationships
Began to formulate a pathway for dedicated staff assignments in all areas where people live with dementia
![Page 36: Dementia Beyond Drugs - Almacasa · If 70-80% of adults living with dementia are outside of care homes, there are probably over 500,000 Americans with dementia taking antipsychotics](https://reader033.fdocuments.us/reader033/viewer/2022042920/5f656605ebe7eb40010985eb/html5/thumbnails/36.jpg)
Arcare (cont.)
Staff education sessions Re-application process for all hands-on staff,
must work at least 3 shifts/week with the same 6-8 residents every time
Positive feedback from most staff and managers
Within 6 weeks, staff spending more time with elders, without sacrificing task completion
![Page 37: Dementia Beyond Drugs - Almacasa · If 70-80% of adults living with dementia are outside of care homes, there are probably over 500,000 Americans with dementia taking antipsychotics](https://reader033.fdocuments.us/reader033/viewer/2022042920/5f656605ebe7eb40010985eb/html5/thumbnails/37.jpg)
Arcare (cont.)
One early-adopting community (38 residents):
- 69% decrease in chest infections
- 90% decrease in pressure injuries
- 100% decrease in formal complaints from families
- 45% increase in family satisfaction
- Decrease in average day/evening personal care staff per person over a month from 28 5 or 6!!
![Page 38: Dementia Beyond Drugs - Almacasa · If 70-80% of adults living with dementia are outside of care homes, there are probably over 500,000 Americans with dementia taking antipsychotics](https://reader033.fdocuments.us/reader033/viewer/2022042920/5f656605ebe7eb40010985eb/html5/thumbnails/38.jpg)
Results (cont.)
25% reduction in skin tears 12.9% reduction in falls 2.92 kg average weight gain 51.6% reduction in PRN psychotropic
medication use
![Page 39: Dementia Beyond Drugs - Almacasa · If 70-80% of adults living with dementia are outside of care homes, there are probably over 500,000 Americans with dementia taking antipsychotics](https://reader033.fdocuments.us/reader033/viewer/2022042920/5f656605ebe7eb40010985eb/html5/thumbnails/39.jpg)
Results (cont.)
27.5% reduction in sick leave 50.2% reduction in staff turnover 19.8% increase in job satisfaction for
care aides 30% increase in job satisfaction for
nurses
![Page 40: Dementia Beyond Drugs - Almacasa · If 70-80% of adults living with dementia are outside of care homes, there are probably over 500,000 Americans with dementia taking antipsychotics](https://reader033.fdocuments.us/reader033/viewer/2022042920/5f656605ebe7eb40010985eb/html5/thumbnails/40.jpg)
Castle & Anderson, (2011, 2013)
Study 1: 2839 US care homes
- Significant decreases in pressure sores, restraints, urinary catheters, and pain in homes with >80% dedicated staff Study 2: 3941 US care homes
- Significantly fewer survey deficiencies in several ‘quality of care/life’ categories in homes with >85% dedicated staffing
- Follow-up study also showed significantly lower care aide turnover and absenteeism
![Page 41: Dementia Beyond Drugs - Almacasa · If 70-80% of adults living with dementia are outside of care homes, there are probably over 500,000 Americans with dementia taking antipsychotics](https://reader033.fdocuments.us/reader033/viewer/2022042920/5f656605ebe7eb40010985eb/html5/thumbnails/41.jpg)
Two studies(Kunik, et al. 2010; Morgan, et al. 2013)
Factors leading to ‘aggressive behavior’
Both studies found a major factor to be a decrease in consistency and quality of staff-elder relationships
![Page 42: Dementia Beyond Drugs - Almacasa · If 70-80% of adults living with dementia are outside of care homes, there are probably over 500,000 Americans with dementia taking antipsychotics](https://reader033.fdocuments.us/reader033/viewer/2022042920/5f656605ebe7eb40010985eb/html5/thumbnails/42.jpg)
Operationalising Well-BeingA Few More Examples
Preferred name, Evolving and bridging identity, Move-in process (Identity)
Knocking, Alarm removal (Security) Continual consent (Autonomy) Rituals (Meaning, Growth, and Joy) Opportunities to care and share wisdom,
Volunteerism (Meaning, Growth) Simple Pleasures (Joy)
![Page 43: Dementia Beyond Drugs - Almacasa · If 70-80% of adults living with dementia are outside of care homes, there are probably over 500,000 Americans with dementia taking antipsychotics](https://reader033.fdocuments.us/reader033/viewer/2022042920/5f656605ebe7eb40010985eb/html5/thumbnails/43.jpg)
A well-being approach can be used for both:
Ongoing support and care
Decoding distress
![Page 44: Dementia Beyond Drugs - Almacasa · If 70-80% of adults living with dementia are outside of care homes, there are probably over 500,000 Americans with dementia taking antipsychotics](https://reader033.fdocuments.us/reader033/viewer/2022042920/5f656605ebe7eb40010985eb/html5/thumbnails/44.jpg)
![Page 45: Dementia Beyond Drugs - Almacasa · If 70-80% of adults living with dementia are outside of care homes, there are probably over 500,000 Americans with dementia taking antipsychotics](https://reader033.fdocuments.us/reader033/viewer/2022042920/5f656605ebe7eb40010985eb/html5/thumbnails/45.jpg)
Filling the ‘Well-Being’ Glasses
![Page 46: Dementia Beyond Drugs - Almacasa · If 70-80% of adults living with dementia are outside of care homes, there are probably over 500,000 Americans with dementia taking antipsychotics](https://reader033.fdocuments.us/reader033/viewer/2022042920/5f656605ebe7eb40010985eb/html5/thumbnails/46.jpg)
The Key…
Turn your backs on the ‘behaviour’, and find the ‘ramps’
to well-being!
![Page 47: Dementia Beyond Drugs - Almacasa · If 70-80% of adults living with dementia are outside of care homes, there are probably over 500,000 Americans with dementia taking antipsychotics](https://reader033.fdocuments.us/reader033/viewer/2022042920/5f656605ebe7eb40010985eb/html5/thumbnails/47.jpg)
True Stories…
Angela Norman, DNP Arkansas Health Care
Foundation
![Page 48: Dementia Beyond Drugs - Almacasa · If 70-80% of adults living with dementia are outside of care homes, there are probably over 500,000 Americans with dementia taking antipsychotics](https://reader033.fdocuments.us/reader033/viewer/2022042920/5f656605ebe7eb40010985eb/html5/thumbnails/48.jpg)
Arkansas Health Care Foundation
Pilot study: Dr. Norman approached one organisation and asked to work with 4 homes who were struggling with antipsychotic use
She began to work with staff on enhancing well-being for all residents proactively and then shifting systems to support.
In 6 months, 3 out of 4 homes had a relative reduction of their antipsychotic rate of >60%, and increased staff satisfaction. All continue to improve, one now >80% relative reduction.
Angela: “I believe this proactive approach is the key. It has changed my practice!”
![Page 49: Dementia Beyond Drugs - Almacasa · If 70-80% of adults living with dementia are outside of care homes, there are probably over 500,000 Americans with dementia taking antipsychotics](https://reader033.fdocuments.us/reader033/viewer/2022042920/5f656605ebe7eb40010985eb/html5/thumbnails/49.jpg)
Arkansas (cont.)
Dr. Norman’s team took the Well-Being Approach to the 25 highest-prescribing homes in the state.
After six months, antipsychotics are reduced by a relative rate of 49% among these homes.
Team is supporting staff from ~100 homes across the state: Almost NO Geri-psych transfers in over 6 months!
Other states are asking Dr. Norman to come and teach the approach
RIA/Power to formally study approach in 2019
![Page 50: Dementia Beyond Drugs - Almacasa · If 70-80% of adults living with dementia are outside of care homes, there are probably over 500,000 Americans with dementia taking antipsychotics](https://reader033.fdocuments.us/reader033/viewer/2022042920/5f656605ebe7eb40010985eb/html5/thumbnails/50.jpg)
Dr. Richard Taylor
“People talk about person-centred care. But if the view of the person doesn't change, then centering on them actually makes it
worse.”