title: Impact of antipsychotic review and non-pharmacological intervention on health-related quality of life in people with dementia living in care homes: WHELD-a factorial cluster randomised controlled trial.
abstract: BACKGROUND
  Very few interventional studies have directly examined the impact of treatment approaches on health-related quality of life (HRQL) in people with dementia. This is of particular importance in therapies to address behavioural symptoms, where HRQL is often severely affected.
  
  
  METHODS
  Analysis within the WHELD cluster randomised factorial study in 16 UK care homes examining the impact of person-centred care in combination with antipsychotic review, social interaction and exercise interventions. This study analysed impact on HRQL through the DEMQOL-Proxy.
  
  
  RESULTS
  Data on HRQL were available for 187 participants. People receiving antipsychotic review showed a significant worsening in two DEMQOL-Proxy domains (negative emotion: p = 0.02; appearance: p = 0.04). A best-case scenario analysis showed significant worsening for total DEMQOL-Proxy score. Social interaction intervention resulted in a significant benefit to HRQL (p = 0.04). There was no deterioration in HRQL in groups receiving both antipsychotic review and social interaction (p = 0.62).
  
  
  CONCLUSIONS
  This demonstrates an important detrimental impact of discontinuation of antipsychotics in dementia on HRQL, highlighting the need for careful review of best practice guidelines regarding antipsychotic use and emphasising the importance of providing evidence-based non-pharmacological interventions in conjunction with antipsychotic review. Copyright © 2016 John Wiley & Sons, Ltd.
authors.affiliation: Wolfson Centre for Age-Related Diseases, King's College London, London, UK.
authors.forename: Clive
authors.initials: C
authors.lastname: Ballard
authors.affiliation: Institute of Mental Health, University of Nottingham, Nottingham, UK.
authors.forename: Martin
authors.initials: M
authors.lastname: Orrell
authors.affiliation: North Wales Organisation for Randomised Trials in Health, Bangor University, Bangor, UK.
authors.forename: Yongzhong
authors.initials: Y
authors.lastname: Sun
authors.affiliation: Faculty of Health and Social Sciences, University of Hull, Hull, UK.
authors.forename: Esme
authors.initials: E
authors.lastname: Moniz-Cook
authors.affiliation: NIHR CLAHRC South London, King's College London, London, UK.
authors.forename: Jane
authors.initials: J
authors.lastname: Stafford
authors.affiliation: Whitaker Research Ltd., Bangor, UK.
authors.forename: Rhiannon
authors.initials: R
authors.lastname: Whitaker
authors.affiliation: DSDC Wales, Bangor University, Bangor, UK.
authors.forename: Bob
authors.initials: B
authors.lastname: Woods
authors.affiliation: Wolfson Centre for Age-Related Diseases, King's College London, London, UK.
authors.forename: Anne
authors.initials: A
authors.lastname: Corbett
authors.affiliation: Centre for Dementia Studies, Brighton and Sussex Medical School, Brighton, UK.
authors.forename: Sube
authors.initials: S
authors.lastname: Banerjee
authors.affiliation: Centre for Age-Related Medicine (SESAM), Stavanger University, Stavanger, Norway.
authors.forename: Ingelin
authors.initials: I
authors.lastname: Testad
authors.affiliation: Oxford Health NHS Foundation Trust, Oxford, UK.
authors.forename: Lucy
authors.initials: L
authors.lastname: Garrod
authors.affiliation: Wolfson Centre for Age-Related Diseases, King's College London, London, UK.
authors.forename: Zunera
authors.initials: Z
authors.lastname: Khan
authors.affiliation: Alzheimer's Society Research Network, Alzheimer's Society, London, UK.
authors.forename: Barbara
authors.initials: B
authors.lastname: Woodward-Carlton
authors.affiliation: Division of Psychiatry, University College London, London, UK.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Wenborn
authors.affiliation: Oxford Health NHS Foundation Trust, Oxford, UK.
authors.forename: Jane
authors.initials: J
authors.lastname: Fossey
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D016000:Cluster Analysis; D003704:Dementia / Q000175:diagnosis / Q000628:therapy*; D005081:Exercise Therapy / Q000379:methods; D005260:Female; D006304:Health Status; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D009735:Nursing Homes / Q000706:statistics & numerical data*; D009629:Person-Centered Psychotherapy / Q000379:methods; D011788:Quality of Life; D012960:Socioenvironmental Therapy / Q000379:methods*
chemical_list: D014150:Antipsychotic Agents
keywords: antipsychotic review; care homes; dementia; psychosocial; quality of life