Lead investigator: Dr Joao Delgado
Institution: University of Exeter
Grant type: Junior fellowship
Duration: 30 months
Scientific title: Improving treatment of people with dementia and additional health conditions
Why did we fund this project?
Comments from members of our Research Network:
"This is a timely and important study which could lead to improved quality of life for people with dementia."
"Effective medication is key to a good quality of life and I fully support the drive to avoid the routine dispensing of prescriptions and a closer examination of current practice."
"A very comprehensive statement. I wholeheartedly support this."
What do we already know?
Effective prescribing of the right medications and avoiding those that are unnecessary are both key to enabling people living with dementia to live as well as possible. Many people with dementia also have other medical conditions that can impact their health, wellbeing, and decisions about care. Better information about the use of potentially inappropriate medicines would help to understand current practice and improve treatment, care and medical education.
Of people living with dementia in 2014, approximately 90% had other medical conditions noted in their medical records, in addition to dementia. About 40% of people living with dementia are prone to falls and 19% experience fractures. A review also showed that many people are affected by confusion. These negative events can be linked in part to inappropriate medications.
There are some recent standards of practice that have been produced to provide guidance for managing additional conditions in older people living with dementia. These standards identify combinations of drugs that are sometimes or always inappropriate in older people, and advise physicians to act when the drugs do more damage to the quality of life, than the expected benefits of the treatment.
What does this project involve?
The project will use data from GPs, carers and hospitals to study dementia alongside other medical conditions, and the prescribing of potentially inappropriate medications.
The researchers will also look at whether having a single doctor or healthcare professional leading a person’s care versus seeing multiple different doctors, and how this may be related to appropriate medication prescribing for people with dementia.
This project will determine whether people living with dementia are more likely to develop incontinence, have a fall or fracture, or be admitted as an emergency to hospital if they are prescribed inappropriate medications.
Dr Delgado and his colleagues will be in communication with the healthcare providers of the people with dementia and will feed back their findings in real time, measuring the effects of any changes in prescribing as the project continues.
Ultimately, the researchers would like to develop a better understanding of the effectiveness of the current systems in place to identify inappropriate medication prescribing for people with dementia, and suggest a new method to improve practice.
How will this benefit people with dementia?
Improving communication between different care staff and facilities, improved training of staff, medication reviews and timely access to specialist medical advice are now seen as key components for improving the care of people with dementia. To put these in to practice in the NHS we need recent data on the current levels of potentially inappropriate prescribing and the ill effect this could be having on people with dementia.
This project aims to address the data gap that exists in order to develop linked up information systems and drive change in treatment of medical conditions for people with dementia. Good quality treatment of other conditions alongside dementia is critical for achieving the best experience for people who have dementia, their family and carers.