Exploring antipsychotic prescribing behaviors for nursing home residents with dementia: a qualitative study

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dc.contributor.author Walsh, Kieran A.
dc.contributor.author Sinnott, Carol
dc.contributor.author Fleming, Aoife
dc.contributor.author Mc Sharry, Jenny
dc.contributor.author Byrne, Stephen
dc.contributor.author Browne, John
dc.contributor.author Timmons, Suzanne
dc.date.accessioned 2018-11-27T11:58:24Z
dc.date.available 2018-11-27T11:58:24Z
dc.date.issued 2018-11
dc.identifier.citation Walsh, K. A., Sinnott, C., Fleming, A., Mc Sharry, J., Byrne, S., Browne, J. and Timmons, S. (2018) 'Exploring Antipsychotic Prescribing Behaviors for Nursing Home Residents With Dementia: A Qualitative Study', Journal of the American Medical Directors Association, 19(11), pp. 948-958.e12. doi: 10.1016/j.jamda.2018.07.004 en
dc.identifier.volume 19 en
dc.identifier.issued 11 en
dc.identifier.startpage 948 en
dc.identifier.endpage 958.e12 en
dc.identifier.issn 1525-8610
dc.identifier.uri http://hdl.handle.net/10468/7151
dc.identifier.doi 10.1016/j.jamda.2018.07.004
dc.description.abstract Objectives: Caution is advised when prescribing antipsychotics to people with dementia. This study explored the determinants of appropriate, evidence-based antipsychotic prescribing behaviors for nursing home residents with dementia, with a view to informing future quality improvement efforts and behavior change interventions. Design: Semistructured qualitative interviews based on the Theoretical Domains Framework (TDF). Setting and Participants: A purposive sample of 27 participants from 4 nursing homes, involved in the care of nursing home residents with dementia (8 nurses, 5 general practitioners, 5 healthcare assistants, 3 family members, 2 pharmacists, 2 consultant geriatricians, and 2 consultant psychiatrists of old age) in a Southern region of Ireland. Measures: Using framework analysis, the predominant TDF domains and determinants influencing these behaviors were identified, and explanatory themes developed. Results: Nine predominant TDF domains were identified as influencing appropriate antipsychotic prescribing behaviors. Participants’ effort to achieve “a fine balance” between the risks and benefits of antipsychotics was identified as the cross-cutting theme that underpinned many of the behavioral determinants. On one hand, neither healthcare workers nor family members wanted to see residents over-sedated and without a quality of life. Conversely, the reality of needing to protect staff, family members, and residents from potentially dangerous behavioral symptoms, in a resource-poor environment, was emphasized. The implementation of best-practice guidelines was illustrated through 3 explanatory themes (“human suffering”; “the interface between resident and nursing home”; and “power and knowledge: complex stakeholder dynamics”), which conceptualize how different nursing homes strike this “fine balance.” Conclusions: Implementing evidence-based antipsychotic prescribing practices for nursing home residents with dementia remains a significant challenge. Greater policy and institutional support is required to help stakeholders strike that “fine balance” and ultimately make better prescribing decisions. This study has generated a deeper understanding of this complex issue and will inform the development of an evidence-based intervention. en
dc.format.mimetype application/pdf en
dc.language.iso en en
dc.publisher Elsevier en
dc.relation.uri http://www.sciencedirect.com/science/article/pii/S1525861018303864
dc.rights © 2018 AMDA - The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier. This preprint manuscript version is made available under the CC-BY-NC-ND 4.0 license. en
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/ en
dc.subject Theoretical Domains Framework (TDF) en
dc.subject Dementia en
dc.subject Antipsychotics en
dc.subject Qualitative en
dc.subject Nursing home en
dc.subject Behavioral and psychological symptoms of dementia (BPSD) en
dc.title Exploring antipsychotic prescribing behaviors for nursing home residents with dementia: a qualitative study en
dc.type Article (peer-reviewed) en
dc.internal.authorcontactother Kieran A. Walsh, Clinical Gerontology & Rehabilitation, University College Cork, Cork, Ireland. +353-21-490-3000 en
dc.internal.availability Full text available en
dc.date.updated 2018-11-27T11:47:42Z
dc.description.version Submitted Version en
dc.internal.rssid 463440568
dc.description.status Peer reviewed en
dc.identifier.journaltitle Journal of the American Medical Directors Association en
dc.internal.copyrightchecked No !!CORA!! en
dc.internal.licenseacceptance Yes en
dc.internal.IRISemailaddress 108334854@umail.ucc.ie en


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© 2018 AMDA - The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier. This preprint manuscript version is made available under the CC-BY-NC-ND 4.0 license. Except where otherwise noted, this item's license is described as © 2018 AMDA - The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier. This preprint manuscript version is made available under the CC-BY-NC-ND 4.0 license.
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