Apathy and Its Response to Antipsychotic Review and Nonpharmacological Interventions in People With Dementia Living in Nursing Homes: WHELD, a Factorial Cluster Randomized Controlled Trial

Rajkumar, Anto P.; Ballard, Clive; Fossey, Jane; Corbett, Anne; Woods, Bob; Orrell, Martin; Prakash, Rohan; Moniz-Cook, Esme; Testad, Ingelin

Abstract

Objectives
Apathy is common, impactful, and difficult to manage in people with dementia. We evaluated the efficacy of nonpharmacological interventions, exercise, and social interaction, in combination with antipsychotic review, to reduce apathy in people with dementia living in nursing homes in a cluster randomized controlled trial (RCT).

Methods
Well-being and health for people with dementia (WHELD) program included a 2 × 2 × 2 factorial cluster RCT involving people with dementia living in 16 nursing homes in the United Kingdom. All homes received training in person-centered care, and were randomized to receive antipsychotic review, social interaction, and exercise, either alone or in combinations. Apathy was one of the secondary outcomes of the WHELD trial, and it was measured by the Neuropsychiatric Inventory–nursing home version at baseline and 9 months (n = 273). We used multilevel mixed effects linear regression models to assess the impact of the interventions on apathy.

Results
Prevalence of apathy was 44.0% (n = 120; 95% confidence interval [CI] 38.1%–49.9%) at baseline. Severity of apathy had significant positive correlations with dementia severity, neuropsychiatric symptoms, depressive symptoms, agitation, and the needs of the people with dementia (P < .001). Antipsychotic review reduced antipsychotic use, but it significantly increased apathy (β = 5.37; SE = 0.91; P < .001). However, antipsychotic review in combination with either social interaction (β = −5.84; SE = 1.15; P < .001) or exercise (β = −7.54; SE = 0.93; P < .001) significantly reduced apathy.

Conclusions
Antipsychotic review can play a significant role in improving apathy in people with dementia living in nursing homes, when combined with psychosocial interventions such as social interaction and exercise. Guidance must be adapted to reflect this subtlety in care.

Citation

Rajkumar, A. P., Ballard, C., Fossey, J., Corbett, A., Woods, B., Orrell, M., …Testad, I. (2016). Apathy and Its Response to Antipsychotic Review and Nonpharmacological Interventions in People With Dementia Living in Nursing Homes: WHELD, a Factorial Cluster Randomized Controlled Trial. Journal of the American Medical Directors Association, 17(8), 741-747. https://doi.org/10.1016/j.jamda.2016.04.006

• Journal Article Type: Article
• Acceptance Date: May 12, 2016
• Online Publication Date: May 12, 2016
• Publication Date: 2016-08
• Deposit Date: Nov 11, 2019
• Publicly Available Date: Nov 11, 2019
• Journal: Journal of the American Medical Directors Association
• Print ISSN: 1525-8610
• Electronic ISSN: 1538-9375
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 17
• Issue: 8
• Pages: 741-747
• DOI: https://doi.org/10.1016/j.jamda.2016.04.006
• Public URL: https://nottingham-repository.worktribe.com/output/3205403
• Publisher URL: https://www.sciencedirect.com/science/article/pii/S1525861016300913?via%3Dihub