Aims: What was the impact of best practice behavioural and environmental strategies on psychotropic use and outcomes in a new specialist dementia unit for residents with tier 5-6 behaviours.
Methods: Audit of case notes for diagnoses, medication changes and outcomes in the first year of operation of a newly opened specialist dementia unit with mixed state and federal funding.
Results: 12 residents admitted in first 13 months. All male, age 67-97. Mean age 77. Two residents had significant CTE risk. Four had a history of seizures. Dementia diagnosis was mostly of mixed cause- including Alzheimer's, Vascular, Alcohol, Lewy body conditions, CTE and FTD. During the first 13 months, 2 patients escalated antipsychotics, 2 remained static and 10 decreased or stopped antipsychotics. Two residents had a decrease in anticonvulsants being used for mood stabilisation. Two residents needed escalations of anticonvulsants for seizures. Neuropathic pain medications were helpful in some needing narcotics for pain. A new antidepressant helped one resident's mood and behaviour. There were 4 Deaths- 2 partly related to covid. One resident failed discharge to stepdown care. One resident was successfully transitioned to high level care due to rapid progression of neurodegeneration. Residents and family members reported improvement in care and support in cottage environment compared to hospital and former residential care experiences, even when significant symptoms and challenges persisted. Re-hospitalisations were brief and few.
Conclusion:-Specialist dementia care was mostly associated with decreased need for antipsychotics although a small number continued to have severe and distressing symptoms.