Short summary

Despite ongoing initiatives, the use of antipsychotic medication among people living with dementia in Danish care homes remains high. The aim of this project is to explore the lived experiences of Danish care home residents with dementia using antipsychotics. Through qualitative methods, including interviews and participant observations, the project seeks to uncover the experiences and mechanisms that influence the use of antipsychotics.

Rationale

Residents of Danish care homes have a high consumption of medications, including antipsychotics, and a political wish to lower the consumption of especially antipsychotics have been a national agenda for the past decade (1). Although previous studies have shown a downward trend in the proportion of Danish patients with dementia receiving antipsychotics from 2000-2012 (2), new data from the Danish Health Data Authority shows that the use of antipsychotics among patients with dementia remains high and has remained nearly unchanged since 2014 (3). Medication management in care of older people is inherently complex due to the unique challenges faced by older patients, particularly those in care homes. Many older adults suffer from multiple chronic conditions, often combined with cognitive impairment, requiring a high number of medications (polypharmacy) (4). This often leads to a delicate balancing act between managing different health conditions and avoiding drug interactions or adverse side effects. Aging affects the body's metabolism and drug clearance, increasing the risk of medication toxicity or ineffectiveness, which makes it crucial to tailor doses and carefully monitor medication effects, which is especially complicated in patients with cognitive impairment (5-7). In care homes, the situation is further complicated by everyday challenges. Staffing shortages and the limited time available for each resident mean that regular monitoring, essential for identifying side effects or reassessing medication needs, can be difficult to maintain. Additionally, the competencies of staff members vary, and while care teams often include dedicated professionals, there may be limited specialized training in pharmacology or geriatric care, which is crucial for managing complex medication regimes safely (8,9). Research in antipsychotics has primarily focused on the pharmacological aspects of use, while including only very limited insights from a user perspective and/or everyday live perspective nor taking into account the realities of care as it unfolds in care home settings (10-12). In order to reach the goal of lowering national consumption of antipsychotics, it is pivotal to understand the lived experiences and mechanisms behind the use. Through ethnographic methods, this project will shed light on the complex relationships shaped through usage of antipsychotics, considering both their therapeutic and social effects. By applying a combination of anthropological and healthcare services research, we aim to explore the role of caregivers and family members as active participants in the care process. Furthermore, prioritizing the lived experiences of individuals with dementia and focusing on their subjective realities, we wish to bring depth and nuances to the current debate on the use of antipsychotics.

Description of the cohort

The project is qualitative, inspired by anthropological ethnographic methods (27,28). During a period of 6-9 months, we will follow older adults in process of transitioning from home to care home. This period is chosen, because our previous research has revealed that the transition to care home is a point in time where medications often are negotiated and changed (29). By following the journey of older adults, their relatives, caretakers, and healthcare professionals, we will track down these negotiations in order to better understand the different perspectives and reasonings in starting (or potentially stopping/pausing) antipsychotic treatment. The project will contain different data elements, all combined by using a multi-sited ethnographical approach (30,31).

Data and biological material

Data will consist of different elements obtained through participant observations, informal conversations, semi-structured interviews and photographs.

Collaborating researchers and departments

Hospital Pharmacy Funen at Odense University Hospital

• Carina Lundby
• Trine Graabæk Hansen

Geriatric Department, Odense University Hospital

• Jesper Ryg

Department of Clinical Pharmacology, Pharmacy, and Environmental Medicine, University of Southern Denmark

• Lotte Rasmussen

Research Unit for General Practice, University of Southern Denmark

• Jens Søndergaard