I wish to explore the use of night sedation for the older person in residential care with particular emphasis on monitoring those who lack capaciity to express themselves or verbalise if they are experiencing side effects.Empirically we know there are many who have a reduced quality of life due to side effects such as the 'hangover' somolience in the mornings.Also as this age group have a higher instance of use of concurent Psychotropic medication, there is a burden on us healthcare professionals to ensure it's use is titrated to appropriat short term use only.
Hello Florence,
Have you heard of the Drug Burden Index? The authors are on ResearchGate, so if you need assistance on its use, they might be able to help:
Hilmer, S. N., Mager, D. E., Simonsick, E. M., Cao, Y., Ling, S. M., Windham, B. G., ... & Bauer, D. C. (2007). A drug burden index to define the functional burden of medications in older people. Archives of internal medicine, 167(8), 781-787.
https://www.researchgate.net/publication/6375615_A_Drug_Burden_Index_to_define_the_functional_burden_of_medications_in_older_people
This is by the same team:
Hilmer, S. N., Mager, D. E., Simonsick, E. M., Ling, S. M., Windham, B. G., Harris, T. B., ... & Study, H. A. (2009). Drug burden index score and functional decline in older people. The American journal of medicine, 122(12), 1142-1149.
https://www.researchgate.net/profile/Eleanor_Simonsick/publication/40445914_Drug_Burden_Index_Score_and_Functional_Decline_in_Older_People/links/00463521f628c6c6dd000000.pdf
There have been quite a few papers written about it, but this is quite recent:
Kouladjian, L., Gnjidic, D., Chen, T. F., Mangoni, A. A., & Hilmer, S. N. (2014). Drug Burden Index in older adults: theoretical and practical issues. Clinical interventions in aging, 9, 1503.
https://www.researchgate.net/profile/Danijela_Gnjidic/publication/266026410_Drug_Burden_Index_in_older_adults_theoretical_and_practical_issues/links/542a4c880cf277d58e8711f1.pdf
The Ramsey Score might be of interest, but does not really answer your question and looks at ICU:
How to use the Ramsay Score to assess the level of ICU Sedation: Michael A. E. Ramsay M.D.
http://5jsnacc.umin.ac.jp/How%20to%20use%20the%20Ramsay%20Score%20to%20assess%20the%20level%20of%20ICU%20Sedation.htm
This is another tool that includes sedation:
Medicines Management Tool for Antipsychotics
http://www.humber.nhs.uk/Downloads/Services/Pharmacy/Guidelines/Medicines%20management%20tool%20for%20antipsychotics.pdf
I will be interested in what others suggest.
Very best wishes,
Mary
Article A Drug Burden Index to Define the Functional Burden of Medic...
Article Drug Burden Index Score and Functional Decline in Older People
Article Drug Burden Index in older adults: theoretical and practical issues
Hi Mary. Thanks a million for these. Yes the DBI is certainly very interesting but unfortunately dosn't fit my requirements. What I need is to be able to format a short uestionaire for Nurses to enable them to assess the level of somolience, deteriration in activity levels etc caused by long term use of hypnotic medication treatment.
Hi Florence.
Yes, I realised that what I had found didn't really answer your question, but thought it would be worth adding my findings. I'll watch with interest to see if anyone comes up with a suitable questionnaire. I had another quick look (this time on CINAHL) but could not locate one, but it may be that there is something out there?
Good luck in your search,
Mary
Thank you Mary. While we wouldn't be able to use the DBI in our study our Chief Pharmacist and research collaborator has found them extremely interesting. Great that we Nurses are leading in research now !!!!!
What about a solely clinical description? So simple, are scales always the best way to score?
We are in the era of scales, let's go back to the clinical ground, with common sense of course.
Thanks Rafael. Yes - this did occur to us after considerable discussion. Back to basics and the human touch !