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Research findings have highlighted the inappropriate use of antipsychotic drugs and there is debate about their value in \u2018managing\u2019 symptoms. This paper presents the combination of approaches used to enable residents of two secure dementia units to live life within their ability and without antipsychotic drugs. Essential to the success of the change process was staff education, knowledge of the person, a varied leisure activity programme and a supportive environment. Evidence of the positive difference these strategies made includes statistics that show a decline in falls and behavioural issues, and feedback from family members. In light of the evidence, this article posits that it is ethically wrong to give people with dementia antipsychotic medications because their behaviour is deemed to be unacceptable, when there are other viable options.<\/jats:p>","DOI":"10.1177\/1471301211421707","type":"journal-article","created":{"date-parts":[[2011,10,12]],"date-time":"2011-10-12T20:36:17Z","timestamp":1318451777000},"page":"111-121","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":17,"title":["Ethical and effective: Approaches to residential care for people with dementia"],"prefix":"10.1177","volume":"12","author":[{"given":"Grace","family":"O'Sullivan","sequence":"first","affiliation":[{"name":"Auckland University of Technology, New Zealand"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2011,10,11]]},"reference":[{"key":"bibr1-1471301211421707","unstructured":"Adamson, D. (2006, November).\n                      Creating a positive workplace: Enhancing leadership skills.\n                      Paper presented at a workshop for the North Shore Hospice, Auckland, New Zealand."},{"issue":"8","key":"bibr2-1471301211421707","first-page":"25","volume":"105","author":"Aschenbrenner D. S.","year":"2005","journal-title":"Drug Watch"},{"key":"bibr3-1471301211421707","doi-asserted-by":"publisher","DOI":"10.1348\/014466501163508"},{"key":"bibr4-1471301211421707","doi-asserted-by":"crossref","unstructured":"Ballard C., Howard R. (2006). Neuroleptic drugs in dementia: Benefits and harm.\n                      Nature Reviews: Neuroscience 7\n                      . Retrieved on October 12, 2006 from http:\/\/www.nature.com\/reviews\/neuro.","DOI":"10.1038\/nrn1926"},{"key":"bibr5-1471301211421707","unstructured":"Banerjee S. (2009).\n                      The use of antipsychotic medication for people with dementia: Time for action\n                      . Retrieved on 15 November, 2010 from http:\/\/www.dh.gov.uk\/prod_consum_dh\/groups\/dh_digitalassets\/documents\/digitalasset\/dh_108302.pdf."},{"key":"bibr6-1471301211421707","doi-asserted-by":"publisher","DOI":"10.1111\/1467-9515.00205"},{"key":"bibr7-1471301211421707","doi-asserted-by":"publisher","DOI":"10.1177\/153944929401400402"},{"key":"bibr8-1471301211421707","volume-title":"Dancing with dementia","author":"Bryden C.","year":"2005"},{"key":"bibr9-1471301211421707","doi-asserted-by":"publisher","DOI":"10.1080\/09602010443000074"},{"key":"bibr10-1471301211421707","volume-title":"Occupation for occupational therapists","author":"Clark F.","year":"2004"},{"key":"bibr11-1471301211421707","doi-asserted-by":"publisher","DOI":"10.1177\/153944920402400104"},{"key":"bibr12-1471301211421707","unstructured":"Coulson, J. C., Fox, K. R., McKenna, J. & Stathi, A. (2008, September).\n                      The OPAL qualitative sub-study: Getting out and about: The role of physical activity and neighbourhood in older people's lives\n                      . Paper presented at the Annual Conference of the British Society of Gerontology Symposium. Bristol, UK."},{"key":"bibr13-1471301211421707","unstructured":"Csikzentmihalyi, M. (2004, May).\n                      Occupational flow and quality of life.\n                      Paper presented at the meeting of the Canadian Society of Occupational Scientists, Toronto, Canada."},{"key":"bibr14-1471301211421707","unstructured":"Fossey J., Ballard C., Juszczak E., James I., Alder N., Jacoby R., Howard R. (2006). Effect of enhanced psychosocial care on antipsychotic use in nursing home residents with severe dementia: Cluster randomized trial.\n                      British Medical Journal\n                      . Retrieved May 23, 2008 from http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/16543297?ordinalpos=56&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum&log$=freejrpmc."},{"key":"bibr15-1471301211421707","doi-asserted-by":"publisher","DOI":"10.1093\/geront\/gnp087"},{"key":"bibr16-1471301211421707","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.319.7208.478"},{"key":"bibr17-1471301211421707","doi-asserted-by":"publisher","DOI":"10.1080\/14427591.2001.10597270"},{"key":"bibr18-1471301211421707","doi-asserted-by":"publisher","DOI":"10.1093\/gerona\/62.9.1002"},{"key":"bibr19-1471301211421707","doi-asserted-by":"publisher","DOI":"10.5014\/ajot.52.6.423"},{"key":"bibr20-1471301211421707","volume-title":"Carved in sand: When attention fails and memory fades in midlife","author":"Jakobson Ramin C.","year":"2007"},{"key":"bibr21-1471301211421707","author":"Kitwood T.","year":"1993","journal-title":"Journal of Dementia Care"},{"key":"bibr22-1471301211421707","volume-title":"Dementia reconsidered: The person comes first","author":"Kitwood T.","year":"1997"},{"key":"bibr23-1471301211421707","doi-asserted-by":"publisher","DOI":"10.1017\/S0144686X0000502X"},{"issue":"2","key":"bibr24-1471301211421707","first-page":"15","volume":"8","author":"Lintern T.","year":"2000","journal-title":"Journal of Dementia Care"},{"key":"bibr25-1471301211421707","doi-asserted-by":"publisher","DOI":"10.1123\/japa.12.2.170"},{"key":"bibr26-1471301211421707","doi-asserted-by":"publisher","DOI":"10.1111\/j.1467-9566.2007.01056.x"},{"issue":"1","key":"bibr27-1471301211421707","first-page":"15","volume":"6","author":"Marshall M.","year":"1998","journal-title":"The Journal of Dementia Care"},{"key":"bibr28-1471301211421707","doi-asserted-by":"publisher","DOI":"10.3928\/0098-9134-20060201-05"},{"issue":"3","key":"bibr29-1471301211421707","first-page":"45","volume":"13","author":"Nolan M. 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