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Effects of a Stepwise Multidisciplinary Intervention for Challenging Behavior in Advanced Dementia: A Cluster Randomized Controlled Trial
Author(s) -
Pieper Marjoleine J. C.,
Francke Anneke L.,
Steen Jenny T.,
Scherder Erik J. A.,
Twisk Jos W. R.,
Kovach Christine R.,
Achterberg Wilco P.
Publication year - 2016
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.13868
Subject(s) - medicine , dementia , randomized controlled trial , depression (economics) , cluster randomised controlled trial , intervention (counseling) , physical therapy , confidence interval , psychiatry , disease , economics , macroeconomics
Objectives To assess whether implementation of a stepwise multicomponent intervention ( STA OP !) is effective in reducing challenging behavior and depression in nursing home residents with advanced dementia. Design Cluster randomized controlled trial. Setting Twenty‐one clusters (single independent nursing home units) in 12 nursing homes within the Netherlands. Participants Residents with advanced dementia (N = 288). Intervention Staff working on intervention units received comprehensive stepwise multidisciplinary training; the control condition received training on general nursing skills, dementia management and pain without the stepwise component. Measurements The primary outcome was agitation (Cohen‐Mansfield Agitation Inventory ( CMAI )). Secondary outcomes included psychotropic medication use, neuropsychiatric symptoms (Neuropsychiatric Inventory—Nursing Home version ( NPI ‐ NH )), and symptoms of depression (Cornell Scale for Depression in Dementia ( CSDD ), Minimum Dataset Depression Rating Scale ( MDS ‐ DRS )). Measurements were made at baseline and 3 and 6 months after the intervention. Multilevel analysis and logistical generalized estimating equations were used to test treatment and time effects. Analysis was on an intention‐to‐treat basis. Results Multilevel modeling revealed an overall effect of the intervention on challenging behavior and depression; CMAI (mean difference −4.07 points, 95% confidence interval = ( CI ) = −7.90 to −0.24, P = .02), NPI ‐ NH (mean difference −3.57 points, 95% CI = −6.30 to −0.84, P = .005), CSDD (mean difference −1.59 points, 95% CI = −2.49 to −0.69, P < .001), and MDS ‐ DRS (mean difference −0.96 points, 95% CI = −1.40 to −0.52, P < .001) scores were significantly lower in the intervention condition than the control condition. There was a significant reduction of antidepressants (N06A) ( OR = 0.32); nonsignificant reductions of antipsychotics (N05A), anxiolytics (N05B), and hypnotic–sedatives (N05C) (odds ratios = 0.69 to 0.90). Conclusion For nursing home residents with advanced dementia and challenging behavior, providing staff with comprehensive training in behavioral management, resulted in improved behavior and less psychotropic medication use.