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Care‐Delivery Interventions to Manage Agitation and Aggression in Dementia Nursing Home and Assisted Living Residents: A Systematic Review and Meta‐analysis
Author(s) -
Jutkowitz Eric,
Brasure Michelle,
Fuchs Erika,
Shippee Tetyana,
Kane Rosalie A.,
Fink Howard A.,
Butler Mary,
Sylvanus Tonye,
Kane Robert L.
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.13936
Subject(s) - medicine , psychological intervention , aggression , antipsychotic , randomized controlled trial , meta analysis , psychomotor agitation , dementia , strictly standardized mean difference , systematic review , poison control , medline , psychiatry , nursing , family medicine , emergency medicine , schizophrenia (object oriented programming) , surgery , disease , pathology , political science , law
Objectives To evaluate the efficacy of nonpharmacological care‐delivery interventions (staff training, care‐delivery models, changes to the environment) to reduce and manage agitation and aggression in nursing home and assisted living residents. Design Three bibliographic databases, references of systematic reviews, ClincalTrials.gov, and the International Controlled Trials Registry Platform were systematically searched for randomized controlled trials reporting behavioral outcomes for nonpharmacological care‐delivery interventions in nursing homes and assisted living facilities. Five investigators independently assessed study eligibility, extracted data, rated risk of bias, and graded strength of evidence. Inclusion was limited to studies with low to moderate risk of bias. Setting Nursing homes and assisted living facilities. Participants Facility caregiving staff. Measurements Agitation, aggression, antipsychotic and other psychotropic use, general behavior. Results Nineteen unique studies met entry criteria, addressing several categories of facility caregiver training interventions: dementia care mapping ( DCM ; n = 3), person‐centered care ( PCC ; n = 3), clinical protocols to reduce the use of antipsychotic and other psychotropic drugs (n = 3), and emotion‐oriented care (n = 2). Eleven additional studies evaluated other unique interventions. Results were pooled for the effect of each type of intervention on agitation and aggression: DCM (standardized mean difference −0.12, 95% confidence interval ( CI ) = −0.66 to 0.42), PCC (standardized mean difference −0.15, 95% CI = −0.67 to 0.38), and protocols to reduce antipsychotic and other psychotropic use (Cohen‐Mansfield Agitation Inventory mean difference −4.5, 95% C = −38.84 to 29.93). Strength of evidence was generally insufficient to draw conclusions regarding efficacy or comparative effectiveness. Conclusion Evidence was insufficient regarding the efficacy of nonpharmacological care‐delivery interventions to reduce agitation or aggression in nursing home and assisted living facility residents with dementia.