Marjoleine J C Pieper1,2,3, Anneke L Francke1,4, Jenny T van der Steen1,2, Erik J A Scherder5, Jos W R Twisk6, Christine R Kovach7, Wilco P Achterberg1,3. 1. Emgo Institute for Health and Care Research, Amsterdam, The Netherlands. 2. Department of General Practice and Elderly Care Medicine, VU University Medical Center Amsterdam, Amsterdam, The Netherlands. 3. Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands. 4. Netherlands Institute for Health Services Research, Utrecht, The Netherlands. 5. Department of Clinical Neuropsychology, VU University Amsterdam, Amsterdam, The Netherlands. 6. Department of Epidemiology and Biostatistics, VU University Medical Center Amsterdam, Amsterdam, the Netherlands. 7. University of Wisconsin-Milwaukee, Milwaukee, Wisconsin.
Abstract
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.
RCT Entities:
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.
Authors: Helma M F Verstraeten; Canan Ziylan; Debby L Gerritsen; Robbert Huijsman; Miharu Nakanishi; Martin Smalbrugge; Jenny T van der Steen; Sytse U Zuidema; Wilco P Achterberg; Ton J E M Bakker Journal: JMIR Res Protoc Date: 2022-06-22
Authors: Maartje S Klapwijk; Monique A A Caljouw; Marjoleine J C Pieper; Jenny T van der Steen; Wilco P Achterberg Journal: Dement Geriatr Cogn Disord Date: 2016-09-27 Impact factor: 2.959
Authors: Paulien H van Dam; Wilco P Achterberg; Jacobijn Gussekloo; Bettina S Husebo; Monique A A Caljouw Journal: BMC Geriatr Date: 2018-11-14 Impact factor: 3.921
Authors: Marjoleine J C Pieper; Wilco P Achterberg; Jenny T van der Steen; Anneke L Francke Journal: Int J Integr Care Date: 2018-09-07 Impact factor: 5.120