Mark E Kunik1, A Lynn Snow2, Nancy Wilson3, Amber B Amspoker3, Shubhada Sansgiry4, Robert O Morgan5, Jun Ying3, Gayle Hersch6, Melinda A Stanley4. 1. Houston VA HSR&D Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX; Baylor College of Medicine, Houston, TX; VA South Central Mental Illness Research, Education and Clinical Center, United States. Electronic address: mkunik@bcm.edu. 2. The University of Alabama and Tuscaloosa Veterans Affairs Medical Center, Tuscaloosa, AL. 3. Houston VA HSR&D Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX; Baylor College of Medicine, Houston, TX. 4. Houston VA HSR&D Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX; Baylor College of Medicine, Houston, TX; VA South Central Mental Illness Research, Education and Clinical Center, United States. 5. Department of Management, Policy and Community Health, The University of Texas School of Public Health-Houston, Houston, TX. 6. Texas Woman's University, Houston, TX.
Abstract
OBJECTIVES: To compare the efficacy of Preventing Aggression in Veterans with Dementia (PAVeD) with that of usual care in decreasing incidence of aggression (primary outcome) and pain and improving depression, pleasant events, caregiver burden, and patient-caregiver relationship quality (secondary outcomes). DESIGN: Randomized controlled trial with assessments at baseline and 3, 6, 9, and 12 months SETTING: Houston, TX. PARTICIPANTS: A total of 203 community-dwelling veterans with pain and dementia and their caregivers. INTERVENTION: PAVeD, 6 to 8 weekly sessions of 45-minute home visits with masters-level clinicians providing instruction to caregivers on recognizing pain, enhancing communication, and making daily activities pleasant and enjoyable, and at least two elective sessions. MEASUREMENTS: Cohen-Mansfield Agitation Inventory (primary outcome), Philadelphia Geriatric Pain Intensity Scale, Geriatric Depression Scale, Pleasant Events Schedule-AD, Burden Interview, Mutuality Scale (secondary outcomes), Client Satisfaction Questionnaire. RESULTS: There were no significant differences in aggression incidence between intervention and control groups, although the PAVeD group had significantly better mutuality than controls. CONCLUSIONS: PAVeD may need to address a broader range and more in-depth coverage of aggression risk factors with person-centered tailoring to target certain types of distress. Interventions to prevent aggression may also need to address medical providers in addition to caregivers. Published by Elsevier Inc.
RCT Entities:
OBJECTIVES: To compare the efficacy of Preventing Aggression in Veterans with Dementia (PAVeD) with that of usual care in decreasing incidence of aggression (primary outcome) and pain and improving depression, pleasant events, caregiver burden, and patient-caregiver relationship quality (secondary outcomes). DESIGN: Randomized controlled trial with assessments at baseline and 3, 6, 9, and 12 months SETTING: Houston, TX. PARTICIPANTS: A total of 203 community-dwelling veterans with pain and dementia and their caregivers. INTERVENTION: PAVeD, 6 to 8 weekly sessions of 45-minute home visits with masters-level clinicians providing instruction to caregivers on recognizing pain, enhancing communication, and making daily activities pleasant and enjoyable, and at least two elective sessions. MEASUREMENTS: Cohen-Mansfield Agitation Inventory (primary outcome), Philadelphia Geriatric Pain Intensity Scale, Geriatric Depression Scale, Pleasant Events Schedule-AD, Burden Interview, Mutuality Scale (secondary outcomes), Client Satisfaction Questionnaire. RESULTS: There were no significant differences in aggression incidence between intervention and control groups, although the PAVeD group had significantly better mutuality than controls. CONCLUSIONS: PAVeD may need to address a broader range and more in-depth coverage of aggression risk factors with person-centered tailoring to target certain types of distress. Interventions to prevent aggression may also need to address medical providers in addition to caregivers. Published by Elsevier Inc.
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