Bjørn Lichtwarck1, Geir Selbaek2, Øyvind Kirkevold3, Anne Marie Mork Rokstad4, Jūratė Šaltytė Benth5, Jonas Christoffer Lindstrøm6, Sverre Bergh7. 1. Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway; Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway. Electronic address: bjornlic@online.no. 2. Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway; Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Sem, Norway. 3. Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway; Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Sem, Norway; Department of Health, Care and Nursing, Faculty of Medicine NTNU, Norwegian University of Science and Technology, Gjøvik, Norway. 4. Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Sem, Norway; Faculty of Health Sciences and Social Care, Molde University College, Molde, Norway. 5. Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway; Institute of Clinical Medicine, Campus Ahus, University of Oslo, Oslo, Norway; HØKH, Research Centre, Akershus University Hospital, Lørenskog, Norway. 6. Institute of Clinical Medicine, Campus Ahus, University of Oslo, Oslo, Norway; HØKH, Research Centre, Akershus University Hospital, Lørenskog, Norway. 7. Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway; Institute of Clinical Medicine, Campus Ahus, University of Oslo, Oslo, Norway.
Abstract
OBJECTIVE: To determine the effectiveness of the Targeted Interdisciplinary Model for Evaluation and Treatment of Neuropsychiatric Symptoms (TIME) for treatment of moderate to severe agitation in people with dementia. METHODS: In a single-blinded, cluster randomized controlled trial in 33 nursing homes (clusters) from 20 municipalities in Norway, 229 patients (104 patients in 17 nursing homes and 125 patients in 16 nursing homes) were randomized to an intervention or control group, respectively. The intervention group received TIME, and the control group received a brief education-only intervention. TIME is an interdisciplinary multicomponent intervention and consists of a comprehensive assessment of the patient with the goal to create and put into action a tailored treatment plan. The primary outcome was the between-group difference in change at the agitation/aggression item of the Neuropsychiatric Inventory Nursing Home version between baseline and 8 weeks. Secondary outcomes were the between-group difference in change at the agitation/aggression between baseline and 12 weeks in other neuropsychiatric symptoms, quality of life, and use of psychotropic and analgesic medications between baseline and 8 and 12 weeks. RESULTS: A significant between-group difference in reduction of agitation at both 8 weeks (1.1; 95% confidence interval: 0.1-2.1; p = 0.03) and 12 weeks (1.6; 95% confidence interval: 0.6-2.7; p = 0.002) in favor of the TIME intervention was found. CONCLUSION: The implementation of TIME resulted in a significant reduction of agitation among nursing homes patients with dementia. These results should inform training programs for care staff in Norway and internationally.
RCT Entities:
OBJECTIVE: To determine the effectiveness of the Targeted Interdisciplinary Model for Evaluation and Treatment of Neuropsychiatric Symptoms (TIME) for treatment of moderate to severe agitation in people with dementia. METHODS: In a single-blinded, cluster randomized controlled trial in 33 nursing homes (clusters) from 20 municipalities in Norway, 229 patients (104 patients in 17 nursing homes and 125 patients in 16 nursing homes) were randomized to an intervention or control group, respectively. The intervention group received TIME, and the control group received a brief education-only intervention. TIME is an interdisciplinary multicomponent intervention and consists of a comprehensive assessment of the patient with the goal to create and put into action a tailored treatment plan. The primary outcome was the between-group difference in change at the agitation/aggression item of the Neuropsychiatric Inventory Nursing Home version between baseline and 8 weeks. Secondary outcomes were the between-group difference in change at the agitation/aggression between baseline and 12 weeks in other neuropsychiatric symptoms, quality of life, and use of psychotropic and analgesic medications between baseline and 8 and 12 weeks. RESULTS: A significant between-group difference in reduction of agitation at both 8 weeks (1.1; 95% confidence interval: 0.1-2.1; p = 0.03) and 12 weeks (1.6; 95% confidence interval: 0.6-2.7; p = 0.002) in favor of the TIME intervention was found. CONCLUSION: The implementation of TIME resulted in a significant reduction of agitation among nursing homes patients with dementia. These results should inform training programs for care staff in Norway and internationally.
Authors: Gill Livingston; Jonathan Huntley; Andrew Sommerlad; David Ames; Clive Ballard; Sube Banerjee; Carol Brayne; Alistair Burns; Jiska Cohen-Mansfield; Claudia Cooper; Sergi G Costafreda; Amit Dias; Nick Fox; Laura N Gitlin; Robert Howard; Helen C Kales; Mika Kivimäki; Eric B Larson; Adesola Ogunniyi; Vasiliki Orgeta; Karen Ritchie; Kenneth Rockwood; Elizabeth L Sampson; Quincy Samus; Lon S Schneider; Geir Selbæk; Linda Teri; Naaheed Mukadam Journal: Lancet Date: 2020-07-30 Impact factor: 79.321