An RCT to evaluate the utility of a clinical protocol for staff in the management of behavioral and psychological symptoms of dementia in residential aged-care settings

McCabe, Marita P.; Bird, Mike; Davison, Tanya E.; Mellor, David; MacPherson, Sarah E.; Hallford, David John; Seedy, Melissa

doi:10.1080/13607863.2014.967659

Cited by 44 publications

(65 citation statements)

References 24 publications

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“…Training for healthcare professionals in dealing with BPSD leads to improvements in the symptoms of people with dementia disease [37] [38]. When healthcare professionals received training, exercise and equipment in the form of a structured BPSD protocol the result was improvements in behavioral symptoms in people with dementia.…”

Section: Education/training For Healthcare Professionalsmentioning

confidence: 99%

Non-Pharmalogical Interventions towards Behavioural and Psychological Symptoms of Dementia—An Integrated Literature Review

Alm¹,

Danielsson²,

Kristiansen³

2018

OJN

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The objective of this integrated literature review was to identify and examine effectiveness of non-pharmacological interventions towards BPSD. Database searches were documented following the PRISMA flow diagram and included papers were judged by the researchers using the SAHTAASS protocol. Coding of the papers was carried out using Polit and Beck matrix for literature review. It was concluded that several non-pharmacological interventions showed a positive influence on BPSD such as stimulating interventions, social and personalized activities and physical exercise. Also, education/training of healthcare professionals and equipment in form of a structured BPSD protocol resulted in decreased BPSD.

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Section: Education/training For Healthcare Professionalsmentioning

confidence: 99%

Non-Pharmalogical Interventions towards Behavioural and Psychological Symptoms of Dementia—An Integrated Literature Review

Alm¹,

Danielsson²,

Kristiansen³

2018

OJN

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“…82 A recent literature review on the effectiveness of staff training for BPSD 60 also indicated some promise for the content of the training and intervention approach we adopted, as did a recent study of clinical algorithm-based protocols for the management of CB in dementia. 311 However, we additionally chose to develop an online intervention, as we were keen to widen the scope of use in the real world of the full range of 'good-quality' (as rated at the time by the CQC) care home settings. We anticipated that ready access to knowledge and resources available for all staff and practitioners who delivered formal care to people with dementia living at home and in care homes would be a way of sustaining ongoing intervention for dementia with CB.…”

Section: Limitationsmentioning

confidence: 99%

“…Rationale for the intervention Previous work, 63 and more recent studies, 97,311 demonstrated the successful use of algorithm-based protocols in the management of CB in care homes. One of the most recent studies 311 used a pencil-andpaper workbook format in care homes.…”

mentioning

confidence: 99%

“…In essence we were building on preliminary work in the dementia literature that had separately demonstrated the value of clinical algorithms, 63,97,311 and current interest in and the use of e-tool technology, [70][71][72][73][74][75][76] as care staff appeared enthusiastic about access to e-learning dementia care opportunities. 127 If successful we would have produced a cost-effective programme that enabled staff to assess problematic presentations; identify causes and underlying needs; develop appropriate care plans; and, based on the learning from the earlier training modules, execute the plans effectively, with minimal external supervision.…”

mentioning

confidence: 99%

“…One of the most recent studies 311 used a pencil-andpaper workbook format in care homes. The workbook, using functional analysis, was evaluated favourably in an Australian RCT 311 with four conditions: clinical protocol alone; clinical protocol, plus extra clinical support; extra clinical support alone, plus a workshop on CB; and treatment as usual.…”

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confidence: 99%

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Challenge Demcare: management of challenging behaviour in dementia at home and in care homes – development, evaluation and implementation of an online individualised intervention for care homes; and a cohort study of specialist community mental health care for families

Moniz–Cook

Hart

Woods

et al. 2017

Programme Grants Appl Res

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BackgroundDementia with challenging behaviour (CB) causes significant distress for caregivers and the person with dementia. It is associated with breakdown of care at home and disruption in care homes. Challenge Demcare aimed to assist care home staff and mental health practitioners who support families at home to respond effectively to CB.ObjectivesTo study the management of CB in care homes (ResCare) and in family care (FamCare). Following a conceptual overview, two systematic reviews and scrutiny of clinical guidelines, we (1) developed and tested a computerised intervention; (2) conducted a cluster randomised trial (CRT) of the intervention for dementia with CB in care homes; (3) conducted a process evaluation of implementation of the intervention; and (4) conducted a longitudinal observational cohort study of the management of people with dementia with CB living at home, and their carers.Review methodsCochrane review of randomised controlled trials; systematic meta-ethnographic review of quantitative and qualitative studies.DesignResCare – survey, CRT, process evaluation and stakeholder consultations. FamCare – survey, longitudinal cohort study, participatory development design process and stakeholder consultations. Comparative examination of baseline levels of CB in the ResCare trial and the FamCare study participants.SettingsResCare – 63 care homes in Yorkshire. FamCare – 33 community mental health teams for older people (CMHTsOP) in seven NHS organisations across England.ParticipantsResCare – 2386 residents and 861 staff screened for eligibility; 555 residents with dementia and CB; 277 ‘other’ residents; 632 care staff; and 92 staff champions. FamCare – every new referral (n = 5360) reviewed for eligibility; 157 patients with dementia and CB, with their carer; and 26 mental health practitioners. Stakeholder consultations – initial workshops with 83 practitioners and managers from participating organisations; and 70 additional stakeholders using eight group discussions and nine individual interviews.InterventionAn online application for case-specific action plans to reduce CB in dementia, consisting of e-learning and bespoke decision support care home and family care e-tools.Main outcome measuresResCare – survey with the Challenging Behaviour Scale; measurement of CB with the Neuropsychiatric Inventory (NPI) and medications taken from prescriptions; implementation with thematic views from participants and stakeholders. FamCare – case identification from all referrals to CMHTsOP; measurement of CB with the Revised Memory and Behaviour Problems Checklist and NPI; medications taken from prescriptions; and thematic views from stakeholders. Costs of care calculated for both settings. Comparison of the ResCare trial and FamCare study participants used the NPI, Clinical Dementia Rating and prescribed medications.ResultsResCare – training with group discussion and decision support for individualised interventions did not change practice enough to have an impact on CB in dementia. Worksite e-learning opportunities were not readily taken up by care home staff. Smaller homes with a less hierarchical management appear more ready than others to engage in innovation. FamCare – home-dwelling people with dementia and CB are referred to specialist NHS services, but treatment over 6 months, averaging nine contacts per family, had no overall impact on CB. Over 60% of people with CB had mild dementia. Families bear the majority of the care costs of dementia with CB. A care gap in the delivery of post-diagnostic help for families supporting relatives with dementia and significant CB at home has emerged. Higher levels of CB were recorded in family settings; and prescribing practices were suboptimal in both care home and family settings.LimitationsFunctionality of the software was unreliable, resulting in delays. This compromised the feasibility studies and undermined delivery of the intervention in care homes. A planned FamCare CRT could not proceed because of insufficient referrals.ConclusionsA Cochrane review of individualised functional analysis-based interventions suggests that these show promise, although delivery requires a trained dementia care workforce. Like many staff training interventions, our interactive e-learning course was well received by staff when delivered in groups with facilitated discussion. Our e-learning and decision support e-tool intervention in care homes, in its current form, without ongoing review of implementation of recommended action plans, is not effective at reducing CB when compared with usual care. This may also be true for staff training in general. A shift in priorities from early diagnosis to early recognition of dementia with clinically significant CB could bridge the emerging gap and inequities of care to families. Formalised service improvements in the NHS, to co-ordinate such interventions, may stimulate better opportunities for practice models and pathways. Separate services for care homes and family care may enhance the efficiency of delivery and the quality of research on implementation into routine care.Future workThere is scope for extending functional analysis-based interventions with communication and interaction training for carers. Our clinical workbooks, video material of real-life episodes of CB and process evaluation tool resources require further testing. There is an urgent need for evaluation of interventions for home-dwelling people with dementia with clinically significant CB, delivered by trained dementia practitioners. Realist evaluation designs may illuminate how the intervention might work, and for whom, within varying service contexts.Trial registrationCurrent Controlled Trials ISRCTN02553381 (the ResCare trial) and ISRCTN58876649 (the FamCare study).FundingThis project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 5, No. 15. See the NIHR Journals Library website for further project information.

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Diagnosis and Management of Dementia: Review

Arvanitakis

Shah

Bennett

2019

JAMA

847

604

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ementia is a common public health problem. 1 Worldwide, approximately 47 million people have dementia, and this number is expected to increase to 131 million by 2050. 1 Reductions in age-adjusted incidence of dementia have occurred in the United States and other developed countries over the last 20 years, perhaps associated with increasing formal educational attainment. However, without improved treatments or preventive therapy, the adverse consequences of dementia will continue to increase. 2 In the United States, the prevalence of dementia is 15% in people older than 68 years. 3 Alzheimer disease (AD) affects 5.8 million people, and 13.8 million are projected to have the diagno-sis of AD by the year 2050. 4 AD is the sixth leading cause of death and the fifth leading cause among people older than 65 years. 5,6 This review summarizes diagnosis and management of dementia, defined as significant cognitive impairment in 2 or more cognitive domains. MethodsWe conducted a literature search in PubMed, using the search terms "dementia and (diagnosis or management)" in the title field. The following inclusion criteria were applied: publication date from IMPORTANCE Worldwide, 47 million people live with dementia and, by 2050, the number is expected to increase to 131 million.OBSERVATIONS Dementia is an acquired loss of cognition in multiple cognitive domains sufficiently severe to affect social or occupational function. In the United States, Alzheimer disease, one cause of dementia, affects 5.8 million people. Dementia is commonly associated with more than 1 neuropathology, usually Alzheimer disease with cerebrovascular pathology. Diagnosing dementia requires a history evaluating for cognitive decline and impairment in daily activities, with corroboration from a close friend or family member, in addition to a thorough mental status examination by a clinician to delineate impairments in memory, language, attention, visuospatial cognition such as spatial orientation, executive function, and mood. Brief cognitive impairment screening questionnaires can assist in initiating and organizing the cognitive assessment. However, if the assessment is inconclusive (eg, symptoms present, but normal examination findings), neuropsychological testing can help determine whether dementia is present. Physical examination may help identify the etiology of dementia. For example, focal neurologic abnormalities suggest stroke. Brain neuroimaging may demonstrate structural changes including, but not limited to, focal atrophy, infarcts, and tumor, that may not be identified on physical examination. Additional evaluation with cerebrospinal fluid assays or genetic testing may be considered in atypical dementia cases, such as age of onset younger than 65 years, rapid symptom onset, and/or impairment in multiple cognitive domains but not episodic memory. For treatment, patients may benefit from nonpharmacologic approaches, including cognitively engaging activities such as reading, physical exercise such as walking, and socialization such as fa...

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An RCT to evaluate the utility of a clinical protocol for staff in the management of behavioral and psychological symptoms of dementia in residential aged-care settings

Abstract: These results demonstrate the effectiveness of the BPSD protocol in reducing BPSD and improving staff self-efficacy and stress.

Cited by 44 publications

References 24 publications

Non-Pharmalogical Interventions towards Behavioural and Psychological Symptoms of Dementia—An Integrated Literature Review

Non-Pharmalogical Interventions towards Behavioural and Psychological Symptoms of Dementia—An Integrated Literature Review

Challenge Demcare: management of challenging behaviour in dementia at home and in care homes – development, evaluation and implementation of an online individualised intervention for care homes; and a cohort study of specialist community mental health care for families

Diagnosis and Management of Dementia: Review

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