Care‐Delivery Interventions to Manage Agitation and Aggression in Dementia Nursing Home and Assisted Living Residents: A Systematic Review and Meta‐analysis

Jutkowitz, Eric; Brasure, Michelle; Fuchs, Erika; Shippee, Tetyana; Kane, Rosalie A.; Fink, Howard A; Butler, Mary; Sylvanus, Tonye; Kane, Robert L

doi:10.1111/jgs.13936

Cited by 61 publications

(61 citation statements)

References 51 publications

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“…This is especially important given that AL is emerging as a particularly attractive residential care option for older adults with dementia [31, 32]. Among the 19 studies included in a recent systematic review on care-delivery interventions to manage agitation and aggressive in dementia among residents of AL and LTC [71], only one small study was from AL and it did not report the impact of the intervention on antipsychotic use [72]. The associations we observed between resident and facility characteristics and antipsychotic use are relevant and valid even if there have been recent changes in the prevalence of use.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of, and Resident and Facility Characteristics Associated With Antipsychotic Use in Assisted Living vs. Long-Term Care Facilities: A Cross-Sectional Analysis from Alberta, Canada

et al. 2016

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BackgroundPotentially inappropriate antipsychotic use in long-term care (LTC) facilities has been the focus of significant policy and clinical attention over the past 20 years. However, most initiatives aimed at reducing the use of these medications have overlooked assisted living (AL) settings.ObjectiveWe sought to compare the prevalence of antipsychotic use (including potentially inappropriate use) among older AL and LTC residents and to explore the resident and facility-level factors associated with use in these two populations.MethodsWe performed cross-sectional analyses of 1089 residents (mean age 85 years; 77% female) from 59 AL facilities and 1000 residents (mean age 85 years; 66% female) from 54 LTC facilities, in Alberta, Canada. Research nurses completed comprehensive resident assessments at baseline (2006–2007). Facility-level factors were assessed using standardized administrator interviews. Generalized linear models were used to estimate odds ratios for associations, accounting for clustering by facility.ResultsOver a quarter of residents in AL (26.4%) and LTC (31.8%) were using antipsychotics (p = 0.006). Prevalence of potentially inappropriate use was similar in AL and LTC (23.4 vs. 26.8%, p = 0.09). However, among users, the proportion of antipsychotic use deemed potentially inappropriate was significantly higher in AL than LTC (AL: 231/287 = 80.5%; LTC: 224/318 = 70.4%; p = 0.004). In both settings, comparable findings regarding associations between resident characteristics (including dementia, psychiatric disorders, frailty, behavioral symptoms, and antidepressant use) and antipsychotic use were observed. Few facility characteristics were associated with overall antipsychotic use, but having a pharmacist on staff (AL), or an affiliated physician (LTC) was associated with a lower likelihood of potentially inappropriate antipsychotic use.ConclusionOur findings illustrate the importance of including AL settings in clinical and policy initiatives aimed at reducing inappropriate antipsychotic use among older vulnerable residents.Electronic supplementary materialThe online version of this article (doi:10.1007/s40266-016-0411-0) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Prevalence of, and Resident and Facility Characteristics Associated With Antipsychotic Use in Assisted Living vs. Long-Term Care Facilities: A Cross-Sectional Analysis from Alberta, Canada

et al. 2016

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“…Additionally, instruction to caregivers to effectively involve persons with dementia in activities may minimize supervisory time and enhance their own wellbeing. However, limitations of previous activity-based research include small sample sizes, lack of randomized trial methodology, poorly characterized samples, inattention to fidelity and caregiver abilities, and lack of control of therapeutic processes (e.g., attention) inherent in providing activity (Jutkowitz et al, 2016). …”

Section: Introductionmentioning

confidence: 99%

Reducing neuropsychiatric symptoms in persons with dementia and associated burden in family caregivers using tailored activities: Design and methods of a randomized clinical trial

Gitlin

Piersol

Hodgson

et al. 2016

Contemporary Clinical Trials

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Among over 5 million people in the USA with dementia, neuropsychiatric symptoms (NPS) are almost universal, occurring across disease etiology and stage. If untreated, NPS can lead to significant morbidity and mortality including increased cost, distress, depression, and faster disease progression, as well as heightened burden on families. With few pharmacological solutions, , identifying nonpharmacologic strategies is critical. We describe a randomized clinical trial, the Dementia Behavior Study, to test the efficacy of an activity program to reduce significant existing NPS and associated caregiver burden at 3 and 6 months compared to a control group intervention. Occupational therapists deliver 8 in-home sessions over 3 months to assess capabilities and interests of persons with dementia, home environments, and caregiver knowledge, and readiness from which activities are developed and families trained in their use. Families learn to modify activities for future declines and use strategies to address care challenges. The comparison group controls for time and attention and involves 8 in-home sessions delivered by health educators who provide dementia education, home safety recommendations, and advanced care planning. We are randomizing 250 racially diverse families (person with dementia and primary caregiver dyads) recruited from community-based social services, conferences and media announcements. The primary outcome is change in agitation/aggression at 3 and 6 months. Secondary outcomes assess quality of life of persons with dementia, other behaviors, burden and confidence of caregivers, and cost effectiveness. If benefits are supported, this activity intervention will provide a clinically meaningful approach to prevent, reduce, and manage NPS.

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“…To our knowledge, few studies have investigated the prevalence and associated factors of NH residents' daily crying episodes (Zarowitz and O'Shea, ), although other behaviour such as agitation, confusion and aggressiveness (e.g. Jutkowitz et al ., ) have been widely studied. According to our study, which represents a specific research line inside a larger regional study (PENSA, Palese et al ., ), around one resident out of six of those living in NHs reported at least one episode of crying on a daily basis in the last month; however, given the lack of available studies in the field (Zarowitz and O'Shea, ; Foley et al ., ), limited comparison is possible.…”

Section: Discussionmentioning

confidence: 99%

Daily crying prevalence and associated factors in older adult persons living in nursing homes: findings from a regional study

Palese

Simeoni

Zuttion³

et al. 2017

Int J Geriat Psychiatry

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Objectives:The study aims to evaluate the prevalence of nursing home (NH) resident crying and associated factors at the individual and NH levels. Design: A regional retrospective study design has been used. Participants and setting: A total of 8875 residents, living in 105 NHs, were included. Measurements: The occurrence of an episode of crying on at least a daily basis in the last month was the dependent variable; independent variables were set at individual and at the NH levels as reported in the Val.Graf regional database. Results: A total of 1,443 (16.3%) residents reported daily episodes of crying over the last month. Several individual variables were significantly associated with crying; female gender (odds ratio [OR] 2.535, 95% confidence interval [CI] 2.069-3.107); sad, pained or worried facial expressions (OR 1.885, 95% CI 1.785-2.021); negative thoughts (OR 1.650, 95% CI 1.508-1.804); unrealistic fears (OR 1.410, 95% CI 1.295-1.534); anger with self or others (OR 1.141, 95% CI 1.043-1.248); repetitive anxious complaints/concerns (OR 1.136, 95% CI 1.045-1.235); clinical instability (OR 1.186, 95% CI 1.018-1.381); pain (OR 1.183, 95% CI 1.058-1.323); night restlessness (OR 1.180, 95% CI 1.100-1.267); communication problems (OR 1.169, 95% CI 1.051-1.300); and cognitive impairment (OR 1.086, 95% CI 1.019-1.156); all increased the likelihood of crying. Conversely, sociability (OR 0.866, 95% CI 0.805-0.932) and being involved in social based activities (OR 0.882, were protective against crying. However, the previously mentioned variables have explained only 35.9% of variance in daily crying. Conclusions: Around one out of six residents living in NH cries on a daily basis, and the reasons are also at the individual level. Residents seem to cry for attachment and clinical needs and to express stress and unhappiness; more research is needed, aiming at discovering other factors associated with resident's daily crying.

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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

Abstract: 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.

Cited by 61 publications

References 51 publications

Prevalence of, and Resident and Facility Characteristics Associated With Antipsychotic Use in Assisted Living vs. Long-Term Care Facilities: A Cross-Sectional Analysis from Alberta, Canada

Prevalence of, and Resident and Facility Characteristics Associated With Antipsychotic Use in Assisted Living vs. Long-Term Care Facilities: A Cross-Sectional Analysis from Alberta, Canada

Reducing neuropsychiatric symptoms in persons with dementia and associated burden in family caregivers using tailored activities: Design and methods of a randomized clinical trial

Daily crying prevalence and associated factors in older adult persons living in nursing homes: findings from a regional study

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