Challenging behaviours in nursing home residents with dementia: a randomized controlled trial of multidisciplinary interventions

Opie, Janet; Doyle, Colleen; O'Connor, Daniel William

doi:10.1002/gps.493

Cited by 70 publications

(96 citation statements)

References 10 publications

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“…While a meta-analysis of risperidone showed it to be effective (De Deyn et al, 2005), a recent large RCT of three atypical antipsychotics in "real world" conditions proved disappointing (Schneider et al, 2006). Even combinations of carefully tailored nursing, psychosocial and medical interventions resulted in relatively modest, though statistically significant, changes in behavior in a nursing trial by Opie et al (2002) in which counts of restlessness and verbal disruption fell by 26% and 20% respectively. Much of this improvement was evident before treatments actually started.…”

Section: Discussionmentioning

confidence: 99%

Psychosocial treatments of behavior symptoms in dementia: a systematic review of reports meeting quality standards

O'Connor

Ames

Gardner

et al. 2008

IPG

Self Cite

174

147

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Objective: To provide a systematic review of selected experimental studies of psychosocial treatments of behavioral disturbances in dementia. Psychosocial treatments are defined here as strategies derived from one of three psychologically oriented paradigms (learning theory, unmet needs and altered stress thresholds).Method: English language reports published or in press by December 2006 were identified by means of database searches, checks of previous reviews and contact with recognized experts. Papers were appraised with respect to study design, participants' characteristics and reporting details. Because people with dementia often respond positively to personal contact, studies were included only if control conditions entailed similar levels of social attention or if one treatment was compared with another.Results: Only 25 of 118 relevant studies met every specification. Treatment proved more effective than an attention control condition in reducing behavioral symptoms in only 11 of the 25 studies. Effect sizes were mostly small or moderate. Treatments with moderate or large effect sizes included aromatherapy, abilityfocused carer education, bed baths, preferred music and muscle relaxation training.Conclusions: Some psychosocial interventions appear to have specific therapeutic properties, over and above those due to the benefits of participating in a clinical trial. Their effects were mostly small to moderate with a short duration of action. This limited action means that treatments will work best in specific, timelimited situations. In the few studies that addressed within-group differences, there were marked variations in response. Some participants benefited greatly from a treatment, while others did not. Interventions proved more effective when tailored to individuals' preferences.

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Section: Discussionmentioning

confidence: 99%

Psychosocial treatments of behavior symptoms in dementia: a systematic review of reports meeting quality standards

O'Connor

Ames

Gardner

et al. 2008

IPG

Self Cite

174

147

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“…The electronic database search yielded 1241 references (Figure 15), of which 12 [321][322][323][324][325][326][327][328][329][330][331][332] met the inclusion criteria. A further three papers [333][334][335] were identified from reference tracking, giving a total of 15 papers, of which seven [321][322][323][324][325]333,334 were relevant to question 1 and 12 [323][324][325][326][327][328][329][330][331][332]334,335 were relevant to question 2.…”

Section: The Literaturementioning

confidence: 99%

“…A further three papers [333][334][335] were identified from reference tracking, giving a total of 15 papers, of which seven [321][322][323][324][325]333,334 were relevant to question 1 and 12 [323][324][325][326][327][328][329][330][331][332]334,335 were relevant to question 2. All were papers published in peer-reviewed journals and each represented a different study.…”

Section: The Literaturementioning

confidence: 99%

“…All were papers published in peer-reviewed journals and each represented a different study. The earliest paper 332 was published in 1992, followed by two papers 326,332 published in 1999, eight papers 321,323,325,[327][328][329]331,333 between 2001 and 2005 and four 322,324,334,335 published between 2006 and 2011. The main reasons for rejection were first, that they focused solely on short-term training initiatives set up for research and second, that their focus was not on mental health support or outreach.…”

Section: The Literaturementioning

confidence: 99%

“…326 Seven studies were undertaken in Australia. [327][328][329][330][331][332]335 Five of the studies described existing service models, three in the UK 322,333,334 and two in Australia, 327,332 while nine studies had been specifically set up for research of which four were UK-based [323][324][325][326] and five were Australian-based 327-331 studies.…”

Section: The Studiesmentioning

confidence: 99%

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National trends and local delivery in old age mental health services: towards an evidence base. A mixed-methodology study of the balance of care approach, community mental health teams and specialist mental health outreach to care homes

Challis

Tucker

Wilberforce

et al. 2014

Programme Grants for Applied Research

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BackgroundThe rising number of older people with mental health problems makes the effective use of mental health resources imperative. Little is known about the clinical effectiveness and/or cost-effectiveness of different service models.AimsThe programme aimed to (1) refine and apply an existing planning tool [‘balance of care’ (BoC)] to this client group; (2) identify whether, how and at what cost the mix of institutional and community services could be improved; (3) enable decision-makers to apply the BoC framework independently; (4) identify variation in the structure, organisation and processes of community mental health teams for older people (CMHTsOP); (5) examine whether or not different community mental health teams (CMHTs) models are associated with different costs/outcomes; (6) identify variation in mental health outreach services for older care home residents; (7) scope the evidence on the association between different outreach models and resident outcomes; and (8) disseminate the research findings to multiple stakeholder groups.MethodsThe programme employed a mixed-methods approach including three systematic literature reviews; a BoC study, which used a systematic framework for choosing between alternative patterns of support by identifying people whose needs could be met in more than one setting and comparing their costs/outcomes; a national survey of CMHTs’ organisation, structure and processes; a multiple case study of CMHTs exhibiting different levels of integration encompassing staff interviews, an observational study of user outcomes and a staff survey; national surveys of CMHTs’ outreach activities and care homes. A planned randomised trial of depression management in care homes was removed at the review stage by the National Institute for Health Research (NIHR) prior to funding award.ResultsBoC: Past studies exhibited several methodological limitations, and just two related to older people with mental health problems. The current study suggested that if enhanced community services were available, a substantial proportion of care home and inpatient admissions could be diverted, although only the latter would release significant monies. CMHTsOP: 60% of teams were considered multidisciplinary. Most were colocated, had a single point of access (SPA) and standardised assessment documentation. Evidence of the impact of particular CMHT features was limited. Although staff spoke positively about integration, no evidence was found that more integrated teams produced better user outcomes. Working in high-integration teams was associated with poor job outcomes, but other factors negated the statistical significance of this. Care home outreach: Typical services in the literature undertook some combination of screening (less common), assessment, medication review, behaviour management and training, and evidence suggested intervention can benefit depressed residents. Care home staff were perceived to lack necessary skills, but relatively few CMHTs provided formal training.LimitationsLimitations include a necessary reliance on observational rather than experimental methods, which were not feasible given the nature of the services explored.ConclusionsBoC: Shifting care towards the community would require the growth of support services; clarification of extra care housing’s (ECH) role; timely responses to people at risk of psychiatric admission; and improved hospital discharge planning. However, the promotion of care at home will not necessarily reduce public expenditure. CMHTsOP: Although practitioners favoured integration, its goals need clarification. Occupational therapists (OTs) and social workers faced difficulties identifying optimal roles, and support workers’ career structures needed delineating. Care home outreach: Further CMHT input to build care home staff skills and screen for depression may be beneficial. Priority areas for further study include the costs and benefits for older people of age inclusive mental health services and the relative cost-effectiveness of different models of mental health outreach for older care home residents.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

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Functional analysis-based interventions for challenging behaviour in dementia

Moniz-Cook

Swift

James

et al. 2012

Cochrane Database of Systematic Reviews

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The delivery of FA has been incorporated within wide ranging multi-component programmes and study designs have varied according to setting - i.e. family care, care homes and hospital, with surprisingly few studies located in care homes. Our findings suggest potential beneficial effects of multi-component interventions, which utilise FA. Whilst functional analysis for challenging behaviour in dementia care shows promise, it is too early to draw conclusions about its efficacy.

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Challenging behaviours in nursing home residents with dementia: a randomized controlled trial of multidisciplinary interventions

Abstract: The consultancies were effective and well received by staff. The change-inducing nature of any new endeavour is an integral part of research in a long-term setting.

Cited by 70 publications

References 10 publications

Psychosocial treatments of behavior symptoms in dementia: a systematic review of reports meeting quality standards

Psychosocial treatments of behavior symptoms in dementia: a systematic review of reports meeting quality standards

National trends and local delivery in old age mental health services: towards an evidence base. A mixed-methodology study of the balance of care approach, community mental health teams and specialist mental health outreach to care homes

Functional analysis-based interventions for challenging behaviour in dementia

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