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The majority of nursing home (NH) patients have mental disorders or behavioral problems, yet no randomized, controlled clinical trials exit comparing methods to treat these problems, we propose to conduct a randomized, controlled clinical trial to test the efficacy of a Psychiatric Intervention Program (PIP) to reduce behavior disorders in demented NH patients. The Psychiatric Intervention Program will consist of three components; 1) Multi-disciplinary clinical rounds directed by a psychiatris , 2) defined psychotropic drug protocols and, 3) an activities program design d specifically for demented patients.

The primary outcome will be behavior disorder and will be assessed by train d raters masked to patients' treatment assignment and by NH staff unmasked to treatment assignment. The behavior outcome will be assessed on three occasions during a six month observation period. We will also examine the impact of the intervention on secondary outcomes such as use of restraints, cognitive status, functional capacity, family satisfaction, nursing staff j b satisfaction and costs of the intervention in relation to other NH costs.

Residents in an intermediate care NH will be screened by a geriatric nurse specialist for behavior disorder and examined for the presence of dementia by a psychiatrist. After consent is obtained from family members and patients those meeting criteria for behavior disorder plus dementia will be randomized to treatment and control groups. In addition to the screening a d psychiatric evaluation, data will be collected from independent observation

of patient behavior, from nursing staff interviews, family interviews and chart reviews.

Because no well-designed clinical studies exist which test the efficacy of treatment programs for behavior disorders in demented NH patients, this wor

will provide information on a new approach to the treatment of behavior disorder in NHs. It is expected that the treatment will be effective at a reasonable cost and has the potential for application in other NHs in the U.S.
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