ARANDOMIZED TRIAL OF DEMENTIA CARE IN NURSING HOMES


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Collapse Overview 
Collapse abstract
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.
Collapse sponsor award id
R01MH045293

Collapse Time 
Collapse start date
1989-08-01
Collapse end date
1993-08-31