Effect of enhanced psychosocial care on antipsychotic use in nursing home residents with severe dementia: cluster randomised trial

BMJ. 2006 Apr 1;332(7544):756-61. doi: 10.1136/bmj.38782.575868.7C. Epub 2006 Mar 16.


Objective: To evaluate the effectiveness of a training and support intervention for nursing home staff in reducing the proportion of residents with dementia who are prescribed neuroleptics.

Design: Cluster randomised controlled trial with blinded assessment of outcome.

Setting: 12 specialist nursing homes for people with dementia in London, Newcastle, and Oxford.

Participants: Residents of the 12 nursing homes; numbers varied during the study period.

Intervention: Training and support intervention delivered to nursing home staff over 10 months, focusing on alternatives to drugs for the management of agitated behaviour in dementia.

Main outcome measures: Proportion of residents in each home who were prescribed neuroleptics and mean levels of agitated and disruptive behaviour (Cohen-Mansfield agitation inventory) in each home at 12 months.

Results: At 12 months the proportion of residents taking neuroleptics in the intervention homes (23.0%) was significantly lower than that in the control homes (42.1%): average reduction in neuroleptic use 19.1% (95% confidence interval 0.5% to 37.7%). No significant differences were found in the levels of agitated or disruptive behaviour between intervention and control homes.

Conclusions: Promotion of person centred care and good practice in the management of patients with dementia with behavioural symptoms provides an effective alternative to neuroleptics.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Accidental Falls
  • Aggression
  • Antipsychotic Agents / therapeutic use*
  • Cluster Analysis
  • Dementia / drug therapy*
  • Health Status
  • Homes for the Aged
  • Humans
  • Nursing Homes
  • Psychomotor Agitation
  • Quality of Life
  • Therapeutic Equivalency


  • Antipsychotic Agents