A randomized trial of dementia care in nursing homes

J Am Geriatr Soc. 1996 Jan;44(1):7-13. doi: 10.1111/j.1532-5415.1996.tb05631.x.

Abstract

Objective: To evaluate the efficacy of a dementia care program to reduce behavior disorders in nursing home patients with dementia.

Design: Randomized controlled clinical trial with 6-month follow-up.

Setting: A 250-bed community nursing home.

Patients: The nursing home was screened to identify patients with dementia and behavior disorders. A total of 118 patients were eligible for randomization. Of these, 89 (75.4%) were randomized, and 81 of these (91.0%) completed the trial.

Intervention: The A.G.E. dementia care program consisted of Activities, Guidelines for psychotropic medications, and Educational rounds. The control treatment was usual nursing home care.

Measurements: Behavior disorders, antipsychotic drug and physical restraint use, patient activity levels, and cognitive and functional status.

Results: After 6 months, 12 of 42 (28.6%) intervention patients exhibited behavior disorders compared with 20 of 39 (51.3%) controls (OR = 0.38; 95% CI [0.15, 0.95]; P = .037). Controls were more than twice as likely to receive antipsychotics (OR = 2.55, 95% CI [0.96, 6.76]; P < .056), to be restrained during activity times (OR = 2.98, 95% CI [1.10, 8.04]; P < .028), and to be restrained on nursing units (OR = 2.14, 95% CI [0.9, 5.3]; P < .10). Intervention patients were much more likely to participate in activities (OR = 13.71; 95% CI [4.51, 41.73]; P = .001).

Conclusions: The A.G.E. program reduces the prevalence of behavior disorders and the use of antipsychotic drugs and restraints. It is practical, feasible, and appears to improve the lives of patients with dementia in nursing homes.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Antidepressive Agents, Tricyclic / therapeutic use
  • Antipsychotic Agents / therapeutic use
  • Baltimore
  • Cognition Disorders / diagnosis
  • Cognition Disorders / therapy
  • Costs and Cost Analysis
  • Dementia / diagnosis
  • Dementia / therapy*
  • Depression / diagnosis
  • Depression / therapy
  • Female
  • Follow-Up Studies
  • Humans
  • Leisure Activities
  • Logistic Models
  • Male
  • Mental Disorders / diagnosis
  • Mental Disorders / therapy
  • Nortriptyline / therapeutic use
  • Nursing Homes / economics
  • Nursing Homes / statistics & numerical data*
  • Outcome and Process Assessment, Health Care
  • Program Evaluation
  • Restraint, Physical
  • Statistics, Nonparametric

Substances

  • Antidepressive Agents, Tricyclic
  • Antipsychotic Agents
  • Nortriptyline