Coming to grips with challenging behavior: A cluster randomized controlled trial on the effects of a multidisciplinary care program for challenging behavior in dementia.

S.A. Zwijsen, M. Smalbrugge, J.A. Eefsting, J.W.R. Twisk, D.L. Gerritsen, A.M. Pot, C.M.P.M. Hertogh

Research output: Contribution to JournalArticleAcademicpeer-review

Abstract

Objectives: The Grip on Challenging Behavior care program was developed using the current guidelines and models on managing challenging behavior in dementia in nursing homes. It was hypothesized that the use of the care program would lead to a decrease in challenging behavior and in the prescription of psychoactive drugs without increase in use of restraints. Design: A randomized controlled trial was undertaken using a stepped-wedge design to implement the care program and to evaluate the effects. An assessment of challenging behavior and psychoactive medication was undertaken every 4 months on all participating units followed by the introduction of the care program in a group of 3 to 4 units. A total of 6 time assessments took place over 20 months. Setting: Seventeen dementia special care units of different nursing homes. Participants: A total of 659 residents of dementia special care units. All residents with dementia on the unit were included. Units were assigned by random allocation software to 1 of 5 groups with different starting points for the implementation of the care program. Intervention: A care program consisting of various assessment procedures and tools, which ensure a multidisciplinary approach and which structure the process of managing challenging behavior in dementia. Measurements: Challenging behavior was measured using the Cohen-Mansfield Agitation Inventory (CMAI) and the Neuropsychiatric Inventory. Research assistants (blinded for intervention status of the unit) interviewed nurses on the units about challenging behavior. Data on psychoactive drugs and restraints were retrieved from resident charts. Results: A total of 2292 assessments took place involving 659 residents (1126 control measurements, 1166 intervention measurements). The group of residents who remained in the intervention condition compared with the group in the control condition differed significantly in the CMAI change scores between successive assessments [-2.4 CMAI points, 95% confidence interval (CI) -4.3 to -0.6]. No significant effects were found for the control-to-intervention group compared with the group who remained in the control group (0.0 CMAI points, 95% CI -2.3 to 2.4). Significant effects were found on 5 of the 12 Neuropsychiatric Inventory items and on the use of antipsychotics (odds ratio 0.54, 95% CI 0.37- 0.80) and antidepressants (odds ratio 0.65, 95% CI 0.44-0.94). No effect on use of restraints was observed. Conclusions: The Grip on Challenging behavior program was able to diminish some forms of challenging behavior and the use of psychoactive drugs. © 2014 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
Original languageEnglish
Article number531.e1
Pages (from-to)531.e1-531.e10
JournalJournal of the American Medical Directors Association
Volume15
Issue number7
DOIs
Publication statusPublished - 2014

Fingerprint

Dementia
Randomized Controlled Trials
Equipment and Supplies
Psychotropic Drugs
Confidence Intervals
Hand Strength
Nursing Homes
Point-of-Care Systems
Odds Ratio
Control Groups
Prescription Drugs
Long-Term Care
Random Allocation
Antidepressive Agents
Antipsychotic Agents
Software
Nurses
Medicine
Guidelines
Research

Cite this

@article{92012ac5b47d42dc9ba9c45fd6eddfbe,
title = "Coming to grips with challenging behavior: A cluster randomized controlled trial on the effects of a multidisciplinary care program for challenging behavior in dementia.",
abstract = "Objectives: The Grip on Challenging Behavior care program was developed using the current guidelines and models on managing challenging behavior in dementia in nursing homes. It was hypothesized that the use of the care program would lead to a decrease in challenging behavior and in the prescription of psychoactive drugs without increase in use of restraints. Design: A randomized controlled trial was undertaken using a stepped-wedge design to implement the care program and to evaluate the effects. An assessment of challenging behavior and psychoactive medication was undertaken every 4 months on all participating units followed by the introduction of the care program in a group of 3 to 4 units. A total of 6 time assessments took place over 20 months. Setting: Seventeen dementia special care units of different nursing homes. Participants: A total of 659 residents of dementia special care units. All residents with dementia on the unit were included. Units were assigned by random allocation software to 1 of 5 groups with different starting points for the implementation of the care program. Intervention: A care program consisting of various assessment procedures and tools, which ensure a multidisciplinary approach and which structure the process of managing challenging behavior in dementia. Measurements: Challenging behavior was measured using the Cohen-Mansfield Agitation Inventory (CMAI) and the Neuropsychiatric Inventory. Research assistants (blinded for intervention status of the unit) interviewed nurses on the units about challenging behavior. Data on psychoactive drugs and restraints were retrieved from resident charts. Results: A total of 2292 assessments took place involving 659 residents (1126 control measurements, 1166 intervention measurements). The group of residents who remained in the intervention condition compared with the group in the control condition differed significantly in the CMAI change scores between successive assessments [-2.4 CMAI points, 95{\%} confidence interval (CI) -4.3 to -0.6]. No significant effects were found for the control-to-intervention group compared with the group who remained in the control group (0.0 CMAI points, 95{\%} CI -2.3 to 2.4). Significant effects were found on 5 of the 12 Neuropsychiatric Inventory items and on the use of antipsychotics (odds ratio 0.54, 95{\%} CI 0.37- 0.80) and antidepressants (odds ratio 0.65, 95{\%} CI 0.44-0.94). No effect on use of restraints was observed. Conclusions: The Grip on Challenging behavior program was able to diminish some forms of challenging behavior and the use of psychoactive drugs. {\circledC} 2014 AMDA - The Society for Post-Acute and Long-Term Care Medicine.",
author = "S.A. Zwijsen and M. Smalbrugge and J.A. Eefsting and J.W.R. Twisk and D.L. Gerritsen and A.M. Pot and C.M.P.M. Hertogh",
year = "2014",
doi = "10.1016/j.jamda.2014.04.007",
language = "English",
volume = "15",
pages = "531.e1--531.e10",
journal = "Journal of the American Medical Directors Association",
issn = "1525-8610",
publisher = "Elsevier Inc.",
number = "7",

}

Coming to grips with challenging behavior: A cluster randomized controlled trial on the effects of a multidisciplinary care program for challenging behavior in dementia. / Zwijsen, S.A.; Smalbrugge, M.; Eefsting, J.A.; Twisk, J.W.R.; Gerritsen, D.L.; Pot, A.M.; Hertogh, C.M.P.M.

In: Journal of the American Medical Directors Association, Vol. 15, No. 7, 531.e1, 2014, p. 531.e1-531.e10.

Research output: Contribution to JournalArticleAcademicpeer-review

TY - JOUR

T1 - Coming to grips with challenging behavior: A cluster randomized controlled trial on the effects of a multidisciplinary care program for challenging behavior in dementia.

AU - Zwijsen, S.A.

AU - Smalbrugge, M.

AU - Eefsting, J.A.

AU - Twisk, J.W.R.

AU - Gerritsen, D.L.

AU - Pot, A.M.

AU - Hertogh, C.M.P.M.

PY - 2014

Y1 - 2014

N2 - Objectives: The Grip on Challenging Behavior care program was developed using the current guidelines and models on managing challenging behavior in dementia in nursing homes. It was hypothesized that the use of the care program would lead to a decrease in challenging behavior and in the prescription of psychoactive drugs without increase in use of restraints. Design: A randomized controlled trial was undertaken using a stepped-wedge design to implement the care program and to evaluate the effects. An assessment of challenging behavior and psychoactive medication was undertaken every 4 months on all participating units followed by the introduction of the care program in a group of 3 to 4 units. A total of 6 time assessments took place over 20 months. Setting: Seventeen dementia special care units of different nursing homes. Participants: A total of 659 residents of dementia special care units. All residents with dementia on the unit were included. Units were assigned by random allocation software to 1 of 5 groups with different starting points for the implementation of the care program. Intervention: A care program consisting of various assessment procedures and tools, which ensure a multidisciplinary approach and which structure the process of managing challenging behavior in dementia. Measurements: Challenging behavior was measured using the Cohen-Mansfield Agitation Inventory (CMAI) and the Neuropsychiatric Inventory. Research assistants (blinded for intervention status of the unit) interviewed nurses on the units about challenging behavior. Data on psychoactive drugs and restraints were retrieved from resident charts. Results: A total of 2292 assessments took place involving 659 residents (1126 control measurements, 1166 intervention measurements). The group of residents who remained in the intervention condition compared with the group in the control condition differed significantly in the CMAI change scores between successive assessments [-2.4 CMAI points, 95% confidence interval (CI) -4.3 to -0.6]. No significant effects were found for the control-to-intervention group compared with the group who remained in the control group (0.0 CMAI points, 95% CI -2.3 to 2.4). Significant effects were found on 5 of the 12 Neuropsychiatric Inventory items and on the use of antipsychotics (odds ratio 0.54, 95% CI 0.37- 0.80) and antidepressants (odds ratio 0.65, 95% CI 0.44-0.94). No effect on use of restraints was observed. Conclusions: The Grip on Challenging behavior program was able to diminish some forms of challenging behavior and the use of psychoactive drugs. © 2014 AMDA - The Society for Post-Acute and Long-Term Care Medicine.

AB - Objectives: The Grip on Challenging Behavior care program was developed using the current guidelines and models on managing challenging behavior in dementia in nursing homes. It was hypothesized that the use of the care program would lead to a decrease in challenging behavior and in the prescription of psychoactive drugs without increase in use of restraints. Design: A randomized controlled trial was undertaken using a stepped-wedge design to implement the care program and to evaluate the effects. An assessment of challenging behavior and psychoactive medication was undertaken every 4 months on all participating units followed by the introduction of the care program in a group of 3 to 4 units. A total of 6 time assessments took place over 20 months. Setting: Seventeen dementia special care units of different nursing homes. Participants: A total of 659 residents of dementia special care units. All residents with dementia on the unit were included. Units were assigned by random allocation software to 1 of 5 groups with different starting points for the implementation of the care program. Intervention: A care program consisting of various assessment procedures and tools, which ensure a multidisciplinary approach and which structure the process of managing challenging behavior in dementia. Measurements: Challenging behavior was measured using the Cohen-Mansfield Agitation Inventory (CMAI) and the Neuropsychiatric Inventory. Research assistants (blinded for intervention status of the unit) interviewed nurses on the units about challenging behavior. Data on psychoactive drugs and restraints were retrieved from resident charts. Results: A total of 2292 assessments took place involving 659 residents (1126 control measurements, 1166 intervention measurements). The group of residents who remained in the intervention condition compared with the group in the control condition differed significantly in the CMAI change scores between successive assessments [-2.4 CMAI points, 95% confidence interval (CI) -4.3 to -0.6]. No significant effects were found for the control-to-intervention group compared with the group who remained in the control group (0.0 CMAI points, 95% CI -2.3 to 2.4). Significant effects were found on 5 of the 12 Neuropsychiatric Inventory items and on the use of antipsychotics (odds ratio 0.54, 95% CI 0.37- 0.80) and antidepressants (odds ratio 0.65, 95% CI 0.44-0.94). No effect on use of restraints was observed. Conclusions: The Grip on Challenging behavior program was able to diminish some forms of challenging behavior and the use of psychoactive drugs. © 2014 AMDA - The Society for Post-Acute and Long-Term Care Medicine.

U2 - 10.1016/j.jamda.2014.04.007

DO - 10.1016/j.jamda.2014.04.007

M3 - Article

VL - 15

SP - 531.e1-531.e10

JO - Journal of the American Medical Directors Association

JF - Journal of the American Medical Directors Association

SN - 1525-8610

IS - 7

M1 - 531.e1

ER -