Optimizing Care for Patients With Dementia

Not Applicable

Completed

Conditions: Alzheimer Disease

Interventions: Other: multidisciplinary approach
Other: transdisciplinary approach

Registration Number: NCT03442322

Lead Sponsor: University of Pittsburgh

Brief Summary: Of the 1.4 million nursing home (NH) residents in long term care facilities, more than half have Alzheimer's disease or dementia. Due to changes in their familiar daily routines, difficulty expressing their thoughts or asking for what they need, and overstimulation (such as noise) or under stimulation (such as lack of activity), individuals with dementia often display disruptive behaviors like resisting help or continually repeating the same phrases. Medications are often prescribed to reduce agitation and aggressive behavior; however, these medications may not be effective and can have a negative impact on the individual. Therefore, families and other stakeholders strongly advocate the use of other types of approaches that focus on minimizing the cause of the behavior. Two facility-based methodologies include the transdisciplinary approach for integrated dementia care, which combines the expertise of all NH staff, who work together to build a common language and approach for each resident, and the multidisciplinary approach for problem-based dementia care, in which each staff member conducts individual assessments and makes discipline-specific recommendations. While prior research suggests that both of these facility-based approaches are useful, the circumstances under which each approach is most effective are not clear. This project will prospectively randomize 80 nursing homes to one of the two treatment arms to compare the effect of the transdisciplinary approach versus the multidisciplinary approach.

This study will examine the difference between the two comparators with respect to facility rates of medications dispensed to residents with dementia, leading to enhanced quality of life for the resident.

This project is important because it will address a key clinical dilemma NH staff face as they strive to optimize the use of alternative approaches to reduce disruptive behaviors in residents with dementia. Transforming the quality of dementia care in NHs and enhancing the quality of life of residents with dementia are high priorities for families and other advocates.

Detailed Description: Not available

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 53

Inclusion Criteria

Eligible nursing home facilities will

lack any existing dementia program targeting reduction of off-label psychotropic medication use
each serve >60 long-term care residents with Alzheimer's or dementia
meet Center for Medicare & Medicaid Services' minimum requirements for NHs (e.g., meeting the mandated number of hours of staff training on dementia care, performing regularly scheduled resident assessments).

Exclusion Criteria

Facilities will be excluded if they have

less than 60 long-stay residents
an existing formal dementia care program in place
an off-label psychotropic medication reduction program
is located in a state that requires more than the Center for Medicare & Medicaid Services' minimum for staff training requirements on the topic of dementia care

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
multidisciplinary approach	multidisciplinary approach	The multidisciplinary approach that is problem-based and draws on the expertise of individual healthcare providers (e.g., occupational therapy) to address care concerns.
transdisciplinary approach	transdisciplinary approach	The transdisciplinary approach that is integrated across disciplines and provides core training for all providers, staff members, and stakeholders, using a common language to address care concerns and support continuity and sustainability

Primary Outcome Measures

Name	Time	Method
Dispensing of Psychotropic Medications	18-month period (months 13-18)	Percentage of nursing home residents with dementia who received one or more antipsychotic medication over Months 13-18 of Intervention.
Behavioral Symptoms	18-month period (months 13-18)	Percentage of nursing home residents with dementia who had behavioral symptoms over Months 13-18 of Intervention.
Wandering	18-month period (months 13-18)	Percentage of nursing home residents with dementia who had wandering over Months 13-18 of Intervention.
Rejection of Care	18-month period (months 13-18)	Percentage of nursing home residents with dementia who had rejection of care over Months 13-18 of Intervention.

Secondary Outcome Measures

Name	Time	Method
Unintended Weight Loss	18-month period (months 13-18)	Percentage of nursing home residents with dementia who had unintended weight loss over Months 13-18 of Intervention.
Falls	18-month period (months 13-18)	Percent of nursing home residents with dementia who had falls over Months 13-18 of Intervention.
Depressive Symptoms	18-month period (months 13-18)	Percent of nursing home residents with dementia who had depressive symptoms over Months 13-18 of Intervention.
Physical Restraints Use	18-month period (months 13-18)	Percent of nursing home residents with dementia who had physical restraint use over Months 13-18 of Intervention.