Behavioural management in nursing and residential homes: a randomised controlled trial Caring for Aged Dementia Care Resident Study (CADRES) of person-centred care, dementia-care mapping, and usual care in dementia: a cluster-randomised trial Effect of Exercise on Mood in Nursing Home Residents With Alzheimer's Disease High-intensity functional exercise program and protein-enriched energy supplement for older persons dependent in activities of daily living: a randomised controlled trial. An investigation of long-term effects of group music therapy on agitation levels of people with Alzheimer's Disease Effects of a physiotherapy and occupational therapy intervention on mobility and activity in care home residents: a cluster randomised controlled trial Effects of a high-intensity functional exercise programme on depressive symptoms and psychological well-being among older people living in residential care facilities: A cluster-randomized controlled trial Effectiveness of integrative and instrumental reminiscence therapies on depression symptoms reduction in institutionalized older adults: An empirical study Effect of enhanced psychosocial care on antipsychotic use in nursing home residents with severe dementia: cluster randomised trial Does a functional activity programme improve function, quality of life, and falls for residents in long term care? Cluster randomised controlled trial Psychiatric symptoms and nursing home placement of patients with Alzheimer's disease. Efficacy of nonpharmacologic interventions for agitation in advanced dementia: a randomized, placebo-controlled trial. Hand motor activity, cognition, mood, and the rest–activity rhythm in dementia: A clustered RCT Exercise training for depressed older adults with Alzheimer's disease The social treatment: the benefits of group interventions in residential care settings. Effect of the BACE intervention on agitation of people with dementia. Efficacy of Music Therapy in the Treatment of Behavioral and Psychiatric Symptoms of Dementia Can agitated behavior of nursing home residents with dementia be prevented with the use of standardized stimuli? The effects of group music with movement intervention on agitated behaviours of institutionalized elders with dementia in Taiwan. A randomized clinical trial of theory-based activities for the behavioral symptoms of dementia in nursing home residents. Exercise program for nursing home residents with Alzheimer's disease: a 1-year randomized, controlled trial. A group music intervention using percussion instruments with familiar music to reduce anxiety and agitation of institutionalized older adults with dementia. Group reminiscence therapy for cognitive and affective function of demented elderly in Taiwan. An exploratory cluster randomized controlled trial of group exercise on mobility and depression in care home residents The effect of integrated emotion-oriented care versus usual care on elderly persons with dementia in the nursing home and on nursing assistants: a randomized clinical trial. A randomized controlled trial of fall prevention by a high-intensity functional exercise program for older people living in residential care facilities Effects of Group Music Intervention on Behavioral and Psychological Symptoms in Patients with Dementia: A Pilot-Controlled Trial AD-venture program: Therapeutic biking for the treatment of depression in long-term care residents with dementia Physical, Affective, and Behavioral Effects of Group Reminiscence on Depressed Institutionalized Elders in Taiwan A randomized, controlled, clinical trial of activity therapy for apathy in patients with dementia residing in long-term care. Effects of a Creative Expression Intervention on Emotions, Communication, and Quality of Life in Persons With Dementia Using silver yoga exercises to promote physical and mental health of elders with dementia in long-term care facilities.
BACKGROUND As more and more elderly people are being cared for in residential and nursing homes , how best can their psychiatric needs be met ? We report on evaluation of a behavioural intervention by an old-age psychiatry hospital outreach team . METHODS This r and omised controlled trial of a training and education intervention over 6 months was done in south Manchester , UK . 12 matched nursing and residential homes were r and omised to the  control or intervention group and within each , the staff selected 10 residents whose behavioural problems made them difficult to care for . Care staff in the intervention homes attended seminars from the hospital outreach team and received weekly visits from a psychiatric nurse to assist in developing care planning skills . The main outcome measures were cognitive impairment and depression , behavioural disturbance , and functional ability , assessed by the geriatric mental state schedule , Crichton Royal behaviour rating scale , and Barthel index , respectively . FINDINGS Residents in the intervention group had significantly improved scores for depression ( before- and -after change difference -0.5 [ 95 % CI -0.8 to -0.1 ] ) and for cognitive impairment ( -0.7 [ -1.1 to -0.2 ] ) but not for behaviour rating or Barthel index .  INTERPRETATION Elderly residents can benefit from improved quality of care achieved by training from a hospital outreach team BACKGROUND Evidence for improved outcomes for people with dementia through provision of person-centred care and dementia-care mapping is largely observational . We aim ed to do a large , r and omised comparison of person-centred care , dementia-care mapping , and usual care . METHODS In a cluster r and omised controlled trial , urban residential sites were r and omly assigned to person-centred care , dementia-care mapping , or usual care . Carers received training and support in either intervention or continued usual care . Treatment allocation was masked to assessors . The primary outcome was agitation measured with the Cohen-Mansfield agitation inventory ( CMAI ) . Secondary outcomes included psychiatric symptoms including hallucinations , neuropsychological status , quality of life , falls , and cost of treatment . Outcome measures were assessed before and directly after 4 months of intervention , and at 4 months of follow-up . Hierarchical linear models were used to test treatment and time effects . Analysis was by intention to treat . This trial is registered with the Australia and New Zeal and Clinical Trials Registry , number ACTRN12608000084381 . FINDINGS 15 care sites with 289 residents were r and omly assigned . Pairwise contrasts revealed that at follow-up , and relative to usual care , CMAI score was lower in sites providing mapping ( mean difference 10.9 , 95 % CI 0.7 - 21.1 ; p=0.04 ) and person-centred care ( 13.6 , 3.3 - 23.9 ; p=0.01 ) . Compared with usual care , fewer falls were recorded in sites that used mapping ( 0.24 , 0.08 - 0.40 ; p=0.02 ) but there were more falls with person-centred care ( 0.15 , 0.02 - 0.28 ; p=0.03 ) . There were no other significant effects . INTERPRETATION Person-centred care and dementia-care mapping both seem to reduce agitation in people with dementia in residential care The purpose oF this study was to examine the eFFects oF 3 behavioral interventions on aFFect and mood in nursing home residents with Alzheimer 's disease . In a pre — post design , 90 residents with Alzheimer 's disease were r and omized to 3 groups : supervised walking , comprehensive exercise ( walking plus strength training , balance , and Flexibility exercises ) , and social conversation ( casual rather than therapeutic themes ) . Interventions were provided 5 days a week and progressed up to 30 minutes per session over 16 weeks . Interventions were conducted primarily indoors . Outcome measures included the Lawton Observed AFFect Scale , Alzheimer Mood Scale , and Dementia Mood Assessment . At posttest , participants receiving comprehensive exercise exhibited higher positive and lower negative aFFect and mood . The social conversation group exhibited the least positive and most negative mood and aFFect . Results suggest that exercise programs be emphasized in long-term care , particularly whole-body involvement rather than walking alone The aims of this r and omised controlled trial were to determine if a high-intensity functional exercise program improves balance , gait ability , and lower-limb strength in older persons dependent in activities of daily living and if an intake of protein-enriched energy supplement immediately after the exercises increases the effects of the training . One hundred and ninety-one older persons dependent in activities of daily living , living in residential care facilities , and with a Mini-Mental State Examination ( MMSE ) score of ? 10 participated . They were r and omised to a high-intensity functional exercise program or a control activity , which included 29 sessions over 3 months , as well as to protein-enriched energy supplement or placebo .  Berg Balance Scale , self-paced and maximum gait speed , and one-repetition maximum in lower-limb strength were followed-up at three and six months and analysed by 2 x 2 factorial ANCOVA , using the intention-to-treat principle . At three months , the exercise group had improved significantly in self-paced gait speed compared with the control group ( mean difference 0.04 m/s , p = 0.02 ) . At six months , there were significant improvements favouring the exercise group for Berg Balance Scale ( 1.9 points , p = 0.05 ) , self-paced gait speed ( 0.05 m/s , p = 0.009 ) , and lower-limb strength ( 10.8 kg , p = 0.03 ) . No interaction effects were seen between the exercise and nutrition interventions . In conclusion , a high-intensity functional exercise program has positive long-term effects in balance , gait ability , and lower-limb strength for older persons dependent in activities of daily living . An intake of protein-enriched energy supplement immediately after the exercises does not appear to increase the effects of the training This study aim ed to investigate the long-term effects of group music therapy on  agitation manifested by nursing home residents with Alzheimer 's disease . A non-r and omised experimental design was employed with one group receiving weekly music therapy ( n = 26 ) and another group receiving st and ard nursing home care ( n = 19 ) .  Agitation levels were measured five times over one year using the Cohen-Mansfield Agitation Inventory ( Cohen-Mansfield , J. ( 1989 ) . Agitation in the elderly . In N. Billig & P. V. Rabins ( Eds . ) , Issues in geriatric psychiatry ( pp . 101–113 ) . Basel , Switzerl and : Karger ) . Although music therapy participants showed short-term reductions in agitation , there were no significant differences between the groups in the range , frequency , and severity of agitated behaviours manifested over time . Multiple measures of treatment efficacy are necessary to better underst and the long-term effects music therapy programs have on this population Objective To compare the clinical effectiveness of a programme of physiotherapy and occupational therapy with st and ard care in care home residents who have mobility limitations and are dependent in performing activities of daily living . Design Cluster r and omised controlled trial , with r and om allocation at the level of care home . Setting Care homes within the NHS South Birmingham primary care trust and the NHS Birmingham East and North primary care trust that had more than five beds and provided for people in the care categories “ physical disability ” and “ older people . ” Participants Care home residents with mobility limitations , limitations in activities of daily living ( as screened by the Barthel index ) , and not receiving end of life care were eligible to take part in the study . Intervention A targeted three month occupational therapy and physiotherapy programme . Main outcome measures Scores on the Barthel index and the Rivermead mobility index . Results 24 of 77 nursing and residential homes that catered for residents with mobility limitations and dependency for activities of daily living were selected for study : 12 were r and omly allocated to the intervention arm ( 128 residents , mean age 86 years ) and 12 to the control arm ( 121 residents , mean age 84 years ) . Participants were evaluated by independent assessors blind to study arm allocation before r and omisation ( 0 months ) , three months after r and omisation ( at the end of the treatment period for patients who received the intervention ) , and again at six months after r and omisation . After adjusting for home effect and baseline characteristics , no significant differences were found in mean Barthel index scores at six months post-r and omisation between treatment arms ( mean effect 0.08 , 95 % confidence interval −1.14 to 1.30 ; P=0.90 ) , across assessment s ( −0.01 , −0.63 to 0.60 ; P=0.96 ) , or in the interaction between assessment and intervention ( 0.42 , −0.48 to 1.32 ; P=0.36 ) . Similarly , no significant differences were found in the mean Rivermead mobility index scores between treatment arms ( 0.62 , −0.51 to 1.76 ; P=0.28 ) , across assessment s ( −0.15 , −0.65 to 0.35 ; P=0.55 ) , or interaction ( 0.71 , −0.02 to 1.44 ; P=0.06 ) . Conclusions The three month occupational therapy and physiotherapy programme had no significant effect on mobility and independence . On the other h and , the variation in residents ’ functional ability , the prevalence of cognitive impairment , and the prevalence of depression were considerably higher in this sample than expected on the basis of previous work . Further research to clarify the efficacy of occupational therapy and physiotherapy is required if access to therapy services is to be recommended in this population . Trial registration IS RCT Objectives : To evaluate the effects of a high-intensity functional exercise programme on depressive symptoms and psychological well-being among older people dependent in activities of daily living ( ADL ) and living in residential care facilities . Method : Cluster-r and omized controlled study . Participants were 191 older people , aged 65–100 , dependent in ADL and with Mini Mental State Examination scores between 10 and 30 . One-hundred ( 52 % ) of the participants had a diagnosed dementia disorder . A high-intensity functional weight-bearing exercise programme and a control activity were performed in groups . Sessions were held five times over each two week period for three months , a total of 29 times . The outcome measures , Geriatric Depression Scale ( GDS-15 ) and Philadelphia Geriatric Center Morale Scale ( PGCMS ) were blindly assessed at baseline , three and six months . Results : At baseline , mean ± SD ( range ) for GDS was 4.4 ± 3.2 ( 0–14 ) , and for PGCMS 11.0 ± 3.5 ( 2–17 ) . There were no significant differences in GDS or PGCMS between the exercise and the control group at the three and six month follow-ups in the total sample . Among people with dementia , there was a between-group difference at three months in PGCMS scores in favour of the exercise group . Conclusion : A high-intensity functional exercise programme seems generally not to influence depressive symptoms or psychological well-being among older people dependent in ADL and living in residential care facilities . An individualized and multifactorial intervention may be needed in this group . However , an exercise programme as a single intervention may have a short-term effect on well-being among people with dementia Objective : Reminiscence therapy is a psychological intervention which is specifically design ed to address issues of particular relevance to older adults , such as depression . The latest approach to the research on therapeutic utility of reminiscence is gaining popularity among research ers and practitioners , and has yielded promising results . Specifying different types of reminiscence is a crucial component of the approach . The aim of this study was to examine the therapeutic effectiveness of integrative and instrumental types of reminiscence for the treatment of depression in institutionalized older adults dwelling in a nursing home . Method : The study employed a three-group pre – post-test design with r and om allocation to instrumental or integrative reminiscence or an active social discussion control condition .  Twenty-nine institutionalized older adults ( 12 men and 17 women ) with depressive symptoms varying from mild to severe constituted the sample . The interventions were implemented in a short-form group format . Findings : Analysis of changes from pre-test to post-test revealed that integrative reminiscence therapy led to statistically significant reduction in symptoms of depression in contrast with the control group . Although instrumental reminiscence therapy also reduced depressive symptoms , this improvement was not statistically significant compared to the control group . Conclusion : This study provides additional support for the effectiveness of integrative reminiscence therapy as an intervention for depressed older adults living in residential care setting s. This study also provides support for the hypothesis that certain types of reminiscence produce their own specific effects Abstract 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 r and omised 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 Objective To assess the effectiveness of an activity programme in improving function , quality of life , and falls in older people in residential care . Design Cluster r and omised controlled trial with one year follow-up . Setting 41 low level dependency residential care homes in New Zeal and . Participants 682 people aged 65 years or over . Interventions 330 residents were offered a goal setting and individualised activities of daily living activity programme by a gerontology nurse , reinforced by usual healthcare assistants ; 352 residents received social visits . Main outcome measures Function ( late life function and disability instruments , elderly mobility scale , FICSIT-4 balance test , timed up and go test ) , quality of life ( life satisfaction index , EuroQol ) , and falls ( time to fall over 12 months ) . Secondary outcomes were depressive symptoms and hospital admissions . Results 473 ( 70 % ) participants completed the trial . The programme had no impact overall . However , in contrast to residents with impaired cognition ( no differences between intervention and control group ) , those with normal cognition in the intervention group may have maintained overall function ( late life function and disability instrument total function , P=0.024 ) and lower limb function ( late life function and disability instrument basic lower extremity , P=0.015 ) . In residents with cognitive impairment , the likelihood of depression increased in the intervention group . No other outcomes differed between groups . Conclusion A programme of functional rehabilitation had minimal impact for elderly people in residential care with normal cognition but was not beneficial for those with poor cognition . Trial registration Australian Clinical Trials Register ACTRN12605000667617 Two hundred ten community-dwelling patients with Alzheimer 's disease were examined prospect ively by psychiatrists as part of a longitudinal study . Twenty-five of these patients who were institutionalized during the next 3 years were then matched to 25 patients who were not institutionalized  , and the groups were compared . The patients who had been institutionalized had higher scores on st and ardized psychiatric rating scales but not on formal neuropsychological tests of cognition . These results suggest that potentially treatable ( noncognitive ) behavioral and psychiatric symptoms are risk factors for institutionalization , and that treating these symptoms might delay or prevent institutionalization of some patients BACKGROUND A r and omized , placebo-controlled clinical trial was undertaken to determine the efficacy of nonpharmacologic individualized interventions ( individualized to address unmet needs such as boredom or pain ) in decreasing agitation in persons with dementia . METHOD Agitated nursing home residents with advanced dementia ( from 9 nursing homes in 5 locations in Maryl and , United States ) were r and omized into an  intervention group ( n = 89 ) and a  placebo control group ( n = 36 ) . On the basis of data from baseline assessment , a systematic methodology for individualizing nonpharmacologic interventions , Treatment Routes for Exploring Agitation ( TREA ) , was used with the intervention group : an unmet need was hypothesized , a corresponding treatment category was identified , and specifics of the treatment were chosen to fit the person 's need , past identity , preferences , and abilities . ( Unmet needs were hypothesized based on physician evaluations , structured staff interviews , relative question naires , direct observations of agitation with the Agitation Behavior Mapping Instrument [ the primary outcome measure ] and affect with Lawton 's Modified Behavior Stream [ the secondary outcome measure ] , and resident assessment s. ) TREA interventions were implemented for 2 weeks , and observations of agitation and affect were recorded . The study was conducted from June 2006 until December 2011 . RESULTS Relative to a control group , TREA interventions for unmet needs produced statistically significant declines in total ( P < .001 ) , physical nonaggressive ( P < .001 ) , and verbal agitation ( P = .004 ) and significant increases in pleasure ( P < .001 ) and interest ( P < .05 ) . CONCLUSIONS This is the first large r and omized controlled trial to demonstrate the efficacy of TREA and one of only a few such trials of nonpharmacologic interventions for agitation in persons with dementia . The translation of these findings into practice is sorely needed and would require structural changes dedicating staff time to observing each agitated resident , determining unmet needs , obtaining appropriate intervention material s , conducting the individualized nonpharmacologic interventions , and evaluating results . TRIAL REGISTRATION Clinical Trials.gov identifier : NCT00820859 BACKGROUND Physical activity such as walking may exert a positive impact on cognition and behaviour in older persons with dementia , but due to the frailty of the population it may be worthwhile to consider other motor activities as well . OBJECTIVE Examining the effects of h and motor activity on cognition , mood and the rest-activity rhythm in older persons with dementia . METHODS Sixty-one older nursing home residents with dementia ( mean age 84.6 years ) were r and omly assigned to either a h and movement program ( experimental ) or read aloud program ( control ) for 30min , 5 days a week , during 6 weeks . Neuropsychological tests , mood question naires , and actigraphy data were assessed at baseline , after 6 weeks , and again after 6 weeks . Apolipoprotein epsilon ( ApoE ) genotype was determined . RESULTS Scores on neuropsychological tests were combined and formed specific Cognitive domains . Symptoms of depression and anxiety formed the Mood domain . Actigraphy variables composed the Rest-activity domain . In mixed model analyses no significant group x time interactions were found on either the Cognitive , Mood or Rest-activity domains in the intention-to-treat analysis . In the per protocol analysis , that included people who attended at least 80 % of the sessions , mood improved only in the experimental group . No significant time x group x ApoE interaction effects were found in either analysis . CONCLUSION In older nursing home residents with dementia , increased attendance to the h and movement program appeared to have a positive effect on mood .  H and motor activity is a type of activity that can be applied at a large scale The purpose of this study was to compare the effects of 16 weeks of a comprehensive exercise routine to supervised walking and social conversation on depression in nursing home residents with Alzheimer 's disease ( AD ) . Method : This study was a three-group , repeated- measures design with r and om assignment to treatment group . Forty-five nursing home residents with moderate to severe AD were r and omly assigned to a 16-week programme of comprehensive exercise , supervised walking or social conversation . Raters were blinded to treatment group assignment . Major outcome variables were depression measured by the Cornell Scale for Depression in Dementia , mood measured by the Dementia Mood Assessment Scale and the Alzheimer 's Mood Scale , and affect measured by the Observed Affect Scale . Depression was reduced in all three groups with some evidence of superior benefit from exercise .  Depression is a common problem with serious and costly consequences for nursing home residents with AD .  Exercise as a behavioural approach to treatment of depression in nursing home residents with severe AD evidence d a clear benefit to participants in this study . More research is needed to clarify the relative benefits of different types of exercise in conjunction with or without pharmacological intervention We report findings from an intervention study that investigates the impact of group reminiscence ( GR ) and individual reminiscence ( IR ) activities on older adults living in care setting s. This research aim ed to provide a theory-driven evaluation of reminiscence based on a social identity framework . This framework predicts better health outcomes for group-based interventions as a result of their capacity to create a sense of shared social identification among participants . A total of 73 residents , living in either st and ard or specialized ( i.e. , dementia ) care units , were r and omly assigned to one of three interventions : GR ( n = 29 ) , IR ( n = 24 ) , and a group control activity ( n = 20 ) . The intervention took place over 6 weeks , and cognitive screening and well-being measures were administered both pre- and post-intervention . Results indicated that only the group interventions produced effective outcomes and that these differed as a modality-specific function of condition : Collective re collection of past memories enhanced memory performance , and engaging in a shared social activity enhanced well-being . Theoretically , these findings point to the important role that group membership plays in maintaining and promoting health and well-being PURPOSE This study tests the effectiveness of the theoretically driven BACE ( i.e. , Balancing Arousal Controls Excesses ) intervention in decreasing agitation in residents of long-term care with moderate or severe dementia . DESIGN AND METHODS A pretest-posttest double-blinded experimental design with r and om assignment was used with a sample of 78 participants . The BACE intervention controls the daily activity schedule so that there is a balance between a person 's high-arousal and low-arousal states . The outcome measure was observed agitation . RESULTS When time spent in arousal imbalance at pretest was controlled for , a repeated measures analysis of covariance revealed a statistically significant Group x Time interaction , F(1 , 69 ) = 4.26 , p = .043 , with a partial eta(2 ) = .06 . The average change in agitation for the treatment group was a decrease of 8.43 points ( SD = 12.01 ) from pretest to posttest , an effect size of.7 . IMPLICATION S The results of this study support the theory that balancing arousal states by using an individualized approach is effective in decreasing agitation levels of people with dementia Background Music therapy ( MT ) has been proposed as valid approach for behavioral and psychologic symptoms ( BPSD ) of dementia . However , studies demonstrating the effectiveness of this approach are lacking . Objective To assess MT effectiveness in reducing BPSD in subjects with dementia . Method Fifty-nine persons with dementia were enrolled in this study . All of them underwent a multidimensional assessment including Mini Mental State Examination , Barthel Index and Neuropsychiatry Inventory at enrolment and after 8 , 16 , and 20 weeks . Subjects were r and omly assigned to experimental ( n=30 ) or control ( n=29 ) group . The MT sessions were evaluated with st and ardized criteria . The experimental group received 30 MT sessions ( 16 wk of treatment ) , whereas the control group received educational support or entertainment activities . Results NPI total score significantly decreased in the experimental group at 8th , 16th , and 20th weeks ( interaction time × group : F3 , 165=5.06 , P=0.002 ) . Specific BPSD ( ie , delusions , agitation , anxiety , apathy , irritability , aberrant motor activity , and night-time disturbances ) significantly improved . The empathetic relationship and the patients ' active participation in the  MT  approach , also improved in the experimental group . Conclusions The study shows that MT is effective to reduce BPSD in patients with moderate-severe dementia OBJECTIVES To assess the relative effect of different types of stimuli on agitated behaviors of nursing home residents with dementia . DESIGN Repeated- measures design with r and omized assignment of conditions . SETTING Seven Maryl and nursing homes . PARTICIPANTS One hundred eleven nursing home residents with a diagnosis of dementia who exhibited agitation . INTERVENTION Different types of stimuli ( music , social stimuli , simulated social stimuli , and individualized stimuli based on the person 's self-identity ) were presented . MEASUREMENTS Agitation was directly observed and recorded using the Agitation Behavior Mapping Instrument . RESULTS All stimulus categories were associated with significantly less physical agitation than baseline observations , and all except for manipulative stimuli were associated with significantly less total agitation . Live social stimuli were associated with less agitation than music , self-identity , work , simulated social , and manipulative stimulus categories . Task and reading stimulus categories were each associated with significantly less agitation than work , simulated social , and manipulative stimulus categories . Music and self-identity stimuli were associated with less agitation than simulated social and manipulative stimuli . CONCLUSION Providing stimuli offers a proactive approach to preventing agitation in persons with dementia , with live social stimuli being the most successful BACKGROUND Agitated behaviours are identified by caregivers as the most challenging in dementia care . Alternative approaches reducing occurrence of agitated behaviours and the need for chemical or physical restraints become valuable for institutionalized elders with dementia . OBJECTIVE AND SETTING This study was to evaluate the effects of group music with movement intervention on occurrence of agitated behaviours of institutionalized elders with dementia in Taiwan . METHODS A r and omized controlled trial was used . Thirty-six institutionalized elders with dementia completed the study , with 18 in the experimental group receiving group music with movement intervention twice a week for 4 weeks and 18 in the control group receiving usual care without intervention  . Modified Cohen-Mansfield Agitation Inventory was used to assess agitated behaviours at baseline , weeks 2 and 4 . RESULTS Agitated behaviours were significantly reduced in the experimental group following 4 weeks of group music with movement intervention compared to that of the control group ( p<0.001 ) . CONCLUSIONS Group music with movement intervention can be beneficial in managing agitated behaviours of those with dementia and should be incorporated into care routines in residential facilities OBJECTIVES To test the main and interactive effects of activities derived from the Need-Driven Dementia-Compromised Behavior model for responding to behavioral symptoms in nursing home residents . DESIGN R and omized double-blind clinical trial . SETTING Nine community-based nursing homes . PARTICIPANTS One hundred twenty-eight cognitively impaired residents r and omly assigned to activities adjusted to functional level ( FL ) ( n=32 ) , personality style of interest ( PSI ) ( n=33 ) ,  functional level and personality style of interest ( FL+PSI ) ( n=31 ) , or active control ( AC ) ( n=32 ) . INTERVENTION Three weeks of activities provided twice daily . MEASUREMENTS Agitation , passivity , engagement , affect , and mood assessed from video recordings and real-time observations during baseline , intervention , r and om times outside of intervention , and 1 week after intervention . RESULTS All treatments improved outcomes during intervention except mood , which worsened under AC . During intervention the PSI group demonstrated greater engagement , alertness , and attention than the other groups ; the FL+PSI group demonstrated greater pleasure . During r and om times , engagement returned to baseline levels except in the FL group in which it decreased . There was also less agitation and passivity in groups with a component adjusted to PSI . One week after the intervention , mood , anxiety , and passivity improved over baseline ; significantly less pleasure was displayed after withdrawal of treatment . CONCLUSION The hypothesis that activities adjusted to FL+PSI would improve behavioral outcomes to a greater extent than partially adjusted or nonadjusted activities was partially supported . PSI is a critical component of individualized activity prescription OBJECTIVES To investigate the effectiveness of an exercise program in improving ability to perform activities of daily living ( ADLs ) , physical performance , and nutritional status and decreasing behavioral disturbance and depression in patients with Alzheimer 's disease ( AD ) . DESIGN R and omized , controlled trial . SETTING Five nursing homes . PARTICIPANTS One hundred thirty-four ambulatory patients with mild to severe AD . INTERVENTION Collective exercise program ( 1 hour , twice weekly of walk , strength , balance , and flexibility training ) or routine medical care for 12 months . MEASUREMENTS ADLs were assessed using the Katz Index of ADLs . Physical performance was evaluated using 6-meter walking speed , the get-up- and -go test , and the one-leg-balance test . Behavioral disturbance , depression , and nutritional status were evaluated using the Neuropsychiatric Inventory , the Montgomery and Asberg Depression Rating Scale , and the Mini-Nutritional Assessment . For each outcome measure , the mean change from baseline to 12 months was calculated using intention-to-treat analysis . RESULTS ADL mean change from baseline score for exercise program patients showed a slower decline than in patients receiving routine medical care ( 12-month mean treatment differences : ADL=0.39 , P=.02 ) . A significant difference between the groups in favor of the exercise program was observed for 6-meter walking speed at 12 months . No effect was observed for behavioral disturbance , depression , or nutritional assessment scores . In the intervention group , adherence to the program sessions in exploratory analysis predicted change in ability to perform ADLs . No adverse effects of exercise occurred . CONCLUSION A simple exercise program , 1 hour twice a week , led to significantly slower decline in ADL score in patients with AD living in a nursing home than routine medical care OBJECTIVE This experimental study aim ed to evaluate the effects of a group music intervention on anxiety and agitation of institutionalized older adults with dementia . METHODS A total of 60 participants were r and omly assigned to an experimental or a control group . The experimental group received a 30-min music intervention using percussion instruments with familiar music in a group setting in mid afternoon twice weekly for 6 weeks , whereas the control group received usual care with no music intervention . The Rating of Anxiety in Dementia scale was used to assess anxiety , and Cohen-Mansfield Agitation Inventory was used to assess agitation at baseline , week 4 and week 6 . RESULTS Repeated measures analysis of covariance indicated that older adults who received a group music intervention had a significantly lower anxiety score than those in the control group while controlling for pre-test score and cognitive level ( F = 8.98 , p = 0.004 ) . However , the reduction of agitation between two groups was not significantly different . CONCLUSIONS Anxiety and agitation are common in older adults with dementia and have been reported by caregivers as challenging care problems . An innovative group music intervention using percussion instruments with familiar music as a cost-effective approach has the potential to reduce anxiety and improve psychological well-being of those with dementia BACKGROUND Elderly people with cognitive impairments are often associated with depressed mood and are heavy consumers in both medical services and need in caregivers . Reminiscence is believed to be effective in improving the cognition and mood of demented people . OBJECTIVES This study tested the hypothesis that structured group reminiscence therapy can prevent the progression of cognitive impairment and enhance affective function in the cognitively impaired elderly . METHODS A r and omized controlled trial ( RCT ) based on a two group pre- and post-test design was used . The experimental subjects underwent eight group sessions , one session per week . The measurements were performed using Mini-Mental State Examination ( MMSE ) , Geriatric Depression Scale short form ( GDS-SF ) , and Cornell Scale for Depression in Dementia ( CSDD ) . RESULTS The sample consisted of 102 subjects , with 51 in the experimental group and 51 in the control group . Results demonstrated that the intervention significantly affected cognitive function and affective function as measured by MMSE and CSDD ( p = 0.015 and 0.026 ) , indicating that the cognitive function of the experimental subjects increased and their depressive symptoms diminished following intervention . CONCLUSION Participation in reminiscence activities can be a positive and valuable experience for demented older persons . Consequently , the development of a structured care program for elderly persons with cognitive impairment and the need for long-term care is essential . Thus , health providers in long-term care facilities should be trained in reminiscence group therapy , and to be able to deliver such a program to the targeted group Objective : To investigate the feasibility , acceptability and potential efficacy of group exercise for residents in care homes . Design : Exploratory cluster r and omized controlled trial . Setting : Five r and omly selected care homes in South Birmingham , UK . Participants : Fifty-six care home residents ( mean age 84.5 , 71 % female ) , 39 ( 70 % ) with cognitive impairments . Intervention : Two homes ( n = 28 ) were r and omized to group exercise held twice weekly for five weeks . The remaining three homes ( n = 28 ) formed the control group and received usual care , with no person specifically responsible for exercise training . Outcome measures : Assessment s were conducted at zero ( pre-intervention ) , three ( post-intervention ) and six months ( follow-up ) using the Rivermead Mobility Index and Hospital Anxiety and Depression Scale or Stroke Aphasic Depression Question naire ( depending on cognitive impairment ) . Adherence to group exercise and retention to the study were also documented . Results : No statistically significant improvements in mobility or depression were found in favour of group exercise .  Retention to the study was high with 46 ( 82 % ) participants completing all assessment s. Adherence to group exercise was somewhat lower with participants attending a mean of 3.61 out of 8.5 prescribed sessions ( 42.5 % ) . Conclusions : Group exercise can be delivered to care home residents with reduced mobility but it is not suitable for residents with severe cognitive impairment . An estimated sample size of 240 participants would be required to detect a clinical ly significant difference in the Rivermead Mobility Index with 90 % power OBJECTIVES To examine the effect of integrated emotion-oriented care on nursing home residents with dementia and nursing assistants . DESIGN A multi-site r and omized clinical trial with matched groups , and measurements at baseline and after seven months . SETTING Sixteen psychogeriatric wards in fourteen nursing homes in the Netherl and s. PARTICIPANTS One hundred and forty-six elderly residents with the diagnosis dementia of the Alzheimer ( DAT ) type , mixed DAT and vascular dementia , and dementia syndrome ( NAO ) and 99 nursing assistants . INTERVENTIONS Integrated emotion-oriented care and usual care . MESUREMENTS : Demented elderly : Behaviour and mood related to adaptation to the illness and the institutionalization . Nursing assistants : General health as measured by feelings of stress , stress reactions , feeling of competence and illness . RESULTS Positive effects in favour of the integrated emotion-oriented care were found in mild to moderately demented residents on two adaptive tasks : maintaining an emotional balance ( less anxiety ) and preserving a positive self-image ( less dissatisfaction ) . In the trained group of nursing assistants fewer stress reactions were found only in those who perceived improvement in their emotion-oriented care skills after training . CONCLUSION Emotion-oriented care is more effective with regard to the emotional adaptation in nursing homes of persons with a mild to moderate dementia . For the severely demented elderly we did not find this surplus value . This outcome is of clinical importance for elderly persons with dementia who are cared for in nursing homes . With respect to the nursing assistants it is concluded that emotion-oriented care has a positive influence on stress reactions in some of them Background and aims : Falls are particularly common among older people living in residential care facilities . The aim of this r and omized controlled trial was to evaluate the effectiveness of a high-intensify functional exercise program in reducing falls in residential care facilities . Methods : Participants comprised 191 older people , 139 women and 52 men , who were dependent in activities of daily ) living . Their mean±SD score on the Mini-Mental State Examination was 17.8±5.1 ( range 10–30 ) . Participants were r and omized to a high-intensity functional exercise program or a control activity , consisting of 29 sessions over 3 months . The fall rate and proportion of participants sustaining a fall were the outcome measures , subsequently analysed using negative binominal analysis and logistic regression analysis , respectively . Results : During the 6-month follow-up period , when all participants were compared , no statistically significant differences between groups were found for fall rate  ( exercise group 3.6 falls per person years [ PY ] , control group 4.6 falls per PY ) , incidence rate ratio ( 95 % CI ) 0.82 ( 0.49−1.39 ) , p=0.46 , or the proportion of participants sustaining a fall  ( exercise 53 % , control 51 % ) , odds ratio ( 95 % CI ) 0.95 ( 0.52−1.74 ) , p=0.86 . A subgroup interaction analysis revealed that , among participants who improved their balance during the intervention period , the exercise group had a lower fall rate than the control group ( exercise 2.7 falls per PY , control 5.9 falls per PY ) , incidence rate ratio ( 95 % CI ) 0.44 ( 0.21−0.91 ) , p=0.03 . Conclusions : In older people living in residential care facilities  , a high-intensity functional exercise program may prevent falls among those who improve their balance We investigated the effects of group music intervention on behavioral and psychological symptoms in patients with dementia . Twenty patients were nonr and omly allocated to either a music-intervention group , or an usual care group . The music-intervention group received 50 minutes of music intervention 3 times per week for 5 consecutive weeks . After 15 sessions , the music-intervention group showed significant in improvement with regard to agitation , and the total scores of both patients and caregivers were lower , compared with the control group . These findings suggest that music can improve behavioral and psychological symptoms , especially in patients with dementia and their caregivers This project tested an innovative intervention in a controlled clinical investigation of a nonpharmacological treatment of depression in long-term care residents with dementia . This treatment utilized a wheelchair bicycle in a recreation therapy protocol , which combined small group activity therapy and one-to-one bike rides with a staff member .  Depression levels were significantly reduced in the two-week portion of the study with levels maintained in the 10-week maintenance period . Improvements were also found in sleep and levels of activity engagement Background : Depression among institutionalized elders is a common problem associated with physical and functional limitations , and effective interventions are needed . Objective : The objective of this study was to determine the effect of group reminiscence on physical function , behavioral competence , and depression among clinical ly depressed , institutionalized elders . Methods : A two-group , r and om-assignment quasi-experimental study was conducted in four long-term care facilities in southern Taiwan . The experimental group ( n = 21 ) received six to eight group reminiscence sessions over 2 months compared with a routine care control group ( n = 24 ) . Outcome measurements included the Behavioral Rating Scale , Barthel 's Index , and the Geriatric Depression Scale-short form . Results : Reminiscence sessions result ed in a significant 2-point decrease in theGeriatric Depression Scale-short form ( p = .002 ) and improved behavioral competence ( p = .001 ) . No change was identified in functional ability . Conclusions : Group reminiscence is a therapeutic intervention for depressed , institutionalized elders that can be managed by trained nursing staff . It is a cost-effective approach to improve psychosocial well-being for institutionalized older people . Additional research is needed on a larger sample across different diseases and cultural groups BACKGROUND Apathy is a common symptom in patients with dementia and has adverse consequences for patients and caregivers . Most treatments for apathy , particularly non-pharmacologic interventions , have not been evaluated in controlled trials . OBJECTIVES This study evaluated the efficacy of a kit-based activity intervention , compared to a time and attention control ( one-on-one meetings with an activity therapist ) in reducing apathy and improving quality of life in 37 patients with dementia . METHODS The design was a r and omized , controlled , partially masked clinical trial . All outcome measures were administered at baseline and follow-up . The primary outcome measure was the apathy score of the Neuropsychiatric Inventory ( NPI ) . Other outcome measures were the NPI total score , the Alzheimer Disease Related Quality of Life scale(ADQRL ) , and the Copper Ridge Activity Index ( CRAI ) . RESULTS There was a significant reduction in NPI apathy scores in both treatment groups . The only significant difference between the two treatment groups was a modest advantage for the control intervention on the CRAI cueing subscale ( p = 0.027 ) , but not on the other CRAI subscales . There was also a greater within group improvement in quality of life ratings in the control intervention ( p=0.03 ) . CONCLUSIONS Despite the substantial improvement in apathy scores during the course of the study , there was no clear advantage to the reminiscence-based intervention over the time and attention , one-on-one control intervention . More research is needed to develop specific behavioral interventions for apathy in patients with dementia Background : Effective nonpharmacological interventions are needed to treat neuropsychiatric symptoms and to improve quality of life for the 5.3 million Americans affected by dementia . Objective : The purpose of this study was to test the effect of a storytelling program , TimeSlips , on communication , neuropsychiatric symptoms , and quality of life in long-term care residents with dementia . Methods : A quasi-experimental , two-group , repeated measures design was used to compare persons with dementia who were assigned to the twice-weekly , 6-week TimeSlips intervention group ( n = 28 ) or usual care group ( n = 28 ) at baseline and postintervention at Weeks 7 and 10 . Outcome measures included the Cornell Scale for Depression in Dementia , the Neuropsychiatric Inventory-Nursing Home Version , the Functional Assessment of Communication Skills , the Quality of Life-Alzheimer 's Disease , and the Observed Emotion Rating Scale ( this last measure was collected also at Weeks 3 and 6 during TimeSlips for the treatment group and during mealtime for the control group ) . Results : Compared with the control group , the treatment group exhibited significantly higher pleasure at Week 3 ( p < .001 ) , Week 6 ( p < .001 ) , and Week 7 ( p < .05 ) . Small to moderate treatment effects were found for Week 7 social communication ( d = .49 ) and basic needs communication ( d = .43 ) . A larger effect was found for pleasure at Week 7 ( d = .58 ) . Discussion : As expected , given the engaging nature of the TimeSlips creative storytelling intervention , analyses revealed increased positive affect during and at 1 week postintervention . In addition , perhaps associated with the intervention 's reliance on positive social interactions and verbal communication , participants evidence d improved communication skills . However , more frequent dosing and booster sessions of TimeSlips may be needed to show significant differences between treatment and control groups on long-term effects and other outcomes BACKGROUND This study aim ed to test the effects of yoga exercises on the physical and mental health of elderly people with dementia living in long-term care facilities . METHODS A quasi-experimental , pretest-post-test design was used . A convenience sample of 68 residents in long-term care facilities in southern Taiwan , aged 60 years and above with mild to moderate dementia , was selected . An experimental group of 33 elders participated in a 12-week yoga training program of three 55-minute sessions a week ; a control group of 35 elders maintained their usual daily activities . Data were collected before and after completing the 12-week study . Measurements included body composition , cardiopulmonary functions , body flexibility , muscle strength and endurance , balance , joints motion , depression , and problem behaviors . RESULTS The yoga-trained participants had better physical and mental health than those who did not participate , including lowered blood pressure , reduced respiration rate , strengthened cardiopulmonary fitness , enhanced body flexibility , improved muscle strength and endurance , improved balance , and increased joints motion ( all p values < 0.05 ) . In addition , the depression state ( p < 0.001 ) and problem behaviors ( p < 0.001 ) of these demented elders were significantly reduced . CONCLUSION Yoga exercise has positive benefits for both the physical and mental health of elders with dementia living in long-term care facilities . It is recommended that yoga be included as one of the routine activities in these long-term care facilities
BACKGROUND Several important systematic review s and meta-analyses focusing on psychosocial interventions have been undertaken in the last decade .
However , they have not focused specifically on the treatment of individual behavioral and psychological symptoms of dementia  ( BPSD ) with personalized interventions .
This up date d systematic review will focus on studies reporting the effect of personalized psychosocial interventions on key  BPSD in care homes .