Caring for Aged Dementia Care Resident Study (CADRES) of person-centred care, dementia-care mapping, and usual care in dementia: a cluster-randomised trial PerCEN trial participant perspectives on the implementation and outcomes of person-centered dementia care and environments. Process evaluation of the implementation of dementia-specific case conferences in nursing homes (FallDem): study protocol for a randomized controlled trial Monetary costs of agitation in older adults with Alzheimer's disease in the UK: prospective cohort study Controlled trial of dementia training with a peer support group for aged care staff. Raising the standard of applied dementia care research: addressing the implementation error Assisting cognitively impaired nursing home residents with bathing: effects of two bathing interventions on caregiving. Introducing a Latin ballroom dance class to people with dementia living in care homes, benefits and concerns: A pilot study Training in dementia care: a cluster-randomized controlled trial of a training program for nursing home staff in Germany. Promoting value in dementia care: Staff, resident and family experience of the capabilities model of dementia care Effect of person-centered showering and the towel bath on bathing-associated aggression, agitation, and discomfort in nursing home residents with dementia: a randomized, controlled trial. The implementation of snoezelen in psychogeriatric care: an evaluation through the eyes of caregivers. Effects of a restraint minimization program on staff knowledge, attitudes, and practice: a cluster randomized trial. AwareCare: a pilot randomized controlled trial of an awareness-based staff training intervention to improve quality of life for residents with severe dementia in long-term care settings. STAR: a dementia-specific training program for staff in assisted living residences. Come talk with me: improving communication between nursing assistants and nursing home residents during care routines. 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. Educating nursing assistants to communicate more effectively with nursing home residents with dementia. Impact of training dementia caregivers in sensitivity to nonverbal emotion signals. Managing behavioural symptoms of dementia: Effectiveness of staff education and peer support Teaching and maintaining behavior management skills in the nursing home. Effects of an abilities-focused program of morning care on residents who have dementia and on caregivers. Evaluating the capabilities model of dementia care: a non-randomized controlled trial exploring resident quality of life and care staff attitudes and experiences. Effects of Dementia-Care Mapping on Residents and Staff of Care Homes: A Pragmatic Cluster-Randomised Controlled Trial Staff outcomes from the caring for aged dementia care resident study (CADRES): a cluster randomised trial. The Economics of Dementia-Care Mapping in Nursing Homes: A Cluster-Randomised Controlled Trial
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 BACKGROUND Well-being and various forms of agitation in people with dementia can be improved in a person-centered long-term care setting . Data obtained during the Person-Centered Dementia Care and Environment ( PerCEN ) r and omized controlled trial shed light on the factors that influenced the adoption and outcomes of person-centered interventions in long-term care from the perspective of study participants . METHODS Data were obtained from PerCEN participants : individual semi-structured interviews with care managers ( 29 ) , nurses and care staff ( 70 ) ; telephone surveys with family members ( 73 ) ; staff reports of care approaches ; and 131 field note entries recorded by the person-centered care and environment facilitators .  Data were interpreted inductively using content analysis , code building , theme development , and synthesis of findings . RESULTS All data sources confirmed that , when adopted , the person-centered model increased the number and variety of opportunities for resident interaction , improved flexibility in care regimens , enhanced staff 's attention to resident needs , reduced resident agitation , and improved their well-being . Barriers and enablers for the person-centered model related to leadership , manager , staff and family appreciation of the model , staff 's capacity , effective communication and team work among direct care staff , care service flexibility , and staff education on how to focus care on the person 's well-being . CONCLUSIONS Successful knowledge translation of the person-centered model starts with managerial leadership and support ; it is sustained when staff are educated and assisted to apply the model , and , along with families , come to appreciate the benefits of flexible care services and teamwork in achieving resident well-being . The Australian New Zeal and Clinical Trials Registry number is ACTRN 12608000095369 Background Challenging behaviors exhibited by individuals with dementia might result from an unmet need that they can not communicate directly due to cognitive restrictions . A dementia-specific case conference represents a promising means of analyzing and exploring these unmet needs . The ongoing FallDem study is a stepped-wedged , cluster-r and omized trial evaluating the effects of two different types of dementia-specific case conferences on the challenging behaviors of nursing home residents . This study protocol describes the process evaluation that is conducted , along with the FallDem study .The goal of the process evaluation is to explain potential discrepancies between expected and observed outcomes , and to provide insights into implementation processes and recruitment strategies , as well as the context s and context ual factors that promote or inhibit the implementation of dementia-specific case conferences . Methods / Design The process evaluation will use a mixed- method design comprising longitudinal elements , in which quantitative and qualitative data will be gathered . Qualitative data will be analyzed using content analysis , documentary analysis and a documentary method . Quantitative data ( st and ardized question naires ) will be analyzed using descriptive statistics . Both types of data will complement one another and provide a more comprehensive picture of the different objects under investigation . Discussion The process evaluation will allow for a comprehensive underst and ing of the changing processes and mechanisms underlying the ‘ black box ’ of the complex intervention of the FallDem study . These findings will provide practical knowledge regarding issues related to the implementation of dementia-specific case conferences in nursing homes . Trial registration Current Controlled Trials identifier : IS RCT N20203855 , registered on 10th July 2013 Objective While nearly half of all people with Alzheimer 's disease ( AD ) have agitation symptoms every month , little is known about the costs of agitation in AD . We calculated the monetary costs associated with agitation in older adults with AD in the UK from a National Health Service and personal social services perspective . Design Prospect i ve cohort study . Setting London and the South East Region of the UK ( LASER-AD study ) . Participants 224 people with AD recruited between July 2002 and January 2003 and followed up for 54 months . Primary and secondary outcome measures The primary outcome was health and social care costs , including accommodation costs and costs of contacts with health and social care services . Agitation was assessed using the Neuropsychiatric Inventory ( NPI ) agitation score . Results After adjustment , health and social care costs varied significantly by agitation , from £ 29 000 over a 1 year period with no agitation symptoms ( NPI agitation score=0 ) to £ 57 000 at the most severe levels of agitation ( NPI agitation score=12 ; p=0.01 ) . The mean excess cost associated with agitation per person with AD was £ 4091 a year , accounting for 12 % of the health and social care costs of AD in our data , and equating to £ 2 billion a year across all people with AD in the UK . Conclusions Agitation in people with AD represents a substantial monetary burden over and above the costs associated with cognitive impairment OBJECTIVE This study evaluated the impact of an eight-session training program for aged care staff  in managing dementia-related challenging behaviours .  Participation in the training program with an additional five-session peer support group was compared with both participation in training only and a wait-list control condition . METHODS Outcomes were evaluated for 90 participating staff members and 113 residents with challenging behaviours from six aged care facilities . Measures of staff attitudes and the behaviours of staff and residents were collected pre- and post-intervention , and at six month follow-up . RESULTS Staff members in both dementia training groups reported improved attitudes regarding their knowledge and skills in managing residents with challenging behaviours , immediately after the training and six months later . Facility supervisors rated the nursing performance of trained staff more positively , particularly those who participated in a peer support group . The dementia training programs , whether with or without the inclusion of peer support , did not impact on levels of staff burnout or substantially reduce the level of challenging behaviours among aged care residents . CONCLUSIONS While training programs may impact positively on staff performance , organisational characteristics of aged care facilities , including low levels of management support for staff training initiatives , limit the potential outcomes . Method ological limitations are discussed Current methodology has made popular the pragmatic r and omized trial ( Foster & Little , 2012 ) and has led to an acknowledged growth of high- quality research in the ‘ new generation ’ of psychosocial interventions in dementia care ( Orrell , 2012 ) . However , many trials of psychosocial interventions in dementia lack impact . It is not clear whether this reflects a genuine ineffectiveness , since the methodology used in dementia care research is at present weak in addressing the important distinction between genuine ineffectiveness and an implementation error . Therefore , potentially effective dementia care interventions that may have a positive impact on patient experience can fail to show effectiveness , thereby reducing treatment options and wasting research money . Method ological discussion s about the success and failure of interventions in dementia care within the European INTERDEM group of multi-professional research ers on psychosocial dementia care ( www.interdem.org/ ) led to a critical analysis of the suitability of the current methodology . This has often relied on the Medical Research Council ’s ( MRC ) Framework for complex interventions and its iterations ( Campbell et al. , 2000 ; Craig et al. , 2008 ; Craig & Petticrew , 2013 ) . Foster and Little ( 2012 ) pinpoint an important obstacle to improving clinical practice as the legacy of ‘ simple ’ drug therapy evaluations which are engrained in the design and conduct of the pragmatic trial , a view that can also be extended more generally to the interpretation and conduct of the MRC framework for complex interventions and its method ologies . The advantage of pragmatic trials is their proximity to daily practice in routine health care setting s. This has particular implication s for the design and conduct of psychosocial intervention research in dementia , where the important distinction between poor attention to implementation and genuine ineffectiveness is often overlooked . Furthermore , better attention to the implication s of this proximity in the design and conduct of psychosocial intervention research trials may reduce the need for a separate large-scale implementation study phase in the way that this is currently conceived within the MRC approach to complex interventions ( Craig et al. , 2008 ; Craig & Petticrew , 2013 ) . This is an urgent issue for psychosocial intervention research in dementia care as today 35.6 million people and families worldwide live with dementia ( Prince et al. , 2013 ) , whilst major pharmaceutical advances in prevention and cure remain elusive ( Miller , 2012 ) . The predicted future growth of dementia cases over the next decade will undoubtedly raise the already high costs of care , estimated at US$ 604 billion in 2010 ( Wimo et al. , 2013 ) , in an illness that is most feared people over the age of 55 years ( Le Couteur , Doust , Creasey , & Brayne , 2013 ) , since it can undermine core human capacities result ing in decline in quality of life ( Selkoe , 2012 ) . Although cure for dementia is not available for dementia patients , we are not empty h and ed . Psychosocial intervention research has emerged as today ’s forerunner , given its aim to improve daily practice among professionals who provide support to people and families living with dementia .  Psychosocial interventions in dementia involve interactions between people to improve psychological and social functioning ( Moniz-Cook , Vernooij-Dassen , Woods , & Orrell , 2011 ; Rabins et al. , 2007 ) , such as cognitive stimulation therapy ( Woods , Aguirre , Spector , & Orrell , 2012 ) , occupational therapy ( Graff et al. , 2006 ) and support programmes for family carers ( Vernooij-Dassen , Draskovic , McCleery , & Downs , 2011 ) . This paper outlines the rationale for a paradigm shift in the design and methodology for evaluation of complex interventions in applied dementia care research . We use  psychosocial intervention research as an exemplar of how research ers and their funders may achieve better value for money PURPOSE When cognitively impaired nursing home residents exhibit agitated and aggressive behaviors during bathing , nursing home caregivers are in a unique position to improve residents ' experience . This report addresses whether certified nursing assistants ( CNAs ) who received training in a person-centered approach with showering and with the towel bath showed improved caregiving behaviors ( gentleness and verbal support ) and experienced greater preparedness ( confidence and ease ) and less distress ( hassles ) when assisting residents with bathing . DESIGN AND METHODS We used a crossover design and r and omized 15 nursing homes into two treatment groups and a control group of 5 facilities each . In one treatment group , CNAs received person-centered training , first with showering for 6 weeks ( Time 1 ) and then with the towel bath for 6 weeks ( Time 2 ) . We reversed the treatment order in the other treatment group . Control group CNAs used usual showering procedures without person-centered training . We collected observational and self-report data at baseline and at the end of Time 1 and Time 2 on five caregiving outcomes . We analyzed data from 37 CNAs assisting 69 residents by using 3x2 repeated measures analyses of variance to compare the three groups on change from baseline . RESULTS Compared with the control group , treatment groups significantly improved in the use of gentleness and verbal support and in the perception of ease . IMPLICATION S A person-centered approach with showering and with the towel bath improved not only how care is given to residents who become agitated and aggressive during bathing but also how CNAs perceive their experience when bathing these residents The objective of the study was to investigate the effect of introducing a dance-based psychomotor intervention using Danzón ( Latin ballroom ) for people with dementia in care homes . This was a grounded theory qualitative study . Thirteen of the 22 participants had dementia and were care-home residents . The remaining participants were care staff and facilitators of the dance sessions .  Interviews were undertaken with seven people with dementia and nine staff , result ing in two separate sets of grounded theory method ologies . Two conceptual models , outlining positive outcomes and negative concerns of the use of Danzón were developed , depicting the experiences of people with dementia and care staff respectively . Danzón psychomotor intervention was found to enhance positive emotional states and general levels of satisfaction for both people with dementia and care staff . The details of these findings have been used to design a quantitative study BACKGROUND This study examines the effectiveness of a nursing home staff training program design ed to improve the interaction between residents with dementia and their caregivers . METHODS A three-arm cluster-r and omized and controlled population of 96 caregivers and 210 residents was used . Caregivers of the intervention group ( IG ) received a three-month training program in dementia care . Data were gathered at baseline , immediately after the training and at a six-month follow-up- assessment . Short- and long-term effects of the training program were assessed in comparison with another intervention referred to as the relaxation group ( RG ) and a wait-list control group ( CG ) . RESULTS Results indicated significant positive effects of the training program on caregivers ' knowledge immediately after the training and on the use of physical restraints at the six-month follow-up . Caregivers ' overall competence increased significantly both in the IG and in the RG . No intervention effects were found on caregivers ' level of burnout , their health complaints or on the use of sedative drugs .  Relaxation training was more successful in the reduction of caregivers ' health complaints . CONCLUSIONS Results of the study indicate both the effectiveness and the limitations of a general training program in dementia care . The complexity of the nursing home setting potentially needs more complex interventions . Ongoing and continued support of the caregivers , as well as changes in organization and environment , are more likely to be helpful in the long-term improvement in the quality of care . Future research should focus on studies of specific interventions , such as the interesting effects of relaxation training on the caregivers ' state of health Objectives : This Australian study examined individual experiences of the implementation of the Capabilities Model of Dementia Care ( CMDC ) and subsequent outcomes for the care of residents with dementia living in long-term care . Furthermore , this study aim ed to explore those factors that facilitated and inhibited the implementation of the new model of care . Methods : The CMDC was developed and then tested in a non-r and omised clinical trial . Staff , residents and family experiences of their involvement and perceptions of the model were captured at the end of 12 months . Semi-structured interviews and focus groups were conducted with the 25 participants ( 12 nursing staff , 6 residents with dementia , 7 family members ) . Questions varied depending on the participant group but were design ed to assess experiences of and changes to care during the intervention . Inductive thematic analysis was used to identify the experiences of the implementation of the CMDC . Results : Five themes included : general reflections on nursing care , implementation of the CMDC intervention , positive outcomes of the CMDC intervention , challenges in the implementation of the CMDC , difficulty sustaining care and tensions between participants ’ perspectives of care . Conclusion : Positive change result ed from implementation of the CMDC , however , staff mentorship was identified as a key to sustaining changes in practice OBJECTIVES To evaluate the efficacy of two nonpharmacological techniques in reducing agitation , aggression , and discomfort in nursing home residents with dementia . The techniques evaluated were person-centered showering and the towel bath ( a person-centered , in-bed bag-bath with no-rinse soap ) . DESIGN A r and omized , controlled trial , with a usual-care control group and two experimental groups , with crossover . SETTING Nine skilled nursing facilities in Oregon and six in North Carolina . PARTICIPANTS Seventy-three residents with agitation during bathing ( 69 completed the trial ) and 37 nursing assistants who bathed them . MEASUREMENTS Agitation and aggression were measured using the Care Recipient Behavior Assessment ; discomfort was measured using a modification of the Discomfort Scale for Dementia of the Alzheimer Type . Raters who were blinded to subject status coded both from videotaped baths . Secondary measures of effect included bath duration , bath completeness , skin condition , and skin microbial flora . RESULTS All measures of agitation and aggression declined significantly in both treatment groups but not in the control group , with aggressive incidents declining 53 % in the person-centered shower group ( P<.001 ) and 60 % in the towel-bath group ( P<.001 ) . Discomfort scores also declined significantly in both intervention groups ( P<.001 ) but not in the control group . The two interventions did not differ in agitation/aggression reduction , but discomfort was less with the towel bath ( P=.003 ) . Average bath duration increased significantly ( by a mean of 3.3 minutes ) with person-centered showering but not with the towel bath . Neither intervention result ed in fewer body parts being bathed ; both improved skin condition ; and neither increased colonization with potentially pathogenic bacteria , corynebacteria , or C and ida albicans . CONCLUSION Person-centered showering and the towel bath constitute safe , effective methods of reducing agitation , aggression , and discomfort during bathing of persons with dementia Many intervention studies lack an investigation of the extent to which the intervention was implemented as intended , which makes outcome measures difficult to interpret . The aim of the present study was to gain insight into the implementation process of snoezelen in 24-h dementia care . The intervention in each of six experimental wards comprised  training sessions in ' snoezelen for caregivers '  , evaluated using a question naire . To study experience with implementation , the follow-up and general meetings ( 20 in total ) were attended and semi-structured interviews ( six in total ) were conducted . The results indicated that the implementation of snoezelen effected a change from task-oriented care to resident-oriented care . The nursing assistants also experienced changes at the resident level and organisational changes . However , the lack of intervention in the organisational structure and obstructive factors such as under-staffing seemed to get in the way of the integration of multi-sensory stimulation in the daily care in two of the six wards OBJECTIVES To evaluate the effects of a restraint minimization education program on staff knowledge and attitudes and use of physical restraints . DESIGN Cluster-r and omized controlled trial with nursing units as the basis for r and omization . SETTING Forty group dwelling units for people with dementia . PARTICIPANTS At baseline , there were 184 staff and 191 residents in the intervention group and 162 staff and 162 residents in the control group . At the 6-month follow-up , there were 156 staff and 185 residents ( 36 newly admitted ) in the intervention group and 133 staff and 165 residents ( 26 newly admitted ) in the control group . INTERVENTION A 6-month education program for all nursing staff . MEASUREMENTS Staff knowledge and attitudes and physical restraint use were measured before and after the education program . RESULTS In the intervention group , staff knowledge about and attitudes toward restraint use changed , and the overall use of physical restraints decreased . A comparison including only residents present during the whole study period showed that the level of use was similar between the groups at baseline , whereas it was significantly lower in the intervention group at follow-up . Adjusted analyses showed that the odds of being restrained at follow-up were lower in the intervention group than in the control group . There was no significant change in the number of falls or use of psychoactive medication . CONCLUSION The results indicate that staff education can increase knowledge , change attitudes , and reduce the use of physical restraints without any change in the incidence of falls or use of psychoactive drugs BACKGROUND The extent to which care home residents with severe dementia show awareness is influenced by the extent to which the environment provides opportunities for engagement and by the way in which care staff interact with them . We aim ed to establish whether training care staff to observe and identify signs of awareness in residents with severe dementia result ed in improved quality of life for residents . METHODS In this pilot cluster r and omized trial , care staff in four homes ( n = 32 ) received training and supervision and carried out structured observations of residents using the AwareCare measure  ( n = 32 ) over an eight-week period , while staff in four control homes ( n = 33 ) had no training with regard to their residents ( n = 33 ) and no contact with the research team . The primary outcome was resident quality of life . Secondary outcomes were resident well-being , behavior and cognition , staff attitudes and well-being , and care practice s in the home . RESULTS Following intervention , residents in the intervention group had significantly better quality of life as rated by family members than those in the control group , but care staff ratings of quality of life did not differ . There were no other significant between-group differences . Staff participating in the intervention identified benefits in terms of their underst and ing of residents ' needs . CONCLUSIONS Staff were able to use the observational measure effectively and relatives of residents in the intervention homes perceived an improvement in their quality of life PURPOSE This article describes , and provides data on , an innovative , comprehensive , dementia-specific training program design ed to teach direct care staff in assisted living residences to improve care and reduce problems in residents with dementia . DESIGN AND METHODS STAR-which st and s for Staff Training in Assisted living Residences-provides two 4-hr workshops augmented by four individualized on-site consultations and three leadership sessions . Developed by means of an iterative process of implementation and revision , it was then evaluated in a small r and omized controlled trial . A total of 114 staff and 120 residents in 15 residences participated . RESULTS STAR was exceptionally well received . Training details are provided with a discussion of unique challenges inherent in implementation . Following training , STAR residents evidence d significantly reduced levels of affective and behavioral distress compared with control residents . Furthermore , STAR residents improved whereas control residents worsened ( p < .05 ) . Staff with STAR staff training reported less adverse impact and reaction to residents ' problems ( p < .05 ) and more job satisfaction ( p < .10 ) compared with control staff . IMPLICATION S STAR is an effective training program for direct care staff working with dementia residents in assisted living . The importance of continued development and investigation of STAR efficacy and effectiveness is underscored by the growing numbers of residents with dementia who are receiving care in these setting PURPOSE We examined the effects of communication skills training and the use of memory books by certified nursing assistants ( CNAs )  on verbal interactions between CNAs ( n = 64 ) and nursing home residents ( n = 67 ) during care routines . DESIGN AND METHODS  CNAs  were taught to use communication skills and memory books during their interactions with residents with moderate cognitive impairments and intact communication abilities . A staff motivational system was used to encourage performance and maintenance of these skills . Formal measures of treatment implementation were included . RESULTS Results were compared with those for participants on no-treatment control units . Trained CNAs talked more , used positive statements more frequently , and tended to increase the number of specific instructions given to residents . Changes in staff behavior did not result in an increase in total time giving care to residents . Maintenance of CNA behavior change was found 2 months after research staff exited the facility . Although an increase was found in positive verbal interactions between CNAs and residents on intervention units , other changes in resident communication were absent . IMPLICATION S Nursing staff can be trained to improve and maintain communication skills during care without increasing the amount of time delivering care . The method ological advantages of including measures to assess treatment implementation are discussed 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 This article describes the development and evaluation of a Nursing Assistant Communication Skills Program ( NACSP ) . NACSP was design ed to help nursing assistants ( NAs ) interact more effectively with nursing home residents with moderate and severe dementia . In two skilled-care nursing homes , NAs in four units were r and omly assigned by unit to NACSP or to a wait-list control condition ( UC ) and were assessed at baseline , 3 months , and 6 months . NACSP result ed in improvement in the well-being of nursing home residents being cared for by NAs who had received the NACSP training . It was also found that NACSP result ed in greater knowledge of caregiving responses and reduced turnover rates among NAs , but the program had no impact on their knowledge of dementia . To disseminate the NACSP program , a leader manual , an accompanying training videotape , and a workbook for participants were developed Ninety-one mid- to late-stage dementia patients residing in nursing homes , along with their staff caregivers , participated in a study design ed to assess whether training caregivers in sensitivity to nonverbal communication could enhance mood and reduce symptoms in patients and improve psychological well-being in caregivers . Patients and staff at three nursing homes comprised three groups that were r and omly assigned to either a nonverbal sensitivity group , a behavioral placebo group that received instruction in the cognitive and behavioral aspects of dementia , and a wait-list control . Training consisted of 10 one-hour sessions taught by a clinical psychologist using prepared material s. Patient measures , which were taken at baseline and at 4 three-week intervals , included patient symptomatology ( depression , agitation , behavioral symptoms ) , as reported by the staff caregivers , and positive and negative facial expressions of emotion elicited during a face-to-face interview and coded by trained research staff . Results indicated that positive affect increased sharply during the first 6 weeks after intervention in the nonverbal group , with the placebo and wait-list controls showing no change . There was also a decline in negative affect across time for all groups . Effects with respect to patient symptomatology did not reach significance . Caregivers in both training groups showed a decline in symptomatology , whereas the wait-list control group did not This study was design ed to investigate the impact of staff education on the behaviour and quality of life of residents with dementia and on staff members ’ attitudes about working with people with dementia and level of burnout .  Staff from three aged care facilities participated in the study ( n = 52 ) . These facilities were r and omly assigned to one of two intervention groups or a control group . Staff assigned to the intervention groups received an eight-week behaviourally-based programme . Staff from one aged care facility also participated in a peer support group design ed to reinforce educational material and facilitate positive changes among staff members . Behavioural symptoms displayed by residents ( n = 76 ) in each of the facilities were also assessed . Assessment s were conducted at pre-intervention , post-intervention , three- and six-month follow-up . The results of this study indicated that education or peer support was not associated with an improvement in resident behaviour or quality of life . Education or peer support also did not impact on staff members ’ level of burnout . There was , however , a change in staff members ’ attitudes about working with people with dementia . Possible explanations for these findings and implication for further research are considered PURPOSE To examine the efficacy of a comprehensive behavior management skills training program for improving certified nursing assistants ' ( CNA ) skill performance in the nursing home , to assess the effectiveness of a staff motivational system for maintaining newly acquired behavior management skills for a 6-month period , and to evaluate any result ing effects on resident agitation . DESIGN AND METHODS This study used a r and omized clinical trial of 88 residents with behavior disturbances and 106 CNAs who cared for them in two urban nursing homes . After CNAs received 4 weeks of behavior management training , supervisory nursing staff implemented formal staff management ( FSM ) , design ed to maintain training effects over time . The supervisory staff used conventional staff management ( CSM , usual supervisory routine ) on control units . We completed behavioral observations and paper- and -pen assessment s at baseline and repeated them during a 4-week post-intervention phase and at 3- and 6-month follow-ups . RESULTS During the immediate post-training phase , both the FSM and CSM groups improved five out of seven communication skills and the ability to delay physical assistance during care routines . Although CNAs showed a reduction in the use of ineffective behavior management strategies , they did not increase their use of effective behavioral strategies . Follow-up assessment s suggested that the FSM system was more effective than CSM for maintaining and even improving communication skills over time . Resident agitation was reduced during care interactions and maintained at follow-up . IMPLICATION S The behavior management skills training program improved CNAs ' ability to interact with behaviorally disturbed nursing home residents and produced sustained reductions in agitation . The FSM system was more effective for maintaining communication skills 6 months after training OBJECTIVE To conduct a controlled investigation to examine the effects of an abilities-focused program of morning care on the interaction behaviors and functioning of residents with dementia and on caregivers ' interaction behaviors and perceptions of caregiving . DESIGN A quasi-experimental , repeated measures design . SETTING The study was conducted on four , nursing-home-level cognitive supports units in a geriatric care center . One of the units was r and omly selected as the experimental unit ; the other three served as controls . PARTICIPANTS The final sample consisted of 40 residents ( 20 each in the experimental and three control groups ) and 44 caregivers ( 16 on the experimental unit and 28 on the three control units ) . INTERVENTION An educational program on delivering abilities-focused morning care , design ed by the authors , was provided to caregivers on the experimental unit . MEASUREMENTS Measures were taken at baseline and at 3 and 6 months postintervention with regard to residents ' interaction behaviors , level of agitation , and level of function and to caregivers ' interaction behaviors , perceived ease of caregiving , and level of stress . RESULTS Repeated measures analysis of variance ( RM-ANOVA ) was used to compare the experimental and control groups in regard to changes in the outcomes over time . Results indicated that the abilities-focused program had statistically significant effects on ( a ) residents ' personal attending and calm/functional behaviors , level of agitation , and levels of overall and social function , and ( b ) caregivers ' verbal relevance and personal attending , relaxed , and social/flexible behaviors . CONCLUSIONS The evidence suggests that both residents and caregivers benefit from morning care that is oriented toward the abilities of people with dementia BACKGROUND This 12 month , Australian study sought to compare the Capabilities Model of Dementia Care ( CMDC ) with usual long-term care ( LTC ) , in terms of ( 1 ) the effectiveness of the CMDC in assisting care staff to improve Quality Of Life ( QOL ) for older people with dementia ; and ( 2 ) whether implementation of the CMDC improved staff attitudes towards , and experiences of working and caring for the person with dementia . METHODS A single blind , non-r and omized controlled trial design , involving CMDC intervention group ( three facilities ) and a comparison usual LTC practice control group ( one facility ) , was conducted from August 2010 to September 2011 . Eighty-one staff members and 48 family members of a person with dementia were recruited from these four LTC facilities . At baseline , 6 and 12 months , staff completed a modified Staff Experiences of Working with Demented Residents question naire ( SEWDR ) , and families completed the Quality of Life - Alzheimer 's Disease question naire ( QOL-AD ) . RESULTS LTC staff in the usual care group reported significantly lower SEWDR scores ( i.e. less work satisfaction ) than those in the CMDC intervention group at 12 months ( p = 0.005 ) . Similarly , family members in the comparison group reported significantly lower levels of perceived QOL for their relative with dementia ( QOL-AD scores ) than their counterparts in the CMDC intervention group at 12 months ( p = 0.012 ) . CONCLUSIONS Although the study has a number of limitations the CMDC appears to be an effective model of dementia care - more so than usual LTC practice . The CMDC requires further evaluation with participants from a diverse range of LTC facilities and stages of cognitive impairment Background The effectiveness of dementia-care mapping ( DCM ) for institutionalised people with dementia has been demonstrated in an explanatory cluster-r and omised controlled trial ( c RCT ) with two DCM research ers carrying out the DCM intervention . In order to be able to inform daily practice , we studied DCM effectiveness in a pragmatic c RCT involving a wide range of care homes with trained nursing staff carrying out the intervention . Methods Dementia special care units were r and omly assigned to DCM or usual care . Nurses from the intervention care homes received DCM training  and conducted the 4-months DCM-intervention twice during the study . The primary outcome was agitation , measured with the Cohen-Mansfield agitation inventory ( CMAI ) . The secondary outcomes included residents ’ neuropsychiatric symptoms ( NPSs ) and quality of life , and staff stress and job satisfaction . The nursing staff made all measurements at baseline and two follow-ups at 4-month intervals . We used linear mixed-effect models to test treatment and time effects . Results 34 units from 11 care homes , including 434 residents and 382 nursing staff members , were r and omly assigned . Ten nurses from the intervention units completed the basic and advanced DCM training . Intention-to-treat analysis showed no statistically significant effect on the CMAI ( mean difference between groups 2·4 , 95 % CI −2·7 to 7·6 ; p = 0·34 ) . More NPSs were reported in the intervention group than in usual care ( p = 0·02 ) . Intervention staff reported fewer negative and more positive emotional reactions during work ( p = 0·02 ) . There were no other significant effects . Conclusions Our pragmatic findings did not confirm the effect on the primary outcome of agitation in the explanatory study . Perhaps the variability of the extent of implementation of DCM may explain the lack of effect . Trial Registration Dutch Trials Registry NTR2314 BACKGROUND Dementia care mapping and person centred care are well-accepted as processes for improving care and well-being for persons with dementia living in the residential setting . However , the impact of dementia care mapping and person centred care on staff has not been well research ed . OBJECTIVES The impact of person centred care and dementia care mapping compared to each other and to usual dementia care on staff outcomes was examined in terms of staff burnout , general well-being , attitudes and reactions towards resident behavioural disturbances , perceived managerial support , and quality of care interactions . DESIGN A cluster-r and omised , controlled trial . SETTING S The study was conducted between 2005 and 2007 in 15 residential aged care sites in the Sydney metropolitan area , Australia , with comparable management structures , staffing mix and ratios , and st and ards of care . PARTICIPANTS 194 consenting managers , nurses , therapists and nurse assistants working in the participating sites . METHODS Intervention care sites received training and support in either person centred care ( n=5 ) or dementia care mapping ( n=5 ) ; control sites continued with usual dementia care ( n=5 ) . Staff outcomes of those three groups were assessed before , directly after the four month intervention ( post ) and after a further four months ( follow-up ) . The primary outcome measures were the Maslach Burnout Inventory-Human Services Survey and the 12-item General Health Question naire . Analysis involved repeated measures analyses of variance for each of the outcome measures and adjustment for potential confounders to limit bias . RESULTS The Maslach Burnout Inventory-Human Services Survey results showed that change over time in emotional exhaustion scores differed between the three groups . Post-hoc analyses for each group separately revealed that the only significant time effect was in the dementia care mapping group ( p=0.006 ) , with emotional exhaustion scores declining over time . At baseline , more perceived support from management was associated with less emotional exhaustion ( r(s)=0.26 , p=0.004 , n=122 ) and less depersonalisation ( r(s)=0.21 , p=0.023 , n=122 ) , but not for any of the other outcome measures . CONCLUSIONS This study has shown that person centred approaches of care , in particular with dementia care mapping , may contribute to reducing staff job related burnout . The findings also highlight a potentially important role of managerial support and a whole of system approach Background Dementia-care mapping ( DCM ) is a cyclic intervention aim ing at reducing neuropsychiatric symptoms in people with dementia in nursing homes . Alongside an 18-month cluster-r and omized controlled trial in which we studied the effectiveness of DCM on residents and staff outcomes , we investigated differences in costs of care between DCM and usual care in nursing homes . Methods Dementia special care units were r and omly assigned to  DCM or usual care .  Nurses from the intervention care homes received DCM training , a DCM organizational briefing day and conducted the 4-months DCM-intervention twice during the study . A single DCM cycle consists of observation , feedback to the staff , and action plans for the residents . We measured costs related to health care consumption , falls and psychotropic drug use at the resident level and absenteeism at the staff level . Data were extracted from resident files and the nursing home records . Prizes were determined using the Dutch manual of health care cost and the cost prices delivered by a pharmacy and a nursing home . Total costs were evaluated by means of linear mixed-effect models for longitudinal data , with the unit as a r and om effect to correct for dependencies within units . Results 34 units from 11 nursing homes , including 318 residents and 376 nursing staff members participated in the cost analyses . Analyses showed no difference in total costs . However certain changes within costs could be noticed . The intervention group showed lower costs associated with outpatient hospital appointments over time ( p = 0.05 ) than the control group . In both groups , the number of falls , costs associated with the elderly-care physician and nurse practitioner increased equally during the study ( p<0.02 ) . Conclusions DCM is a cost-neutral intervention . It effectively reduces outpatient hospital appointments compared to usual care . Other considerations than costs , such as nursing homes ’ preferences , may determine whether they adopt the DCM method . Trial Registration Dutch Trials Registry
OBJECTIVES This review aims to underst and what elements of psychosocial interventions are associated with improved outcomes for  people with dementia  to inform implementation in care homes .