Effects of a Stepwise Multidisciplinary Intervention for Challenging Behavior in Advanced Dementia: A Cluster Randomized Controlled Trial. Effect of individualized social activity on sleep in nursing home residents with dementia. Effects of a physiotherapy and occupational therapy intervention on mobility and activity in care home residents: a cluster randomised controlled trial Agitation in nursing home residents with dementia (VIDEANT trial): effects of a cluster-randomized, controlled, guideline implementation trial. Individual music therapy for managing neuropsychiatric symptoms for people with dementia and their carers: a cluster randomised controlled feasibility study Effect of Music Therapy on Anxiety and Depression in Patients with Alzheimer’s Type Dementia: Randomised, Controlled Study Process evaluations for cluster-randomised trials of complex interventions: a proposed framework for design and reporting Efficacy of nonpharmacologic interventions for agitation in advanced dementia: a randomized, placebo-controlled trial. Evaluation of personalised, one-to-one interaction using Montessori-type activities as a treatment of challenging behaviours in people with dementia: the study protocol of a crossover trial Efficacy of Recreational and Occupational Activities Associated to Psychologic Support in Mild to Moderate Alzheimer Disease: A Multicenter Controlled Study Evaluating two group programmes of cognitive training in mild-to-moderate AD: Is there any difference between a ‘global’ stimulation and a ‘cognitive-specific’ one? Consort 2010 statement: extension to cluster randomised trials Efficacy of Theory‐Based Activities for Behavioral Symptoms of Dementia Observed affect in nursing home residents with Alzheimer's disease. A randomized controlled trial for an individualized positive psychosocial intervention for the affective and behavioral symptoms of dementia in nursing home residents. Effect of the BACE intervention on agitation of people with dementia. Using acupressure and Montessori-based activities to decrease agitation for residents with dementia: a cross-over trial. Effects of multimodal nondrug therapy on dementia symptoms and need for care in nursing home residents with degenerative dementia: a randomized-controlled study with 6-month follow-up. The effects of a psychomotor activation programme for use in groups of cognitively impaired people in homes for the elderly. Estimating the prevalence of dementia: cognitive screening in Glasgow nursing homes. A randomized crossover trial to study the effect of personalized, one-to-one interaction using Montessori-based activities on agitation, affect, and engagement in nursing home residents with Dementia. Effect of individualized social activities on quality of life among older adults with mild to moderate cognitive impairment in a geriatric psychiatry facility Activity calendars for older adults with dementia: What you see is not what you get [Effects of multisensory stimulation using familiarity: persons with dementia in long-term care facility in Korea]. A randomized clinical trial of theory-based activities for the behavioral symptoms of dementia in nursing home residents. Effects of Behavioral Interventions on Disruptive Behavior and Affect in Demented Nursing Home Residents Multisensory Stimulation as an Intervention Strategy for Elderly Patients With Severe Dementia The Challenging Behaviour Scale (CBS): development of a scale for staff caring for older people in residential and nursing homes. The relationships of environment and personal characteristics to agitated behaviors in nursing home residents with dementia. A randomized, controlled, clinical trial of activity therapy for apathy in patients with dementia residing in long-term care. Engagement in persons with dementia: the concept and its measurement. Providing activity for people with dementia in care homes: a cluster randomised controlled trial.
OBJECTIVES To assess whether implementation of a stepwise multicomponent intervention ( STA OP ! ) is effective in reducing challenging behavior and depression in nursing home residents with advanced dementia . DESIGN Cluster r and omized controlled trial . SETTING Twenty-one clusters ( single independent nursing home units ) in 12 nursing homes within the Netherl and s. PARTICIPANTS Residents with advanced dementia ( N = 288 ) . INTERVENTION Staff working on intervention units received comprehensive stepwise multidisciplinary training ; the control condition received training on general nursing skills , dementia management and pain without the stepwise component . MEASUREMENTS The primary outcome was agitation ( Cohen-Mansfield Agitation Inventory ( CMAI ) ) . Secondary outcomes included psychotropic medication use , neuropsychiatric symptoms ( Neuropsychiatric Inventory-Nursing Home version ( NPI-NH ) ) , and symptoms of depression ( Cornell Scale for Depression in Dementia ( CSDD ) , Minimum Data set Depression Rating Scale ( MDS-DRS ) ) . Measurements were made at baseline and 3 and 6 months after the intervention . Multilevel analysis and logistical generalized estimating equations were used to test treatment and time effects . Analysis was on an intention-to-treat basis . RESULTS Multilevel modeling revealed an overall effect of the intervention on challenging behavior and depression ; CMAI ( mean difference -4.07 points , 95 % confidence interval = ( CI ) = -7.90 to -0.24 , P = .02 ) , NPI-NH ( mean difference -3.57 points , 95 % CI = -6.30 to -0.84 , P = .005 ) , CSDD ( mean difference -1.59 points , 95 % CI = -2.49 to -0.69 , P < .001 ) , and MDS-DRS ( mean difference -0.96 points , 95 % CI = -1.40 to -0.52 , P < .001 ) scores were significantly lower in the intervention condition than the control condition . There was a significant reduction of antidepressants ( N06A ) ( OR = 0.32 ) ; nonsignificant reductions of antipsychotics ( N05A ) , anxiolytics ( N05B ) , and hypnotic-sedatives ( N05C ) ( odds ratios = 0.69 to 0.90 ) . CONCLUSION For nursing home residents with advanced dementia and challenging behavior , providing staff with comprehensive training in behavioral management , result ed in improved behavior and less psychotropic medication use OBJECTIVES To test the efficacy of an individualized social activity intervention ( ISAI ) on decreasing daytime sleep , improving nighttime sleep , and lowering the day/night sleep ratio and to determine its cost . DESIGN Pretest/posttest r and omized with an experimental and control group . SETTING Seven nursing homes . PARTICIPANTS One hundred forty-seven residents with dementia . INTERVENTION One to 2 hours of individualized social activities for 21 consecutive days . MEASUREMENTS Twenty-four-hour sleep/wake patterns using an Actigraph . RESULTS The ISAI group had significantly less daytime sleep ( P=.001 ) and a lower day/night sleep ratio ( P=.03 ) than the control group , after adjusting for baseline values . Because 40 % of the sample slept 7 or more hours at night , a secondary analysis was conducted . When only those residents with a sleep efficiency of less than 50 % ( n=50 ) were included , the ISAI group ( n=20 ) had less daytime sleep ( P=.005 ) , a lower day/night sleep ratio ( P=.02 ) , fell asleep faster ( P=.03 ) , and were awake less at night ( P=.04 ) than the control group ( n=30 ) , after adjusting for baseline values . The weekly cost of the ISAI was roughly $ 70 per participant . Initial training and supply costs were $ 1,944 . CONCLUSION The ISAI provides an alternative to medications , without side effects 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 OBJECTIVE To test the effect of a complex guideline -based intervention on agitation and psychotropic prescriptions . DESIGN , SETTING , PARTICIPANTS Cluster r and omized controlled trial ( VIDEANT ) with blinded assessment of outcome in 18 nursing homes in Berlin , Germany , comprising 304 dementia patients . INTERVENTION Training , support , and activity therapy intervention , delivered at the level of each nursing home , focusing on the management of agitation in dementia . Control group nursing homes  received treatment as usual . MEASUREMENTS Levels of agitated and disruptive behavior ( Cohen-Mansfield agitation inventory [ CMAI ] ) as the primary outcome . Number of neuroleptics , antidepressants , and cholinesterase inhibitors ( ChEIs ) prescribed in defined daily dosages ( DDDs ) . RESULTS Of 326 patients screened , 304 ( 93.3 % ) were eligible and cluster-r and omized to 9 intervention ( n = 163 ) and 9 control ( n = 141 ) nursing homes . Data were collected from 287 ( 94.4 % ) patients at 10 months . At 10 months , compared with controls , nursing home residents with dementia in the intervention group exhibited significantly less agitation as measured with the CMAI ( adjusted mean difference , 6.24 ; 95 % CI 2.03 - 14.14 ; P = .009 ; Cohen 's d = 0.43 ) , received fewer neuroleptics ( P < .05 ) , more  ChEIs  ( P < .05 ) , and more antidepressants ( P < .05 ) . CONCLUSION Complex guideline -based interventions are effective in reducing agitated and disruptive behavior in nursing home residents with dementia . At the same time , increased prescription of ChEIs and antidepressants together with decreased neuroleptic prescription suggests an effect toward guideline -based pharmacotherapy Background Previous research highlights the importance of staff involvement in psychosocial interventions targeting neuropsychiatric symptoms of dementia . Music therapy has shown potential effects , but it is not clear how this intervention can be programmed to involve care staff within the delivery of patients ’ care . This study reports initial feasibility and outcomes from a five month music therapy programme including weekly individual active music therapy for people with dementia and weekly post-therapy video presentations for their carers in care homes . Methods 17 care home residents and 10 care staff were r and omised to the  music therapy intervention group or st and ard care control group . The cluster r and omised , controlled trial included baseline , 3-month , 5-month and post-intervention 7-month measures of residents ’ symptoms and well-being . Carer-resident interactions were also assessed . Feasibility was based on carers ’ feedback through semi-structured interviews , programme evaluations and track records of the study . Results The music therapy programme appeared to be a practicable and acceptable intervention for care home residents and staff in managing dementia symptoms . Recruitment and retention data indicated feasibility but also challenges . Preliminary outcomes indicated differences in symptoms ( 13.42 , 95 % CI : [ 4.78 to 22.07 ; p = 0.006 ] ) and in levels of wellbeing ( −0.74 , 95 % CI : [ −1.15 to −0.33 ; p = 0.003 ] ) between the two groups , indicating that residents receiving music therapy improved . Staff in the intervention group reported enhanced caregiving techniques as a result of the programme . Conclusion The data supports the value of developing a music therapy programme involving weekly active individual music therapy sessions and music therapist-carer communication . The intervention is feasible with modifications in a more rigorous evaluation of a larger sample size . Trial registration Clinical trials.gov , number NCT01744600 Background / Aims : Numerous studies have indicated the value of music therapy in the management of patients with Alzheimer ’s disease . A recent pilot study demonstrated the feasibility and usefulness of a new music therapy technique . The aim of this controlled , r and omised study was to assess the effects of this new music therapy technique on anxiety and depression in patients with mild to moderate Alzheimer-type dementia . Methods : This was a single-centre , comparative , controlled , r and omised study , with blinded assessment of its results . The duration of follow-up was 24 weeks . The treated group ( n = 15 ) participated in weekly sessions of individual , receptive music therapy . The musical style of the session was chosen by the patient . The vali date d ‘ U ’ technique was employed . The control group ( n = 15 ) participated under the same conditions in reading sessions . The principal endpoint , measured at weeks 1 , 4 , 8 , 16 and 24 , was the level of anxiety ( Hamilton Scale ) . Changes in the depression score ( Geriatric Depression Scale ) were also analyzed as a secondary endpoint . Results : Significant improvements in anxiety ( p < 0.01 ) and depression ( p < 0.01 ) were observed in the music therapy group as from week 4 and until week 16 . The effect of music therapy was sustained for up to 8 weeks after the discontinuation of sessions between weeks 16 and 24 ( p < 0.01 ) . Conclusion : These results confirm the valuable effect of music therapy on  anxiety and depression  in patients with mild to moderate Alzheimer ’s disease . This new music therapy technique is simple to implement and can easily be integrated in a multidisciplinary programme for the management of Alzheimer ’s disease Background Process evaluations are recommended to open the ‘ black box ’ of complex interventions evaluated in trials , but there is limited guidance to help research ers design process evaluations . Much current literature on process evaluations of complex interventions focuses on qualitative methods , with less attention paid to quantitative methods . This discrepancy led us to develop our own framework for design ing process evaluations of cluster-r and omised controlled trials . Methods We review ed recent theoretical and method ological literature and selected published process evaluations ; these publications identified a need for structure to help design process evaluations . We drew upon this literature to develop a framework through iterative exchanges , and tested this against published evaluations . Results The developed framework presents a range of c and i date approaches to underst and ing trial delivery , intervention implementation and the responses of targeted participants . We believe this framework will be useful to others design ing process evaluations of complex intervention trials . We also propose key information that  process evaluations could report to facilitate their identification and enhance their usefulness . Conclusion There is no single best way to design and carry out a process evaluation . Research ers will be faced with choices about what questions to focus on and which methods to use . The most appropriate design depends on the purpose of the process evaluation ; the framework aims to help research ers make explicit their choices of research questions and methods .Trial registration Clinical trials.gov 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 The agitated behaviours that accompany dementia ( e.g. pacing , aggression , calling out ) are stressful to both nursing home residents and their carers and are difficult to treat . Behaviours stemming from pain , major depression or psychosis benefit from treatment with analgesics , antidepressants or antipsychotics . In other cases , psychotropic medications have limited efficacy but are used very widely . Therefore , increasingly more attention has been paid to nonpharmacological interventions which are associated with fewer risks . The aim of the current study is to test if personalised one-to-one interaction activities based on Montessori principles will reduce the frequency of behavioural symptoms of dementia significantly more than a relevant control condition . Methods / Design We will conduct a controlled trial with r and omised cross-over between conditions . Persons with moderate to severe dementia and associated behavioural problems living in aged care facilities will be included in the study . Consented , willing participants will be assigned in r and om order to Montessori or control blocks for two weeks then switched to the other condition . Montessori activities derive from the principles espoused by Maria Montessori and subsequent educational theorists to promote engagement in learning , namely task breakdown , guided repetition , progression in difficulty from simple to complex , and the careful matching of dem and s to levels of competence . The control intervention consists of conversation or reading from and looking at pictures in a newspaper to control for non-specific benefits of one-to-one interaction . Presence of target behaviour will be noted as well as level of engagement and type of affect displayed . Secondary measures also include the Cohen-Mansfield Agitation Inventory and information on time and funds spend to prepare the activities . Discussion If our results show that use of Montessori activities is effective in treating challenging behaviours in individuals with dementia , it will potentially provide a safer and more enjoyable intervention rather than reliance on pharmacology alone . Trial Registration Australian New Zeal and Clinical Trials Registry - We evaluated the efficacy of a stimulation program mainly based on recreational and occupational activities , associated with a brief cycle of support psychotherapy for patients and caregivers , in mild to moderate Alzheimer Disease ( AD ) associated or not with cerebrovascular lesions . Sixty-seven patients and 31 controls from 2 Italian towns entered the study . The control group was comprised of AD subjects who voluntarily declined to participate in the program for practical reasons . Patients were divided in groups of 4 subjects : treatment was delivered for 6 weeks . Multidimensional efficacy assessment of functional , behavioral , and neuropsychologic aspects was performed . When comparing baseline with posttraining condition , patients displayed a substantial reduction in disruptive behavior , and a tendency to a general reduction of behavioral symptoms compared with controls ( Revised Memory and Behavior Problems Checklist — RMBPC — symptoms frequency-total P=0.07 ; frequency of disruptive behavior P=0.008 ) . This reduction was mirrored by a significant reduction of caregiver reaction to behavioral disturbances ( RMBPC caregiver reaction-total P=0.035 ; reaction to disruptive behavior , P=0.011 ) . At 3 months follow-up , the reduction of caregiver reaction to behavioral symptoms results was confirmed ( RMBPC caregiver reaction-total P=0.014 , caregiver reaction to disruptive behavior P=0.028 ) . No other significant difference was detected . These results partially confirm findings of previous studies , showing that AD patients treated with similar techniques demonstrated an improvement in behavioral disturbances This study evaluated the efficacy of two different group procedures of non-pharmacological treatment in mild-to-moderate Alzheimer 's disease ( AD ) . Thirty-two patients entered the study and were divided in groups of four subjects . We compared recreational activities ( ‘ global ’ stimulation ) with a combination of procedural memory training on activities of daily living and neuropsychological rehabilitation of ‘ residual ’ functions ( ‘ cognitive-specific ’ ) .  All patients and caregivers were ensured psychological support . Both group treatments were delivered for six weeks . Multidimensional efficacy assessment of functional , behavioural and neuropsychological aspects was performed . Patients receiving ‘ global ’ stimulation showed a substantial reduction in behavioural disturbances ( Neuropsychiatric Inventory [ NPI ] : frequency p = 0.034 ; severity p = 0.012 ) ; Revised Memory Behaviour Problems Checklist ( frequency p = 0.008 ; reaction p = 0.027 ) , and better performance in the Functional Living Skills Assessment ( FLSA ) , a st and ardized direct measure of performance in everyday life ( p = 0.021 ) and Verbal Fluency for Letters ( p = 0.000 ) . Patients receiving ‘ cognitive-specific ’ treatment improved only on the scale evaluating functional competence in daily living ( Nurses ’ Observation Scale for Geriatric Patients [ NOSGER ] p = 0.018 ) . At follow-up ( six months later ) , compared with baseline , patients following the ‘ global ’ stimulation treatment showed an improvement at caregiver distress on NPI ( p = 0.04 ) . No other significant difference was detected . Our results support the contention that a ‘ global ’ treatment can lead to a significant improvement in AD patients , both for behavioural and functional aspects . The ‘ cognitive-specific ’ treatment we used in this research did not show better efficacy The Consoli date d St and ards of Reporting Trials ( CONSORT ) statement was developed to improve the reporting of r and omised controlled trials . It was initially published in 1996 and focused on the reporting of parallel group r and omised controlled trials . The statement was revised in 2001 , with a further up date in 2010 . A separate CONSORT statement for the reporting of abstract s was published in 2008 . In earlier papers we considered the implication s of the 2001 version of the CONSORT statement for the reporting of cluster r and omised trial . In this paper we provide up date d and extended guidance , based on the 2010 version of the CONSORT statement and the 2008 CONSORT statement for the reporting of abstract s. Background Agitation and passivity are behavioral symptoms exhibited by 90 % of nursing home residents with dementia . They account for many poor health outcomes , caregiver burden , and increased costs of long-term care . Objectives This study tested the efficacy of recreational activities derived from the Need-driven Dementia-compromised Behavior ( NDB ) model : activities matched to skill level only ; activities matched to style of interest only ; and a combination of both ( NDB-derived ) for responding to the behavioral symptoms of dementia . Methods Thirty participants were r and omly assigned to 1 of 6 possible order-of-condition presentations in this crossover experimental design with repeated measures of dependent variables . Trained research assistants , blind to condition match , implemented each condition for 12 consecutive days . Measures of engagement ( time on task and participation ) , affect , and behavioral symptoms ( agitation and passivity ) were taken from videotape recordings of each session . Mood was measured with the Dementia Mood Picture Test . The primary analysis method was mixed-model analysis of variance . Results Significantly more time on task , greater participation , more positive affect , and less passivity were found under NDB-derived and matched to interest only treatments compared with the matched to skill level only treatment or baseline . Agitation and negative affect improved under all treatments compared with baseline . There was no significant change in mood . Discussion The NDB-derived activities are tailored to meet individual needs and improve behavioral symptoms associated with dementia . These findings help to explain factors that produce behavioral symptoms and the mechanisms that underlie their successful treatment A method for assessing affect states among older people with Alzheimer 's disease was developed for use in a study design ed to evaluate a special care unit for such residents of a nursing home . The 6-item  Philadelphia Geriatric Center Affect Rating Scale was design ed for the use of research and other staff in assessing positive affect ( pleasure , interest , contentment ) and negative affect ( sadness , worry/anxiety , and anger ) by direct observation of facial expression , body movement , and other cues that do not depend on self-report , among 253 demented and 43 nondemented residents . Each affect scale was highly reliable , expressed in estimated portions of a 10-minute observation period when the affect expression occurred . Validity estimates were affirmative in showing discriminant correlations between the positive states and various independent measures of social and other outwardly engaged behavior and between negative states and other measures of depression , anger , anxiety , and withdrawal . Limited support for the two-factor dimensionality of the affect ratings was obtained , although positive and negative affect were correlated , rather than independent . Some hope is offered that the preference and aversions of Alzheimer patients may be better understood by observations of their emotional behaviors and that such methods may lead to a better ability to judge institutional quality OBJECTIVES This r and omized controlled study tested the effectiveness of individualized activities , led by certified nursing assistants ( CNAs ) , to increase positive and reduce negative affect and behavior among nursing home residents with dementia . METHOD Nursing home residents with mild to advanced dementia ( N = 180 ) were r and omly assigned to usual care ( UC , n = 93 ) or 1 of 2 experimental conditions . Residents in the attention control group ( AC , N = 43 ) participated in st and ardized one-to-one activities with their CNAs . Individualized Positive Psychosocial Intervention ( IPPI ) participants ( n = 44 ) received a CNA-led activity matched to their interests and ability . Outcomes were residents ' positive and negative affect and verbal and nonverbal behavior . RESULTS The IPPI and AC groups experienced similar benefits -more pleasure , alertness , engagement , positive touch , and positive verbal behavior-compared with UC . The AC group displayed more anger , uncooperativeness , and very negative verbal behavior than UC or IPPI . DISCUSSION This study demonstrates the value of individualized activities for nursing home residents with dementia . In a stringent test , residents were happier and less angry during a customized intervention compared with a st and ardized intervention . Even brief individualized CNA-led activities bring pleasure to nursing home residents and constitute an effective strategy to enhance positive affect and engagement in persons with dementia 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 OBJECTIVES To explore the effectiveness of acupressure and Montessori-based activities in decreasing the agitated behaviors of residents with dementia . DESIGN A double-blinded , r and omized ( two treatments and one control ; three time periods ) cross-over design was used . SETTING Six special care units for residents with dementia in long-term care facilities in Taiwan were the sites for the study . PARTICIPANTS One hundred thirty-three institutionalized residents with dementia . INTERVENTION Subjects were r and omized into three treatment sequences : acupressure-presence-Montessori methods , Montessori methods -acupressure-presence and presence-Montessori methods -acupressure . All treatments were done once a day , 6 days per week , for a 4-week period . MEASUREMENT The Cohen-Mansfield Agitation Inventory , Ease-of-Care , and the Apparent Affect Rating Scale . RESULTS After receiving the intervention , the acupressure and Montessori-based-activities groups saw a significant decrease in agitated behaviors , aggressive behaviors , and physically nonaggressive behaviors than the presence group . Additionally , the ease-of-care ratings for the acupressure and Montessori-based-activities groups were significantly better than for the presence group . In terms of apparent affect , positive affect in the Montessori-based-activities group was significantly better than in the presence group . CONCLUSION This study confirms that a blending of traditional Chinese medicine and a Western activities program would be useful in elderly care and that in-service training for formal caregivers in the use of these interventions would be beneficial for OBJECTIVES To determine the efficacy of multimodal , nondrug therapy on symptoms of dementia and need for care in institutionalized individuals with degenerative dementia . DESIGN R and omized , controlled , longitudinal trial . Data were analyzed using multiple linear regression . SETTING Five German nursing homes . PARTICIPANTS One hundred thirty-nine nursing home residents with primary degenerative dementia ( Mini-Mental State Examination score < 24 ) . INTERVENTION The 6-month intervention comprised three components : motor stimulation , activities of daily living , and cognitive stimulation ( MAKS ) . Groups of 10 patients led by two therapists participated in the st and ardized intervention for 2 hours , 6 days a week . The intervention was described in detail in an intervention manual . Adherence to the manual was high . Controls received treatment as usual . MEASUREMENTS Overall geriatric symptoms were recorded using the Nurses ' Observation Scale for Geriatric Patients , functional independence using the Barthel Index , and care time using the Re source Utilization in Dementia-Formal Care . RESULTS Of 646 individuals screened , 146 were eligible , and 130 were included in the intention-to-treat analysis . At 6 months , results of the per- protocol analysis ( n = 119 ) showed improvement in overall dementia symptoms in the MAKS group and no change in the control group ( adjusted mean difference ( AMD ) = -6.8 , 95 % confidence interval ( CI ) = -10.3 to -3.3 ; P < .001 , Cohen d = 0.66 ) . This effect was greatest on the social behavior ( AMD = -1.9 , 95 % CI = -2.9 to -0.8 ; P < .001 ; Cohen d = 0.54 ) and instrumental activity of daily living ( IADL ) ( AMD = -1.4 , 95 % CI = -2.5 to -0.30 ; P = .01 ; Cohen d = 0.43 ) subscales . No effect was seen on functional independence or total care time . CONCLUSION This 6-month nondrug multimodal intervention improved dementia symptoms in nursing home residents , especially in social behavior and IADL capabilities OBJECTIVES To test the effects of the Psychomotor Activation Programme ( PAP ) on the behaviour and cognition of demented elderly people . DESIGN R and omized controlled trial with an experimental group and a control group . Post-test after 6 months . SETTING Group care projects for demented elderly people living in 11 different homes for the elderly in The Netherl and s. PARTICIPANTS One hundred and thirty-four subjects entered the study ( 72 in the experimental group and 62 in the control group ) , 42 of whom dropped out ( 27 in the experimental group and 15 in the control group ) . MEASUREMENTS Individual behaviour and group behaviour were scored using two Dutch scales ( BIP and SIPO respectively ) developed and vali date d for use in psychogeriatric population s. Cognition was measured with the short and the long versions of the Cognitive Screening Test ( CST-14 and CST-20 ) . Disability was measured with the Barthel Index . Medicine use , falls , other accidents and life events were registered . RESULTS The PAP had a beneficial effect on cognition ( CST-14 , F = 2.63 , p < or = 0.05 , effect size 0.4 ) ( CST-20 , F = 3.77 , p < or = 0.05 , effect size 0.5 ) and increased positive group behaviour in participants with relatively mild cognitive problems ( SIPO , F = 4.46 p < or = 0.05 ) . CONCLUSIONS The PAP stabilizes cognitive performance and has some beneficial effects on behaviour . Positive findings were supported by a simultaneously conducted process evaluation OBJECTIVES The purpose of this study is to establish existing levels of dementia in nursing homes . DESIGN The design was a r and omised sample of every sixth nursing home resident in Glasgow City .  Cognitive testing of 341 residents was carried out using the St and ardised Mini Mental State Examination ( SMMSE ) . For clients who had difficulty participating , the Functional Assessment Staging Tool ( FAST ) was used . Existing dementia diagnoses were compared with the prevalence indicated through cognitive testing . MAIN OUTCOME MEASURES St and ardised Mini Mental State Examination  and the FAST were used . SETTING This study was conducted in the nursing homes in the Glasgow City Council Local Authority , Scotl and , UK ( N = 49 ) . Forty-eight homes participated in the study and one declined . PARTICIPANTS The participants were residents of the nursing homes in Glasgow City , including those in existing dementia units ( sample = 422 of population 2532 ) ; 19 declined and 403 participated . RESULTS Two hundred thirty-four ( 58 % ) residents already had a diagnosis of dementia written in their care plans . One hundred twenty-eight residents ( 31.8 % ) without diagnosis of dementia in their care plans scored within the range of possible dementia ( less than 24/30 on the SMMSE ) . A group of 55 ( 13.6 % ) residents had no diagnosis of dementia but had some type of cognitive impairment recorded in their notes and scored within the range of possible dementia on the SMMSE . CONCLUSION Existing levels of dementia diagnosis are 58 % . This study finds an additional 31.8 % of residents without a diagnosis of dementia who score within the range of possible dementia , giving a ceiling of 89.8 % . It appears that underdiagnosis of dementia exists within this 31.8 % group BACKGROUND Increasingly more attention has been paid to non-pharmacological interventions as treatment of agitated behaviors  that accompany dementia . The aim of the current study is to test if personalized one-to-one interaction activities based on Montessori principles will improve agitation , affect , and engagement more than a relevant control condition . METHODS We conducted a r and omized crossover trial in nine residential facilities in metropolitan Melbourne , Australia ( n = 44 ) .  Personalized one-to-one activities that were delivered using Montessori principles were compared with a non-personalized activity to control for the non-specific benefits of one-to-one interaction . Participants were observed 30 minutes before , during , and after the sessions . The presence or absence of a selected physically non-aggressive behavior was noted in every minute , together with the predominant type of affect and engagement . RESULTS Behavior counts fell considerably during both the Montessori and control sessions relative to beforeh and . During Montessori activities , the amount of time spend actively engaged was double compared to during the control condition and participants displayed more positive affect and interest as well . Participants with no fluency in English ( all from non-English speaking background s ) showed a significantly larger reduction in agitation during the Montessori than control sessions . CONCLUSION Our results show that even non-personalized social contact can assist in settling agitated residents . Tailoring activities to residents ' needs and capabilities elicit more positive interactions and are especially suitable for people who have lost fluency in the language spoken predominantly in their residential facility . Future studies could explore implementation by family members and volunteers to avoid dem and s on facilities ' re sources . TRIAL REGISTRATION Australian New Zeal and Clinical Trials Registry - ACTRN12609000564257 Objectives : The study examined the effect of an individualized social activities intervention ( ISAI ) on quality of life among older adults with mild to moderate cognitive impairment in a geriatric psychiatry facility . Method : This r and omized control trial consisted of 52 older adults ( M = 70.63 , SD = 5.62 ) with mild to moderate cognitive impairment in a geriatric inpatient psychiatry facility . A 2 ( group condition ) × 2 ( time of measurement ) design was used to compare the control ( treatment-as-usual ) and intervention ( treatment-as-usual plus ISAI ) conditions at pre- and post-treatment . ISAI consisted of 30- to 60-minute sessions for up to 15 consecutive days . The Dementia Quality of Life instrument and Neurobehavioral Rating Scale – Revised were used to examine quality of life and behavioral and psychological symptoms of dementia at pre- and post-treatment . Results : Intent-to-treat analyses indicated a significant time × group condition interaction on quality of life , with this effect remaining when only completer data were included . There was no evidence of a significant treatment effect on behavioral and psychological symptoms of dementia . Conclusion : Findings suggest that individualized social activities are a promising treatment for cognitively impaired geriatric in patients This paper reports on a two-part study of nursing home recreation . In part one , a retrospective activity calendar and chart review was used in this comparative study of 107 long-term care residents with dementia . Data were collected and documented regarding demographics , cognitive and physical functioning , medications , activities listed on facility activity calendars , leisure preferences , and actual involvement in recreation over a two-week consecutive period during baseline . In part two , this information was compared to opportunities offered during a two-week clinical trial of recreational therapy . The results showed that , during baseline , almost 45 percent of the subjects in the sample received little or no facility activities , 20 percent received occasional activities , and 12 percent received daily activities but they were deemed inappropriate based on the functioning levels or interests of the residents . The clinical trial period demonstrated that small group recreational therapy was successful in engaging residents 84 percent of the time PURPOSE The purpose of the study was to examine the effects of multisensory stimulation ( MSS ) using familiarity on persons with dementia ( PWDs ) residing in nursing homes in Korea . METHODS A nonequivalent control group with pre and posttests was used . Fifty one PWDs were included if they : 1 ) were over 65 yr old , 2 ) were diagnosed with dementia , 3 ) had no visual or speech impairments , 4 ) were able to communicate , and 5 ) had spent more than one month in a nursing home . The experimental group ( n=25 ) received a 55 min MSS program twice a week for 10 weeks . The outcome variables included were cognition , activities of daily living , grip strength , depression , w and ering , and aggressive behaviors . Repeated ANOVA was used for data analysis . RESULTS There were no significant differences in demographics or the main variables at pretest . Cognition , depression , w and ering , and aggressive behaviors were significant over time between the two groups . Grip strength was only significant when accounting for interaction between group and time . CONCLUSION An intervention of MSS using familiarity was marginally effective in improving cognition , depression , w and ering , and aggression . Future study is suggested with a larger sample and longer treatment to retest the effects of MSS 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 Background Disruptive behaviors are prevalent in nursing home residents with dementia and often have negative consequences for the resident , caregiver , and others in the environment . Behavioral interventions might ameliorate them and have a positive effect on residents ’ mood ( affect ) . Objectives This study tested two interventions —an activities of daily living and a psychosocial activity intervention— and a combination of the two to determine their efficacy in reducing disruptive behaviors and improving affect in nursing home residents with dementia . Methods The study had three treatment groups ( activities of daily living , psychosocial activity , and a combination ) and two control groups ( placebo and no intervention ) . Nursing assistants hired specifically for this study enacted the interventions under the direction of a master ’s prepared gerontological clinical nurse specialist . Nursing assistants employed at the nursing homes recorded the occurrence of  disruptive behaviors  . Raters analyzed videotapes filmed during the study to determine the interventions ’ influence on affect . Results Findings indicated significantly more positive affect but not reduced disruptive behaviors in treatment groups compared to control groups . Conclusions The treatments did not specifically address the factors that may have been triggering disruptive behaviors . Interventions much more precisely design ed than those employed in this study require development to quell disruptive behaviors . Nontargeted interventions might increase positive affect . Treatments that produce even a brief improvement in affect indicate improved quality of mental health as m and ated by federal law The objective of this study was to compare the effect of multisensory stimulation environment ( MSSE ) and one-to-one activity sessions in the symptomatology of elderly individuals with severe dementia . Thirty-two participants were r and omly assigned to the following 3 groups : MSSE , activity , and control group . The MSSE and activity groups participated in two 30-minute weekly sessions over 16 weeks . Pre- , mid- , and posttrial ; 8-week follow-up behavior ; mood ; cognitive status ; and dementia severity were registered . Patients in the MSSE group demonstrated a significant improvement in the Neuropsychiatric Inventory and Bedford Alzheimer Nursing Severity Scale scores compared with the activity group . Both MSSE and activity groups showed an improvement during the intervention in the Cohen-Mansfield Agitation Inventory aggressive behavior factor and total score , with no significant differences between groups . The MSSE may have better effects on neuropsychiatric symptoms and dementia severity in comparison with one-to-one activity sessions in patients with severe dementia OBJECTIVES A review of behavioural rating scales identified the need for a measure of resident behaviours that staff in care homes for older people find difficult to manage . A 25-item , broad-based rating scale , the Challenging Behaviour Scale ( CBS ) , was developed to meet this need and its psychometric properties were examined . DESIGN Cross-sectional surveys . METHODS Ratings of 484 residents , living in 16 homes across Engl and , were used to examine four methods of collecting inter-rater reliability data . Ratings of 382 residents living in 13 homes were used to evaluate criterion validity and to establish norms . Six further homes were used to explore qualitatively the validity of the suggested norms . Ratings of 98 residents living in four further homes were used to examine concurrent validity . The predictive validity of the  CBS ' challenge ' score  was evaluated , using time- sample d direct observation of challenging behaviour in 237 residents , living in 11 homes . RESULTS The scale records staff reports of the incidence , frequency and ' management difficulty ' of resident behaviour and it can also identify ' challenging residents ' through a computed score . It has good internal consistency , good test-retest reliability and adequate validity . Inter-rater reliability is good when staff receive training or when staff groups of at least three , of mixed qualifications , complete the scale . Norms are suggested for prospect i ve studies of the prevalence of challenging behaviour . CONCLUSIONS The CBS is quick to complete and may have potential for the evaluation of psychosocial interventions in care setting s. It is , as far as we know , the first staff observational rating scale that is based on the reports of care staff , who constitute the backbone of residential care provision . Suggestions for improvements in criterion and content validity are outlined OBJECTIVE To explore the impact of personal attributes , environmental attributes , and the presentation of 9 categories of stimuli on agitation in nursing home residents with dementia . METHOD Participants in this r and omized , controlled , observational cross-sectional study were 193 residents of 7 nursing homes , all with a diagnosis of dementia , for whom we obtained data pertaining to cognitive functioning ( via the Mini-Mental State Examination ) , performance of activities of daily living ( Minimum Data Set ) , and role-identity/activities of past interest ( Self-Identity Question naire ) .  Environmental attributes (  eg ,  noise , lighting )  and  direct observations of agitation  ( primary outcome ) were recorded via the Agitation Behavior Mapping Inventory .  Engagement was measured using the Observational Measurement of Engagement . Both agitation and engagement were assessed for each stimulus ( including a control condition ) . RESULTS Univariate findings ( ie , for 1 explanatory variable at a time ) showed agitation to be related to several personal attributes -- ie , female gender was related to verbal agitation ( P < .0001 ) ; low cognitive function was related to total , verbal , and physical agitation ( P < .001 for each ) ; low performance of activities of daily living was significantly related to all types of agitation ( P < .01 for total agitation and P < .05 for each type of agitation ) ; and unclear speech was significantly related to total agitation ( P < .01 ) . Eight of the 9 stimulus categories were significantly related to decreased levels of agitation , with ORs ranging from 0.37 ( live human stimuli , P < .001 ) to 0.79 ( inanimate social stimuli , P < .05 ) . Higher levels of engagement were related to lower levels of agitation ( P < .001 for total agitation ) . In the multivariate analyses , higher cognitive function ( P < .001 ) , male gender ( P < .05 ) , level of engagement with stimuli ( eg , duration of engagement for 3 minutes or longer , P < .05 ) , and all 9 stimulus categories , with the exception of music , were independently predictive of lower levels of agitation ( P < .001 ) . CONCLUSIONS The finding that both type of stimuli and engagement level with the stimuli were significant predictors of agitation underscores the importance of engagement as a determinant of agitation levels 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 PURPOSE The aim of this article is to delineate the underlying premises of the concept of engagement in persons with dementia and present a new theoretical framework of engagement . SETTING /SUBJECTS The sample included 193 residents of seven Maryl and nursing homes . All participants had a diagnosis of dementia . METHODOLOGY The authors describe a model of factors that affect engagement of persons with dementia . Moreover , the authors present the psychometric qualities of an assessment design ed to capture the dimensions of engagement ( Observational Measurement of Engagement ) . Finally , the authors detail plans for future research and data analyses that are currently underway . DISCUSSION This article lays the foundation for a new theoretical framework concerning the mechanisms of interactions between persons with cognitive impairment and environmental stimuli . Additionally , the study examines what factors are associated with interest and negative and positive feelings in engagement BACKGROUND Activity levels remain low in care homes , but activity engagement can enhance residents ' quality of life . AIM This study aim ed to assess an occupational therapy programme design ed to enable care home staff to increase activity provision . METHOD A cluster r and omised controlled trial with blinded assessment of outcome was conducted . A total of 210 residents with dementia in 16 care homes were recruited . Intervention homes received the programme , and control homes were provided usual care . Primary outcome is quality of life ; secondary measures are dependency , challenging behaviour , depression , anxiety , severity of dementia and number and type of medication . RESULTS Quality of life decreased overall with statistically significant change in staff ratings ( p < 0.001 ) . At follow-up , staff-rated quality of life was slightly lower in the intervention group ( mean difference in staff ratings = -1.91 , 95 % CI -3.39 to -0.43 , p = 0.01 ) . There were no significant differences between the two groups for self-rated quality of life or secondary outcomes . CONCLUSION The results may be related to the following : wide variability in how the intervention was implemented , such as low staff attendance at the education and coaching sessions , and patchy provision of additional activities to residents ; or the residents ' severity of dementia or the choice of outcome measures . Future studies need to pay more attention to process measures such as implementation and fidelity strategies , and outcome measures that better capture the focus of the intervention such as level of engagement and activity
BACKGROUND People with dementia who are being cared for in long-term care setting s are often not engaged in meaningful activities .
Offering them activities which are tailored to their individual interests and preferences might improve their quality of life and reduce challenging behaviour .
OBJECTIVES ∙ To assess the effects of personally tailored activities on psychosocial outcomes for people with dementia living in long-term care facilities.∙ To describe the components of the interventions .∙ To describe conditions which enhance the effectiveness of personally tailored activities in this setting .