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Therapeutic interventions in dementia 2: non-cognitive symptoms
- Authors:
- TAYLOR Clare, et al
- Journal article citation:
- Nursing Times, 20.1.08, 2008, pp.14-15.
- Publisher:
- Nursing Times
The second part of a two part article on therapeutic interventions in dementia. The article examines interventions for non-cognitive symptoms of dementia, which can include delusions, hallucinations, depression, anxiety, agitation and challenging behaviour.
Rapid tranquillisation of violent or agitated patients in a psychiatric emergency setting
- Authors:
- ALEXANDER Jacob, et al
- Journal article citation:
- British Journal of Psychiatry, 185(1), July 2004, pp.63-69.
- Publisher:
- Cambridge University Press
The pharmacological management of violence in people with psychiatric disorders is under-researched. The authors compare interventions commonly used for controlling agitation or violence in people with serious psychiatric disorders. They randomised 200 people to receive intramuscular lorazepam (4 mg) or intramuscular haloperidol (10 mg) plus promethazine (25–50 mg mix). At blinded assessments 4 h
Improving mental health and reducing antipsychotic use in people with dementia in care homes: the WHELD research programme including two RCTs
- Authors:
- BALLARD C., et al
- Journal article citation:
- Programme Grants for Applied Research, 8(6), 2020, Online only
- Publisher:
- National Institute for Health Research
- Place of publication:
- Southampton
Objective: to develop and evaluate a complex intervention to improve well-being, reduce antipsychotic use and improve quality of life in people with dementia in care homes through person-centred care, management of agitation and non-drug approaches. Design: This was a 5-year programme that consisted of six work packages. Work package 1 consisted of two systematic reviews of personalised in 16 care homes. Work package 4 involved optimisation of the WHELD programme based on work package 3 data. Work package 5 involved a multicentre randomised controlled trial in 69 care homes, which evaluated the impact of the optimised WHELD programme on quality of life, agitation and overall neuropsychiatric symptoms in people with dementia. Work package 6 focused on dissemination of the programme. of quality of life for residents with dementia. There was also a significant reduction in mortality. There were improvements in symptoms of agitation among people receiving the exercise intervention. The results demonstrated benefits in quality of life, a reduction in agitation and improvement in quality of care for residents in those homes who were receiving the WHELD programme, at a reduced cost compared with usual care. Conclusions: The WHELD programme is effective in improving quality of life and reducing both agitation and overall neuropsychiatric symptoms in people with dementia in care homes. It provides a structured training and support intervention for care staff, with lower overall costs for resident care than treatment as usual. (Edited publisher abstract)
Non-pharmacological interventions for agitation in dementia: systematic review of randomised controlled trials
- Authors:
- LIVINGSTON Gill, et al
- Journal article citation:
- British Journal of Psychiatry, 205(6), 2014, pp.436-442.
- Publisher:
- Cambridge University Press
Background: Agitation in dementia is common, persistent and distressing and can lead to care breakdown. Medication is often ineffective and harmful. Aims: To systematically review randomised controlled trial evidence regarding non-pharmacological interventions. Method: The authors reviewed 33 studies fitting predetermined criteria, assessed their validity and calculated standardised effect sizes (SES). Results: Person-centred care, communication skills training and adapted dementia care mapping decreased symptomatic and severe agitation in care homes immediately (SES range 0.3-1.8) and for up to 6 months afterwards (SES range 0.2-2.2). Activities and music therapy by protocol (SES range 0.5-0.6) decreased overall agitation and sensory intervention decreased clinically significant agitation immediately. Aromatherapy and light therapy did not demonstrate efficacy. Conclusions: There are evidence-based strategies for care homes. Future interventions should focus on consistent and long-term implementation through staff training. Further research is needed for people living in their own homes. (Edited publisher abstract)
Pain treatment of agitation in patients with dementia: a systematic review
- Authors:
- HUSEBO B.S., BALLARD C., AARSLAND D.
- Journal article citation:
- International Journal of Geriatric Psychiatry, 26(10), October 2011, pp.1012-1018.
- Publisher:
- Wiley
Dementia is frequently accompanied by behavioural and psychological symptoms (BPSD), including agitation and aggression, particularly in nursing home patients. Advancing age is associated with a high prevalence of pain. It has been suggested that unrecognised and untreated pain may contribute to BPSD in people with dementia. The objective of this paper is to systematically review the evidence that pain medication can improve agitation in people with dementia. A systematic search of the PubMed and Cochrane databases for the period 1992–2010 was performed. The search aimed to identify controlled studies of interventions focusing on pain reduction for patients with dementia with outcome measures including agitation or other related behavioural disturbances. Only 3 trials were identified; all were cross-over trials, and 2 included small sample sizes of less than 50 participants. The findings were inconsistent, and although some correlations were reported, these did not support the hypothesis that pain management reduces agitation. The article concludes that there is a lack of rigorous studies of the effect of pain treatment in patients with dementia and agitation.
Nursing home structure and association with agitation and use of psychotropic drugs in nursing home residents in three countries: Norway, Austria and England
- Authors:
- TESTAD I., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 25(7), July 2010, pp.725-731.
- Publisher:
- Wiley
Agitation is commonly observed in most dementia syndromes. The aim of this exploratory study was to compare the severity of agitation and psychotropic drug use in nursing homes with different organisations and structures in 3 different countries. Baseline data for 3 different intervention studies in Austria (n = 38), England (n = 302) and Norway (n = 163) were combined posthoc for analytical purposes. Patients were grouped according to their dementia severity using the global deterioration scale (GDS), functional assessment staging (FAST) and clinical dementia rating (CDR) scales. For the measurement of agitation, the Cohen-Mansfield Agitation Inventory (CMAI) was used. Data analysis was performed using one-way ANOVA, multivariate and linear regression analysis. The results showed that CMAI scores were available for 503 subjects with dementia. There were significant differences between the nursing home residents in the 3 countries regarding age, gender and dementia severity. In the multivariate analyses, the level of agitation differed with higher mean scores in the Austrian compared to UK and Norwegian nursing homes. Similarly, the use of psychotropic drugs differed significantly, with a higher proportion of neuroleptics in UK and Austrian compared to Norwegian nursing homes. The article concludes that there are differences in agitation and antipsychotic drug use which are likely related to structural and cultural differences in nursing homes in these 3 European countries. These findings suggest that structural changes can improve quality of care and quality of life for nursing home
A comparison of the effects of Snoezelen and reminiscence therapy on the agitated behaviour of patients with dementia
- Authors:
- BAILLON Sarah, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 19(11), November 2004, pp.1047-1052.
- Publisher:
- Wiley
Behavioural disturbance, such as agitation, is a common feature of dementia, and causes significant problems and distress for carers. Snoezelen is increasingly used with people who have dementia, but there is limited evidence of its efficacy. This crossover randomised controlled study aimed to evaluate the effect of Snoezelen on the mood and behaviour of patients with dementia, in comparison
A short-term inpatient programme for agitated demented nursing home residents
- Authors:
- WIENER Pauline K., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 16(9), September 2001, pp.866-872.
- Publisher:
- Wiley
Describes the various contributors of disruptive behavior in demented nursing home residents and outlines the necessary steps to identify and treat them. Overall clinical improvement was assessed with the global assessment of functioning scale. Agitation was evaluated with the brief agitation rating scale and the nursing home scale for agitation. Medication side-effects were measured with the Simpson-Angus scale and the abnormal involuntary movement scale. Results found the patients showed significantly more overall clinical improvement at discharge compared with admission. Additionally, agitation scores were significantly lower at discharge and at follow-up compared with admission. Concludes that a comprehensive medical and neurological assessment, an accurate identification of comorbid
A randomized, placebo-controlled trial of thiothixene in agitated, demented nursing home patients
- Authors:
- FINKEL Sandford I., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 10(2), February 1995, pp.129-136.
- Publisher:
- Wiley
The therapeutic efficacy of thiothixene in the treatment of behaviourally agitated dementia nursing home patients was studied in a double-blind, randomised, placebo-controlled clinical trial. Thiothixene was significantly more effective than placebo in the reduction of agitation at the end of eleven weeks treatment. Symptoms tended to return after discontinuation. The results suggest the efficacy of low doses of thiothixene for well-defined agitation in specifically selected demented nursing home patients.