A Randomized Trial of Dementia Care in Nursing Homes

Abstract

OBJECTIVE: To evaluate the efficacy of a dementia care program to reduce behavior disorders in nursing home patients with dementia. DESIGN: Randomized controlled clinical trial with 6-month follow-up. SETTING: A 250-bed community nursing home. PATIENTS: The nursing home was screened to identify patients with dementia and behavior disorders. A total of 118 patients were eligible for randomization. Of these, 89 (75.4%) were randomized, and 81 of these (91.0%) completed the trial. INTERVENTION: The A.G.E. dementia care program consisted of Activities, Guidelines for psychotropic medications, and Educational rounds. The control treatment was usual nursing home care. MEASUREMENTS: Behavior disorders, antipsychotic drug and physical restraint use, patient activity levels, and cognitive and functional status. RESULTS: After 6 months, 12 of 42 (28.6%) intervention patients exhibited behavior disorders compared with 20 of 39 (51.3%) controls (OR = 0.38; 95% CI [0.15, 0.95]; P = .037). Controls were more than twice as likely to receive antipsychotics (OR = 2.55, 95% CI [0.96, 6.76]; P < .056), to be restrained during activity times (OR = 2.98, 95% CI [1.10, 8.04]; P < .028), and to be restrained on nursing units (OR = 2.14, 95% CI [0.9, 5.3]; P < .10). Intervention patients were much more likely to participate in activities (OR = 13.71; 95% CI [4.51, 41.73]; P = .001). CONCLUSIONS: The A.G.E. program reduces the prevalence of behavior disorders and the use of antipsychotic drugs and restraints. It is practical, feasible, and appears to improve the lives of patients with dementia in nursing homes.