Effect of enhanced psychosocial care on antipsychotic use in nursing home residents with severe dementia: cluster randomised trial

TLDR

The study evaluated whether a 10‑month training and support intervention for nursing home staff could reduce the proportion of residents with dementia prescribed neuroleptics. In a cluster randomised controlled trial across 12 specialist dementia nursing homes, residents received the intervention and were followed for 12 months, with the primary outcome being the proportion of residents prescribed neuroleptics and secondary outcomes of agitation and disruptive behaviour measured by the Cohen‑Mansfield Agitation Inventory. After 12 months, neuroleptic use decreased from 42.1% to 23.0% in intervention homes—a 19.1% absolute reduction (95% CI 0.5%–37.7%)—while agitation and disruptive behaviour scores showed no significant difference between groups.

Abstract

<h3>Abstract</h3> <b>Objective</b> To evaluate the effectiveness of a training and support intervention for nursing home staff in reducing the proportion of residents with dementia who are prescribed neuroleptics. <b>Design</b> Cluster randomised controlled trial with blinded assessment of outcome. <b>Setting</b> 12 specialist nursing homes for people with dementia in London, Newcastle, and Oxford. <b>Participants</b> Residents of the 12 nursing homes; numbers varied during the study period. <b>Intervention</b> Training and support intervention delivered to nursing home staff over 10 months, focusing on alternatives to drugs for the management of agitated behaviour in dementia. <b>Main outcome measures</b> Proportion of residents in each home who were prescribed neuroleptics and mean levels of agitated and disruptive behaviour (Cohen-Mansfield agitation inventory) in each home at 12 months. <b>Results</b> At 12 months the proportion of residents taking neuroleptics in the intervention homes (23.0%) was significantly lower than that in the control homes (42.1%): average reduction in neuroleptic use 19.1% (95% confidence interval 0.5% to 37.7%). No significant differences were found in the levels of agitated or disruptive behaviour between intervention and control homes. <b>Conclusions</b> Promotion of person centred care and good practice in the management of patients with dementia with behavioural symptoms provides an effective alternative to neuroleptics.