Table 8. Management of behavioral and psychological symptoms of dementia.
| First author, year | Study design, intervention length, number of sites, baseline sample size | Control condition | Education material | Training | Reminders | Audit and feedback | Mentoring or support | Champion/s | Team meetings | Policy/procedure changes | Organizational restructure | Intervention description | Staff direct behavior outcomes | Staff indirect outcomes | Resident outcomes |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Proctor, 1998, 1999 | Paired, clustered RCT, 26 wks, 12 sites, CG: 60 res, IG: 60 res | Usual care | + | + | Training on organic and functional disorders in old age, approaches to care, activities. Supervision in individual program planning including observation and assessment, perceived needs and goal planning, breaking down the goal into steps and small targets, monitoring and recording progress. | At follow-up a larger proportion of CG staff met criteria for caseness on the General Health Questionnaire compared with IG staff. No differences over time between groups on sources of work related pressure. | Compared to CG, over time IG had less cognitive decline and more improvement in depression. No differences between groups over time on level of behavior or physical disability. | ||||||||
| Deudon, 2009 | Cluster, randomized RCT, 8 wks, follow-up at 12 wks, 16 sites, CG: 132 res; IG: 174 res | Usual care | + | + | + | + | + | Training on behavioral and psychological symptoms of dementia (BPSD), “how to” staff instruction cards on managing BPSD, what to do and what to avoid in care, non-pharmacological interventions. Personalized staff consultation. | Compared to CG, over time the IG had significantly lower global agitation, physically non-aggressive, verbally non-aggressive behaviors, and observed behavioral disturbances. | ||||||
| Zimmerman, 2010 | Nested cohort RCT, 6 wks, 3 months follow-up, 16 sites, CG: 371 staff; IG: 291 staff | Usual care | + | Training for supervisors and direct care staff on dementia care and pain reduction. Supervisors trained on leadership skills. | Immediate improvement in communication and in pain awareness and after 3 months, communication improvements persisted. | Compared to the CG, the IG work stress increased and supervisory support received decreased for direct care staff and supervisors. | |||||||||
| Van de ven, 2013 | Minimization on cluster randomized RCT, 35 wks, 34 sites, CG: 198 staff, 166 res; IG: 178 staff, 102 res | + | 2 staff members trained in Dementia Care Mapping (DCM). DCM briefing day for organization. | Compared to CG, over time the IG reported fewer negative emotional reactions and more positive emotional reactions, greater autonomy and work pleasure. No differences between groups on general health or job satisfaction. | Compared to CG, IG deteriorated on total neuropsychiatric symptoms. No differences between groups over time on agitation. Indirect outcomes: no differences between groups on quality of life. | ||||||||||
| Leone, 2013 | Cluster, randomized RCT, 4 wks, 13 wks follow-up, 16 sites, CG: 111 res; IG: 119 res | + | + | Training for staff on apathy in dementia, depression, deficits in function, structured activities; information including recommendations for non-pharmacological interventions summarized on Dos and Don’ts card. | No differences between groups on prescriptions of psychotropics, antidepressants, anxiolytics or antipsychotics. | Compared to CG, IG improved on emotional blunting, but not an initiative or interest, and had greater deterioration on affective and psychotic symptoms. IG had improvements on some activities of daily living (dressing and transferring), and deterioration on others (toileting and continence). | |||||||||
| Eisses, 2005 | Paired, cluster randomized RCT, 2 wks, 26 wks follow-up, 10 sites, CG: 228 res; IG: 198 res | + | + | + | Training for staff on differences between dementia and depression behaviors. Video material. Use of standardized screening instrument for depression, reviews at staff meetings. | Improvement in sensitivity, but not specificity, in recognition of depression symptoms. No improvements in treatment of depression. | Improvement in depressive symptoms. No difference for prevalence and incidence of depression. |
NRCT, non-randomized controlled trial; RCT, randomized controlled trial; CG, control group; IG, intervention group; wks, weeks; res, residents.