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Optimizing care for patients with dementia: a comparison of two non-pharmacological treatment approaches
Investigator (PI): Leland, Natalie E
Performing Organization (PO): (Current): University of Pittsburgh, School of Health and Rehabilitation Sciences, Department of Occupational Therapy / (412) 383-6620
(Past): University of Southern California, Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy / (323) 442-2850
Supporting Agency (SA): Patient-Centered Outcomes Research Institute (PCORI)
Initial Year: 2018
Final Year: 2023
Record Source/Award ID: PCORI/IHS-1608-35732
Funding: Total Award Amount: $4,722,108
Award Type: Contract
Award Information: PCORI: More information and project results (when completed)
Abstract: Of the 1.4 million nursing home (NH) residents in long term care facilities, more than half have Alzheimer's disease or dementia. Due to changes in their familiar daily routines, difficulty expressing their thoughts or asking for what they need, and overstimulation (such as noise) or under-stimulation (such as lack of activity), individuals with dementia often display disruptive behaviors like resisting help or continually repeating the same phrases. Medications are often prescribed to reduce agitation and aggressive behavior; however, these medications may not be effective and can have a negative impact on the individual. Therefore, families and other stakeholders strongly advocate the use of other types of approaches that focus on minimizing the cause of the behavior. Two approaches include the transdisciplinary approach for integrated dementia care, which combines the expertise of all NH staff, who work together to build a common language and approach for each resident, and the multidisciplinary approach for problem based dementia care, in which each staff member conducts individual assessments and makes discipline specific recommendations. While prior research suggests that both of these approaches are useful, the circumstances under which each approach is most effective are not clear. This project will compare the effect of the transdisciplinary approach versus the multidisciplinary approach by implementing them on a randomized basis within 80 facilities representing 10 geographic areas across the United States. We hope to show that there is a difference between the two comparators with respect to reducing the amount of medications dispensed to residents with dementia, leading to enhanced quality of life for the resident. In addition, we will determine if there is a difference between the two approaches in the number and frequency of disruptive behaviors in the resident with dementia, as well as other quality of life and safety factors for the resident and staff. Finally, we aim to gain the perspectives of the residents, families, and NH staff in order to identify benefits and drawbacks of each approach. This project is important because it will address a key clinical dilemma NH staff face as they strive to optimize the use of alternative approaches to reduce disruptive behaviors in residents with dementia. Transforming the quality of dementia care in NHs and enhancing the quality of life of residents with dementia are high priorities for families and other advocates. To guide the project's success, an advisory committee of key stakeholders that represent experts in dementia care and diverse perspectives of individuals with dementia, caregivers, and NH staff, will guide all aspects of the project to ensure that study approaches are clinically meaningful and responsive to stakeholder priorities.
MeSH Terms:
  • Aged
  • Behavior
  • Dementia /economics
  • /*rehabilitation
  • Geriatrics /organization & administration
  • Humans
  • Interdisciplinary Communication
  • Long-Term Care /economics
  • /*organization & administration
  • Models, Organizational
  • Multicenter Studies as Topic
  • Noise
  • Nursing Homes /economics
  • /*organization & administration
  • Patient Safety
  • Program Development
  • Program Evaluation
  • Quality of Life
  • Randomized Controlled Trials as Topic
  • United States
Country: United States || United States
State: Pennsylvania || California
Zip Code: 15260 / 90089
UI: 20181591
Project Status: Ongoing
Record History: ('2018: Start date changed from 2017 to 2018 and project extended to 2023. Changed PO.',)