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


METHODS
Cluster randomised controlled trial with blinded assessment of outcome.


METHODS
12 specialist nursing homes for people with dementia in London, Newcastle, and Oxford.


METHODS
Residents of the 12 nursing homes; numbers varied during the study period.


METHODS
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
Promotion of person centred care and good practice in the management of patients with dementia with behavioural symptoms provides an effective alternative to neuroleptics.
Oxford University and Oxford Mental Healthcare Trust, Oxford.
Jane
J
Fossey
Clive
C
Ballard
Edmund
E
Juszczak
Ian
I
James
Nicola
N
Alder
Robin
R
Jacoby
Robert
R
Howard
D000058:Accidental Falls; D000374:Aggression; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D016000:Cluster Analysis; D003704:Dementia / Q000188:drug therapy*; D006304:Health Status; D006707:Homes for the Aged; D006801:Humans; D009735:Nursing Homes; D011595:Psychomotor Agitation; D011788:Quality of Life; D013810:Therapeutic Equivalency
D014150:Antipsychotic Agents