title: What are the barriers to performing nonpharmacological interventions for behavioral symptoms in the nursing home?
abstract: OBJECTIVE
  Behavioral symptoms are common in persons with dementia, and nonpharmacological interventions are recommended as the first line of therapy. We describe barriers to conducting nonpharmacological interventions for behavioral symptoms.
  
  
  METHODS
  A descriptive study of barriers to intervention delivery in a controlled trial.
  
  
  METHODS
  The study was conducted in six nursing homes in Maryland.
  
  
  METHODS
  Participants were 89 agitated nursing home residents with dementia.
  
  
  METHODS
  Personalized interventions were developed using the Treatment Routes for Exploring Agitation decision tree protocol. Trained research assistants prepared and delivered the interventions. Feasibility of the interventions was determined.
  
  
  METHODS
  Barriers to Intervention Delivery Assessment, activities of daily living, cognitive functioning, depressed affect, pain, observed agitation, and observed affect.
  
  
  RESULTS
  Barriers were observed for the categories of resident barriers (specifically, unwillingness to participate; resident attributes, such as unresponsive), barriers related to resident unavailability (resident asleep or eating), and external barriers (staff-related barriers, family-related barriers, environmental barriers, and system process variables). Interventions pertaining to food/drink and to 1-on-1 socializing were found to have the fewest barriers, whereas higher numbers of barriers occurred with puzzles/board games and arts and crafts activities. Moreover, when successful interventions were presented to participants after the feasibility period, we noted fewer barriers, presumably because barrier identification had been used to better tailor interventions to each participant and to the environment.
  
  
  CONCLUSIONS
  Knowledge of barriers provides a tool by which to tailor interventions so as to anticipate or circumvent barriers, thereby maximizing intervention delivery.
authors.affiliation: Research Institute on Aging of Charles E. Smith Life Communities, Rockville, MD 20852, USA. cohen-mansfield@hebrew-home.org
authors.forename: Jiska
authors.initials: J
authors.lastname: Cohen-Mansfield
authors.forename: Khin
authors.initials: K
authors.lastname: Thein
authors.forename: Marcia S
authors.initials: MS
authors.lastname: Marx
authors.forename: Maha
authors.initials: M
authors.lastname: Dakheel-Ali
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D032763:Behavior Control / Q000379:methods*; D001526:Behavioral Symptoms / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D016009:Chi-Square Distribution; D003144:Communication Barriers; D003704:Dementia / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment / Q000379:methods; D006707:Homes for the Aged; D006801:Humans; D008297:Male; D008396:Maryland; D015999:Multivariate Analysis; D009483:Neuropsychological Tests; D009735:Nursing Homes; D010353:Patient Education as Topic / Q000379:methods; D010358:Patient Participation / Q000706:statistics & numerical data; D004364:Pharmaceutical Preparations; D011595:Psychomotor Agitation / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D004364:Pharmaceutical Preparations