title: Agitation in nursing home residents with dementia (VIDEANT trial): effects of a cluster-randomized, controlled, guideline implementation trial.
abstract: OBJECTIVE
  To test the effect of a complex guideline-based intervention on agitation and psychotropic prescriptions.
  
  
  METHODS
  Cluster randomized controlled trial (VIDEANT) with blinded assessment of outcome in 18 nursing homes in Berlin, Germany, comprising 304 dementia patients.
  
  
  METHODS
  Training, support, and activity therapy intervention, delivered at the level of each nursing home, focusing on the management of agitation in dementia. Control group nursing homes received treatment as usual.
  
  
  METHODS
  Levels of agitated and disruptive behavior (Cohen-Mansfield agitation inventory [CMAI]) as the primary outcome. Number of neuroleptics, antidepressants, and cholinesterase inhibitors (ChEIs) prescribed in defined daily dosages (DDDs).
  
  
  RESULTS
  Of 326 patients screened, 304 (93.3%) were eligible and cluster-randomized to 9 intervention (n = 163) and 9 control (n = 141) nursing homes. Data were collected from 287 (94.4%) patients at 10 months. At 10 months, compared with controls, nursing home residents with dementia in the intervention group exhibited significantly less agitation as measured with the CMAI (adjusted mean difference, 6.24; 95% CI 2.03-14.14; P = .009; Cohen's d = 0.43), received fewer neuroleptics (P < .05), more ChEIs (P < .05), and more antidepressants (P < .05).
  
  
  CONCLUSIONS
  Complex guideline-based interventions are effective in reducing agitated and disruptive behavior in nursing home residents with dementia. At the same time, increased prescription of ChEIs and antidepressants together with decreased neuroleptic prescription suggests an effect toward guideline-based pharmacotherapy.
authors.affiliation: Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Berlin, Germany; Social and Preventive Medicine, Department of Health and Sports Sciences, University of Potsdam, Potsdam, Germany. Electronic address: michael.rapp@uni-potsdam.de.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Rapp
authors.forename: Thomas
authors.initials: T
authors.lastname: Mell
authors.forename: Tomislav
authors.initials: T
authors.lastname: Majic
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Treusch
authors.forename: Johanna
authors.initials: J
authors.lastname: Nordheim
authors.forename: Mechthild
authors.initials: M
authors.lastname: Niemann-Mirmehdi
authors.forename: Hans
authors.initials: H
authors.lastname: Gutzmann
authors.forename: Andreas
authors.initials: A
authors.lastname: Heinz
mesh_terms: D000369:Aged, 80 and over; D000928:Antidepressive Agents / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000627:therapeutic use; D001521:Behavior Therapy; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use; D016000:Cluster Analysis; D003704:Dementia / Q000150:complications*; D005260:Female; D015577:Geriatric Assessment; D005858:Germany; D006801:Humans; D008297:Male; D009735:Nursing Homes; D017410:Practice Guidelines as Topic; D011595:Psychomotor Agitation / Q000188:drug therapy* / Q000209:etiology* / Q000523:psychology; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents; D014150:Antipsychotic Agents; D002800:Cholinesterase Inhibitors
keywords: Dementia; agitation; guideline; nursing home; trial