title: Modeling and evaluating evidence-based continuing education program in nursing home dementia care (MEDCED)--training of care home staff to reduce use of restraint in care home residents with dementia. A cluster randomized controlled trial.
abstract: OBJECTIVE
  The aim of this study was to evaluate the effectiveness of a tailored 7-month training intervention "Trust Before Restraint," in reducing use of restraint, agitation, and antipsychotic medications in care home residents with dementia.
  
  
  METHODS
  This is a single-blind cluster randomized controlled trial in 24 care homes within the Western Norway Regional Health Authority 2011-2013.
  
  
  RESULTS
  From 24 care homes, 274 residents were included in the study, with 118 in the intervention group and 156 in the control group. Use of restraint was significantly reduced in both the intervention group and the control group despite unexpected low baseline, with a tendency to a greater reduction in the control group. There was a significant reduction in Cohen-Mansfield Agitation Inventory score in both the intervention group and the follow-up group with a slightly higher reduction in the control group, although this did not reach significance and a small nonsignificant increase in use of antipsychotics (14.1-17.7%) and antidepressants (35.9-38.4%) in both groups.
  
  
  CONCLUSIONS
  This study reports on the statistically significant reduction in use of restraint in care homes, both prior and during the 7-month intervention periods, in both intervention and control groups. When interpreted within the context of the current climate of educational initiatives to reduce restraint and a greater focus on the importance of person-centered care, the study also highlights the potential success achieved with national training programs for care staff and should be further evaluated to inform future training initiatives both in Norway and internationally.
authors.affiliation: Centre for Age-Related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norway.|Department of Health Studies, Stavanger University, Stavanger, Norway.
authors.forename: Ingelin
authors.initials: I
authors.lastname: Testad
authors.affiliation: Centre for Care Research-Western Norway, Bergen University College, Norway.
authors.forename: Tone Elin
authors.initials: TE
authors.lastname: Mekki
authors.affiliation: Centre for Care Research-Western Norway, Bergen University College, Norway.|Haraldsplass Deaconess University College, Bergen, Norway.
authors.forename: Oddvar
authors.initials: O
authors.lastname: Førland
authors.affiliation: Centre for Care Research-Western Norway, Bergen University College, Norway.|Stord/Haugesund University College, Norway.
authors.forename: Christine
authors.initials: C
authors.lastname: Øye
authors.affiliation: Centre for Care Research-Western Norway, Bergen University College, Norway.
authors.forename: Eva Marie
authors.initials: EM
authors.lastname: Tveit
authors.affiliation: Centre for Care Research-Western Norway, Bergen University College, Norway.|Betanien University College, Bergen, Norway.
authors.forename: Frode
authors.initials: F
authors.lastname: Jacobsen
authors.affiliation: Norwegian Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Norway.|Centre of Old Age Psychiatry Research, Innlandet Hospital Trust, Norway.|Gjøvik University College, Faculty of Health, Care and Nursing, Norway.
authors.forename: Øyvind
authors.initials: Ø
authors.lastname: Kirkevold
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000928:Antidepressive Agents / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000627:therapeutic use; D003704:Dementia / Q000451:nursing* / Q000628:therapy; D004509:Education, Nursing, Continuing / Q000379:methods / Q000592:standards; D005260:Female; D006707:Homes for the Aged / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D009664:Norway; D009735:Nursing Homes / Q000706:statistics & numerical data*; D011595:Psychomotor Agitation / Q000517:prevention & control; D012149:Restraint, Physical / Q000706:statistics & numerical data; D016037:Single-Blind Method
chemical_list: D000928:Antidepressive Agents; D014150:Antipsychotic Agents
keywords: agitation; antipsychotic medications; care home; dementia; educational intervention; restraint