title: Care-Delivery Interventions to Manage Agitation and Aggression in Dementia Nursing Home and Assisted Living Residents: A Systematic Review and Meta-analysis.
abstract: OBJECTIVE
  To evaluate the efficacy of nonpharmacological care-delivery interventions (staff training, care-delivery models, changes to the environment) to reduce and manage agitation and aggression in nursing home and assisted living residents.
  
  
  METHODS
  Three bibliographic databases, references of systematic reviews, ClincalTrials.gov, and the International Controlled Trials Registry Platform were systematically searched for randomized controlled trials reporting behavioral outcomes for nonpharmacological care-delivery interventions in nursing homes and assisted living facilities. Five investigators independently assessed study eligibility, extracted data, rated risk of bias, and graded strength of evidence. Inclusion was limited to studies with low to moderate risk of bias.
  
  
  METHODS
  Nursing homes and assisted living facilities.
  
  
  METHODS
  Facility caregiving staff.
  
  
  METHODS
  Agitation, aggression, antipsychotic and other psychotropic use, general behavior.
  
  
  RESULTS
  Nineteen unique studies met entry criteria, addressing several categories of facility caregiver training interventions: dementia care mapping (DCM; n = 3), person-centered care (PCC; n = 3), clinical protocols to reduce the use of antipsychotic and other psychotropic drugs (n = 3), and emotion-oriented care (n = 2). Eleven additional studies evaluated other unique interventions. Results were pooled for the effect of each type of intervention on agitation and aggression: DCM (standardized mean difference -0.12, 95% confidence interval (CI) = -0.66 to 0.42), PCC (standardized mean difference -0.15, 95% CI = -0.67 to 0.38), and protocols to reduce antipsychotic and other psychotropic use (Cohen-Mansfield Agitation Inventory mean difference -4.5, 95% C = -38.84 to 29.93). Strength of evidence was generally insufficient to draw conclusions regarding efficacy or comparative effectiveness.
  
  
  CONCLUSIONS
  Evidence was insufficient regarding the efficacy of nonpharmacological care-delivery interventions to reduce agitation or aggression in nursing home and assisted living facility residents with dementia.
authors.affiliation: Division of Health Policy and Management, University of Minnesota, Minneapolis, Minnesota.|Minnesota Evidence-based Practice Center, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Eric
authors.initials: E
authors.lastname: Jutkowitz
authors.affiliation: Division of Health Policy and Management, University of Minnesota, Minneapolis, Minnesota.|Minnesota Evidence-based Practice Center, University of Minnesota, Minneapolis, Minnesota.|Geriatric Research, Education and Clinical Center, Veterans Affairs Health Care System, Minneapolis, Minnesota.
authors.forename: Michelle
authors.initials: M
authors.lastname: Brasure
authors.affiliation: Division of Health Policy and Management, University of Minnesota, Minneapolis, Minnesota.|Minnesota Evidence-based Practice Center, University of Minnesota, Minneapolis, Minnesota.|Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Erika
authors.identifier: http://orcid.org/0000-0002-5243-8464
authors.initials: E
authors.lastname: Fuchs
authors.affiliation: Division of Health Policy and Management, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Tetyana
authors.initials: T
authors.lastname: Shippee
authors.affiliation: Division of Health Policy and Management, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Rosalie A
authors.initials: RA
authors.lastname: Kane
authors.affiliation: Minnesota Evidence-based Practice Center, University of Minnesota, Minneapolis, Minnesota.|Geriatric Research, Education and Clinical Center, Veterans Affairs Health Care System, Minneapolis, Minnesota.
authors.forename: Howard A
authors.initials: HA
authors.lastname: Fink
authors.affiliation: Division of Health Policy and Management, University of Minnesota, Minneapolis, Minnesota.|Minnesota Evidence-based Practice Center, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Mary
authors.initials: M
authors.lastname: Butler
authors.affiliation: Division of Health Policy and Management, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Tonye
authors.initials: T
authors.lastname: Sylvanus
authors.affiliation: Division of Health Policy and Management, University of Minnesota, Minneapolis, Minnesota.|Minnesota Evidence-based Practice Center, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Kane
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000374:Aggression / Q000523:psychology*; D040561:Assisted Living Facilities; D003695:Delivery of Health Care / Q000379:methods; D003704:Dementia / Q000150:complications / Q000451:nursing*; D019468:Disease Management; D017050:Episode of Care; D005260:Female; D006707:Homes for the Aged; D006801:Humans; D008297:Male; D009735:Nursing Homes; D009740:Nursing Staff / Q000193:education; D011595:Psychomotor Agitation / Q000451:nursing* / Q000523:psychology; D016032:Randomized Controlled Trials as Topic
keywords: behavioral symptoms; dementia; nonpharmacological; nursing homes; psychosocial interventions