Effect of enhanced psychosocial care on antipsychotic use in nursing home residents with severe dementia: cluster randomised trial.
Fossey J., Ballard C., Juszczak E., James I., Alder N., Jacoby R., Howard R.
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. DESIGN: Cluster randomised controlled trial with blinded assessment of outcome. SETTING: 12 specialist nursing homes for people with dementia in London, Newcastle, and Oxford. PARTICIPANTS: Residents of the 12 nursing homes; numbers varied during the study period. INTERVENTION: 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. MAIN OUTCOME MEASURES: 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.