Effect of enhanced psychosocial care on antipsychotic use in nursing home residents with severe dementia: cluster randomised trial

Abstract

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.

Figures

Fig 1

Flow of nursing homes and residents through trial

Fig 2

Neuroleptic use at baseline and 12 months in homes allocated to training and support intervention or to treatment as usual (size of circle proportional to size of cluster). As control homes have almost identical proportions of residents taking neuroleptics at 12 months, points overlap and appear to be only five

Fig 3

Percentage of residents prescribed neuroleptics in each home (size of circle proportional to size of home). Diagonal line represents no change in percentage of residents taking neuroleptics from baseline to 12 months. Homes above line experienced increase in percentage of residents taking neuroleptics and homes below line experienced decrease. Homes near line show little change

Fig 4

Neuroleptic use over study period, July 2003 to June 2004