Challenging behaviours in nursing home residents with dementia: a randomized controlled trial of multidisciplinary interventions

Objectives To test the premise that individually tailored psychosocial, nursing and medical interventions to nursing home residents with dementia will reduce the frequency and severity of behavioural symptoms. Methods A four-member team comprising a psychiatrist, psychologist and nurses conducted detailed assessments of 99 nursing home residents with advanced dementia who were rated by staff as having frequent, severe behavioural disturbances. Residents were then randomly assigned to an 'early' or 'late' intervention group and observed for four weeks. Interventions encompassed psychosocial strategies, nursing approaches, psychotropic medications and management of pain. Outcome measures included the frequency and severity of disruptive behaviours and assessments of change by senior nursing home staff. Results While improvements in behaviour were noted in both groups from the outset of observations, pointing to a powerful Hawthorne effect, consultancies were associated with a modest but statistically significant decrease in challenging behaviours. Staff assessments of the interventions were highly favourable. Conclusions The consultancies were effective and well received by staff. The change-inducing nature of any new endeavour is an integral part of research in a long-term setting. Copyright (C) 2002 John Wiley Sons, Ltd.