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Social interaction, staff training reduce agitation in dementia patients

[February 23, 2018] By Mary Gillis

(Reuters Health) - An approach to nursing home care that fosters interest and social interaction among patients and staff may reduce agitation and other neuropsychiatric symptoms in dementia sufferers and improve their quality of life, a recent trial suggests.

“Agitation is a syndrome defined by a cluster of things including verbal and physical aggression, restlessness as well as shouting associated with distress and anxiety,” said lead author Clive Ballard. “It profoundly affects people with dementia and their quality of living.”

Delusions and hallucinations, euphoria and disinhibition, aberrant behavior as well as night-time disturbances and eating abnormalities are just a few indications of neuropsychosis, he told Reuters Health.

In the UK, about one third of people with dementia live in nursing homes, and in the U.S., close to two thirds of people in nursing homes who are covered by Medicare have dementia, Ballard’s team writes in PLoS Medicine. Despite an established link between quality of life and neuropsychiatric symptoms, as well as risk of falls and mortality, few trials have looked at quality of life interventions, they note.

To test an approach that emphasizes so-called person-centered care for dementia patients and special training for nursing home staff, Ballard’s team recruited 69 nursing homes in the UK and randomly assigned roughly half to implement a program the researchers devised.

In facilities implementing the program, staff received training in techniques for facilitating social interaction and education in the effects and risks of antipsychotic medications. In the other facilities, patients continued to receive their usual care.

Of 847 patients in the initial study group, 533 completed the study and were evaluated over a nine-month period - once before the intervention and then again at its conclusion.

“A key element of this research is that we worked alongside caregivers for nine months to embed these learned elements into everyday practice,” said Ballard, a professor, pro-vice chancellor and executive dean at University of Exeter Medical School. “This was essential because just a one-off training seminar or a training book - without this mentoring - would not have resulted in a successful intervention,” he said by email.

A “person-centered” approach incorporates the individual patients’ wants and needs as a way to facilitate healing and, at times, these wants and needs are prioritized over and above healthcare professional goals, Ballard said.

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The staff training included an educational process designed to help clinicians understand patients’ interests and hobbies, then use that knowledge to develop a personalized care plan.

“It also has the advantage of building stronger relationships between dementia patients and care staff,” Ballard said.

Training also covered risks associated with antipsychotic medication used to treat agitation. These kinds of medications, including Abilify, Seroquel and Risperdal, can increase the risk of falls and fractures, chest infections, pneumonia and an acceleration in cognitive decline. There’s also evidence that if dementia patients become over-reliant on antipsychotic meds, their risk of stroke and of death rises, the researchers note.

This fact alone warrants studying non-pharmacological approaches, they write.

Patients who received the intervention showed statistically meaningful decreases in agitation and neuropsychiatric symptoms and increased quality of life after nine months compared to the usual-care group. But there were no differences in use of antipsychotic medications, although use was quite low to start, at less than 10 percent.

“Changes in brain chemistry and structure are part of the disease,” Ballard said. “There’s a reduced ability to understand and deal with challenging situations and the physical environment in care homes can make people feel isolated, frustrated, bored.”

These circumstances all add to the heightened sensitivity of agitation, neuropsychiatric disturbances and lower quality of life among dementia patients living under care.

But these results show that when people are engaged and socially stimulated, the outcome can be completely different, he added.

SOURCE: http://bit.ly/2E92LvZ PLoS Medicine, online February 6, 2018.

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