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Multidisciplinary Intervention for Challenging Behaviour (Agitation) in Patients With Dementia (TID)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT01183351
Recruitment Status : Completed
First Posted : August 17, 2010
Last Update Posted : December 12, 2014
Norwegian Medical Association
Information provided by (Responsible Party):
Sykehuset Innlandet HF

Brief Summary:
The increasing prevalence of dementia is a major challenge to the health authorities in most countries. Nearly all the persons suffering from dementia experience behavioural and psychological symptoms (BPSD). The prevalence of BPSD is particularly high in nursing homes. BPSD are often treated with psychotropic drugs even though the evidence for effect is minimal and the risk of serious adverse events is considerable. All the major treatment recommendations advise that non-pharmacological measures should be applied first when treating BPSD even though the evidence for such treatment is limited. The investigators will conduct a pilot study of a non-pharmacological treatment for BPSD. The method has been developed in Norway and has already been implemented in a number of nursing homes in the county of Nordland.

Condition or disease Intervention/treatment Phase
Dementia Behavioral: Psychosocial intervention Not Applicable

Detailed Description:

Intervention description:

Initially the intervention group will receive education about dementia, BPSD, quality of care and use of psychotropic drugs Subsequently, staff in the nursing home will receive training in the intervention method: MID. Two or three nurses from each nursing home will receive more intensive training in the method to ensure effective implementation of the method in daily practice. After this initial period that will last for four weeks, trained research nurses will visit each nursing home every fortnight ensuring that the intervention is properly implemented and thereby assure adherence to the treatment protocol.

Description of the intervention Multidisciplinary Intervention model for challenging behaviour in Dementia, MID, consists of three stages: a registration-observation stage, a staff guiding stage, and an evaluation stage.

  1. Registration-observation stage:

    The nurses use a daily registration sheet for the actual types of behaviour that are challenging. This ensures that the behaviour is properly observed on a daily basis.

    The next step in the registration-observation stage is:

    • Collection of the medical history by the nursing home nurses
    • Standard physical examination by the nursing home physician
    • Critical review of medication by the nursing home physician
    • Pain assessment (clinical), by the nursing home physician
    • Assessment of the type and degree of dementia by the nursing home physician
    • Assembly of the patients personal history by the nursing homes nurses After completion of the registration-observation stage (lasting 1 day up to 4 weeks) the staff guiding stage starts.
  2. Staff guiding stage - guiding meeting The trained nurses from the nursing home set a meeting for 1-1,5 hours for the nursing home health workers. The meeting is lead by the nursing home nurses and the nursing home physician.

    The meeting follows a structured agenda and is conducted following the principles of problem solving in cognitive behavioural therapy taking into account one type of challenging behaviour at a time. Results from the registration-observation stage are presented at the beginning of the meeting. (A 5-column sheet, based on classical cognitive change thoughts records, is used to structure problem solving during the meeting: 1.facts, 2.interpretations (thoughts), 3.feelings, 4. solutions/actions and 5. evaluation)

  3. Evaluation stage This stage starts just after the guiding meeting and is conducted by the nursing home nurses. The nurses continue the same registration of the behaviour on a daily basis as in the registration-observation stage for the next 4 weeks.

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 30 participants
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Pilot Study of a Multidisciplinary Intervention for Challenging Behaviour (Agitation) in Patients With Dementia
Study Start Date : May 2011
Actual Primary Completion Date : August 2011
Actual Study Completion Date : August 2012

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Dementia

Arm Intervention/treatment
Experimental: Psychosocial intervention
This is a single-group pilot-study
Behavioral: Psychosocial intervention
Multidisciplinary Intervention for challenging behavior in patients with Dementia (MID) is developed in clinical practice in nursing homes as an answer to the need of a systematic and simple tool for the nursing home health workers to meet agitation. The model is based on the theoretical framework of cognitive behavioural therapy (CBT) where human behaviour is understood as always acting under the influence of biological, social and psychological factors. The systematic and structured approach of CBT to problem solving is central and is transformed in the model to meet the specific characteristics of challenging behaviour in dementia.
Other Names:
  • Multidisclinary Intervention in Dementia patients
  • Psychosocial intervention for challenging behavior

Primary Outcome Measures :
  1. Agitation measured by the C-MAI (The Cohen-Mansfield Agitation Inventory) [ Time Frame: 8 months ]

Secondary Outcome Measures :
  1. The Cornell scale for depression in dementia (CSDD) [ Time Frame: 8 months ]
  2. Neuropsychiatric Inventory (NPI ) which measures neuropsychiatric symptoms and behaviour [ Time Frame: 8 months ]
  3. Lawton's self-maintenance scale (Lawton and Brody 1969), which measures function in activities of daily living (ADL) [ Time Frame: 8 months ]
  4. Quality of life in Alzheimers's Disease (QUALID) (Weiner et al. 2000), which measures quality of life [ Time Frame: 8 months ]
  5. Staff measures: Psychosocial factors in work life will be measured by a scale developed by Sund (1992). [ Time Frame: 8 months ]
  6. Use of antipsychotic drugs [ Time Frame: 8 months ]
  7. Staff measures:P-cat:Person-centered Care Assessment Tool [ Time Frame: 8 months ]
    Measure of the degree of person-centered dementia care in the unit

Information from the National Library of Medicine

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Ages Eligible for Study:   Child, Adult, Older Adult
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Patients are eligible for inclusion if they have a possible or probable dementia diagnosis and clinically significant agitation score 6 or higher (as measured by the CMAI: Cohen-Mansfield Agitation Behaviour
  • A permanent stay in nursing home of at least 4 weeks
  • Given verbal or written assent for participation or has written consent given on their behalf by their next of kin

Exclusion Criteria:

  • Lack of consent, terminal state,unremitting pain.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT01183351

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Department for Research and Development, Innlandet Hospital Trust
Hamar, Norway, 2312
Sponsors and Collaborators
Sykehuset Innlandet HF
Norwegian Medical Association
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Study Chair: Geir Selbaek, MD PhD Sykehuset Innlandet HF

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Responsible Party: Sykehuset Innlandet HF Identifier: NCT01183351     History of Changes
Other Study ID Numbers: MID
First Posted: August 17, 2010    Key Record Dates
Last Update Posted: December 12, 2014
Last Verified: May 2011
Keywords provided by Sykehuset Innlandet HF:
Challenging behaviour
Behavioural and psychological symptoms in dementia (BPSD)
Additional relevant MeSH terms:
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Psychomotor Agitation
Brain Diseases
Central Nervous System Diseases
Nervous System Diseases
Neurocognitive Disorders
Mental Disorders
Neurologic Manifestations
Psychomotor Disorders
Neurobehavioral Manifestations
Signs and Symptoms