Care-Delivery Interventions to Manage Agitation and Aggression in Dementia Nursing Home and Assisted Living Residents: A Systematic Review and Meta-analysis

Eric Jutkowitz, Michelle Brasure, Erika Fuchs, Tetyana Shippee, Rosalie A. Kane, Howard A. Fink, Mary Butler, Tonye Sylvanus, Robert L. Kane

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

Objectives To evaluate the efficacy of nonpharmacological care-delivery interventions (staff training, care-delivery models, changes to the environment) to reduce and manage agitation and aggression in nursing home and assisted living residents. Design Three bibliographic databases, references of systematic reviews, ClincalTrials.gov, and the International Controlled Trials Registry Platform were systematically searched for randomized controlled trials reporting behavioral outcomes for nonpharmacological care-delivery interventions in nursing homes and assisted living facilities. Five investigators independently assessed study eligibility, extracted data, rated risk of bias, and graded strength of evidence. Inclusion was limited to studies with low to moderate risk of bias. Setting Nursing homes and assisted living facilities. Participants Facility caregiving staff. Measurements Agitation, aggression, antipsychotic and other psychotropic use, general behavior. Results Nineteen unique studies met entry criteria, addressing several categories of facility caregiver training interventions: dementia care mapping (DCM; n = 3), person-centered care (PCC; n = 3), clinical protocols to reduce the use of antipsychotic and other psychotropic drugs (n = 3), and emotion-oriented care (n = 2). Eleven additional studies evaluated other unique interventions. Results were pooled for the effect of each type of intervention on agitation and aggression: DCM (standardized mean difference -0.12, 95% confidence interval (CI) = -0.66 to 0.42), PCC (standardized mean difference -0.15, 95% CI = -0.67 to 0.38), and protocols to reduce antipsychotic and other psychotropic use (Cohen-Mansfield Agitation Inventory mean difference -4.5, 95% C = -38.84 to 29.93). Strength of evidence was generally insufficient to draw conclusions regarding efficacy or comparative effectiveness. Conclusion Evidence was insufficient regarding the efficacy of nonpharmacological care-delivery interventions to reduce agitation or aggression in nursing home and assisted living facility residents with dementia.

Original languageEnglish (US)
Pages (from-to)477-488
Number of pages12
JournalJournal of the American Geriatrics Society
Volume64
Issue number3
DOIs
StatePublished - Mar 1 2016
Externally publishedYes

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Assisted Living Facilities
Nursing Homes
Aggression
Dementia
Meta-Analysis
Antipsychotic Agents
Bibliographic Databases
Confidence Intervals
Psychotropic Drugs
Clinical Protocols
Caregivers
Registries
Emotions
Randomized Controlled Trials
Research Personnel
Equipment and Supplies

Keywords

  • behavioral symptoms
  • dementia
  • nonpharmacological
  • nursing homes
  • psychosocial interventions

ASJC Scopus subject areas

  • Geriatrics and Gerontology

Cite this

Care-Delivery Interventions to Manage Agitation and Aggression in Dementia Nursing Home and Assisted Living Residents : A Systematic Review and Meta-analysis. / Jutkowitz, Eric; Brasure, Michelle; Fuchs, Erika; Shippee, Tetyana; Kane, Rosalie A.; Fink, Howard A.; Butler, Mary; Sylvanus, Tonye; Kane, Robert L.

In: Journal of the American Geriatrics Society, Vol. 64, No. 3, 01.03.2016, p. 477-488.

Research output: Contribution to journalArticle

Jutkowitz, Eric ; Brasure, Michelle ; Fuchs, Erika ; Shippee, Tetyana ; Kane, Rosalie A. ; Fink, Howard A. ; Butler, Mary ; Sylvanus, Tonye ; Kane, Robert L. / Care-Delivery Interventions to Manage Agitation and Aggression in Dementia Nursing Home and Assisted Living Residents : A Systematic Review and Meta-analysis. In: Journal of the American Geriatrics Society. 2016 ; Vol. 64, No. 3. pp. 477-488.
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abstract = "Objectives To evaluate the efficacy of nonpharmacological care-delivery interventions (staff training, care-delivery models, changes to the environment) to reduce and manage agitation and aggression in nursing home and assisted living residents. Design Three bibliographic databases, references of systematic reviews, ClincalTrials.gov, and the International Controlled Trials Registry Platform were systematically searched for randomized controlled trials reporting behavioral outcomes for nonpharmacological care-delivery interventions in nursing homes and assisted living facilities. Five investigators independently assessed study eligibility, extracted data, rated risk of bias, and graded strength of evidence. Inclusion was limited to studies with low to moderate risk of bias. Setting Nursing homes and assisted living facilities. Participants Facility caregiving staff. Measurements Agitation, aggression, antipsychotic and other psychotropic use, general behavior. Results Nineteen unique studies met entry criteria, addressing several categories of facility caregiver training interventions: dementia care mapping (DCM; n = 3), person-centered care (PCC; n = 3), clinical protocols to reduce the use of antipsychotic and other psychotropic drugs (n = 3), and emotion-oriented care (n = 2). Eleven additional studies evaluated other unique interventions. Results were pooled for the effect of each type of intervention on agitation and aggression: DCM (standardized mean difference -0.12, 95{\%} confidence interval (CI) = -0.66 to 0.42), PCC (standardized mean difference -0.15, 95{\%} CI = -0.67 to 0.38), and protocols to reduce antipsychotic and other psychotropic use (Cohen-Mansfield Agitation Inventory mean difference -4.5, 95{\%} C = -38.84 to 29.93). Strength of evidence was generally insufficient to draw conclusions regarding efficacy or comparative effectiveness. Conclusion Evidence was insufficient regarding the efficacy of nonpharmacological care-delivery interventions to reduce agitation or aggression in nursing home and assisted living facility residents with dementia.",
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AU - Fuchs, Erika

AU - Shippee, Tetyana

AU - Kane, Rosalie A.

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