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Targeted Interdisciplinary Model for Evaluation and Treatment of Neuropsychiatric Symptoms: A Cluster Randomized Controlled Trial

      Highlights

      • Agitation in dementia is common, and causes profound suffering for patients and caregivers. Because psychotropic drugs are associated with serious side-effects, non-pharmacological interventions are recommended as a first-line approach.
      • There is conflicting evidence about the effectiveness of non-pharmacological interventions for agitation in patients with dementia. Trials of multicomponent interventions are requested.
      • A multicomponent biopsychosocial approach (TIME) significantly reduced agitation in patients with dementia living in nursing homes.
      • Since agitation in dementia often represent complex problems with multifactorial causes, multicomponent interventions with a comprehensive biopsychosocial approach should be applied.

      Objective

      To determine the effectiveness of the Targeted Interdisciplinary Model for Evaluation and Treatment of Neuropsychiatric Symptoms (TIME) for treatment of moderate to severe agitation in people with dementia.

      Methods

      In a single-blinded, cluster randomized controlled trial in 33 nursing homes (clusters) from 20 municipalities in Norway, 229 patients (104 patients in 17 nursing homes and 125 patients in 16 nursing homes) were randomized to an intervention or control group, respectively. The intervention group received TIME, and the control group received a brief education-only intervention. TIME is an interdisciplinary multicomponent intervention and consists of a comprehensive assessment of the patient with the goal to create and put into action a tailored treatment plan. The primary outcome was the between-group difference in change at the agitation/aggression item of the Neuropsychiatric Inventory Nursing Home version between baseline and 8 weeks. Secondary outcomes were the between-group difference in change at the agitation/aggression between baseline and 12 weeks in other neuropsychiatric symptoms, quality of life, and use of psychotropic and analgesic medications between baseline and 8 and 12 weeks.

      Results

      A significant between-group difference in reduction of agitation at both 8 weeks (1.1; 95% confidence interval: 0.1–2.1; p = 0.03) and 12 weeks (1.6; 95% confidence interval: 0.6–2.7; p = 0.002) in favor of the TIME intervention was found.

      Conclusion

      The implementation of TIME resulted in a significant reduction of agitation among nursing homes patients with dementia. These results should inform training programs for care staff in Norway and internationally.

      Key Words

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      Linked Article

      • TIME in the Context of Emerging Evidence Regarding Training Interventions for Dementia in Nursing Homes
        The American Journal of Geriatric PsychiatryVol. 26Issue 1
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          More than 90% of people with dementia will develop at least one clinically significant neuropsychiatric symptom over the course of their dementia.1 Agitation and aggression are probably the most important of these symptoms. Cross-sectionally, they occur in more than 20% of individuals with dementia living in the community and more than half of people with dementia living in nursing homes.2 Agitation accelerates institutionalization, results in distress for individuals and their caregivers, leads to social isolation, and often triggers treatment with antipsychotics and/or other psychotropic medications.
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