Managing behavioural problems in nursing home residents with dementia

• Netherlands

Netherlands Organisation for Health Research and Development (ZonMw)

368173

1-3-2010

48

• Alzheimer’s disease and other dementias

Dementia; Behavioral problems; Antipsychotics; Neuroleptics; Nursing Homes; Costs-and-Cost-Analysis; Therapeutics; Quality-of-Life

Objective: to quantify cost-effectiveness of a multidisciplinary, guideline based, care program ‘managing behavior problems (BPs) in nursing home (NH) residents with dementia’. Study design: a longitudinal controlled study on 14 dementia special care units that, in a stepped wedge design, all will implement the program. Study population: all patients on participating units. Intervention: evidence based standardization of the management of BP in NH residents with dementia, including standardized use of measurement instruments, a standardized method of analysis, and individually tailored psychosocial, psychological and pharmacological treatment according to protocol. Primary outcomes: prevalence of behavioral problems (CMAI); quality of life (EQ-5D). Sample size calculation/data analysis. Sample size: 6 measurements on 14 dementia special care units (each with 20 residents on average) are needed (assumptions: BP prevalence 80%, effect 10 points decrease CMAI-score, almost no attrition, alpha 0.05, power 0.80, ICC 0.1). Data analysis: primary effects will be calculated using multilevel linear and logistic regression analyses. Prescription rate of antipsychotics and the EQ5D will be used in the primary analysis. Secondary analyses will include: prescription rate of antipsychotics; workload (burnout) and job satisfaction of nursing staff; use of restraints. Economic evaluation: from a healthcare perspective, two ICERs will be calculated for costs per: 1 one point decrease in CMAI-score; 2) one QALY increase. Time schedule: 48 months (21 months data collection).

• Health and social care research