Person-Centered Care Decreases Agitation: Promoting Choice, Self-Determination Helps Dementia Patients without Resorting to Drugs

Article excerpt

Holistic, person-centered care can reduce symptoms of agitation in dementia patients, compared with the effects of standard long-term care, a randomized controlled trial by Australian researchers indicates.

Focusing on the patient as a whole and seeking to make the most of his or her remaining abilities is also economical and easy to implement, the researchers recently reported (Lancet Neurol. 2009;8:317-25).

"Care that addresses residents' total human needs can mitigate cognitive and functional deterioration," asserted the team led by Lynn Chenoweth, Ph.D., of the University of New South Wales, Sydney.

The Caring for Aged Dementia Care Residents Study (CADRES) was composed of 289 residents living in 15 Australian long-term care facilities. All of the residents had progressive dementia with persistent behaviors that made it difficult for staff to care for them.

The facilities were randomized to three interventions: usual care, person-centered care, and dementia-care mapping, which includes person-centered care.

The researchers provided staff training in the facilities randomized to one of the experimental plans. The person-centered care training consisted of a 2-day session for two staff members of each facility, who then developed and implemented practices in their respective facilities. Training stressed that behavior is a form of communication and that feelings persist in individuals despite cognitive decline.

Trainees were encouraged to focus on "the unique way those residents express feelings and needs" and how staff actions could address individuals' preferences and needs.

Dementia-mapping care training also consisted of a 2-day session for two staff members per facility, and they, too, then helped their colleagues implement the approach.

This system of care entails observation of which care factors most affect resident behavior, either negatively or positively. Daily observations are then integrated into a person-centered care plan.

Care continued as usual at the control sites, characterized by custodial tasks, physical restraint, and "a tendency to neglect residents' psychosocial needs when meeting activities of daily living," according to the researchers. Staff at these facilities paid little attention to promoting choice and encouraging self-determination by residents with dementia, according to Dr. Chenoweth and her colleagues.

Outcome measures included the 29-item Cohen-Mansfield Agitation Inventory (CMAI), the Neuropsychiatry Inventory for the Nursing Home, and the Quality of Life in Late-Stage Dementia (QUALID) scale. Outcomes were measured at baseline, after 4 months of intervention that included telephone support by the researchers, and again 4 months after that (8 months after the start of the study).

The patients' average age at baseline was 84 years. …