Nonpharmacological treatment of agitation: A controlled trial of systematic individualized intervention
Nonpharmacological treatment of agitation: A controlled trial of systematic individualized intervention
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DOI：
10.1093/gerona/62.8.908
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发表时间：
2007-08-01
影响因子：
5.1
通讯作者：
Marx, Marcia S.
中科院分区：
文献类型：
--
作者：
Cohen-Mansfield, Jiska;Libin, Alexander;Marx, Marcia S.
Objective.本研究的目的是检查一个系统的算法提供个性化的，非药物干预，以减少老年痴呆症的养老院居民激动行为的有效性。这项安慰剂对照研究结合了规则和表意方法。该研究在马里兰州的12个养老院建筑中进行; 6个用作治疗设施，6个用作对照设施。参与者是167名老年疗养院痴呆症患者。干预措施是针对激动参与者的个人资料，使用系统的算法，考虑类型的激动和未满足的需求。然后设计干预措施，以满足人们的认知，身体和感官能力，以及他们的终身习惯和角色的需要。在最大搅拌的4小时期间提供干预10天。由经过培训的研究助理通过激越行为绘图仪（ABMI）记录激越的直接观察结果。积极和消极影响的评价也是基于直接观察和通过劳顿的修改行为流评估。采用SPSS软件进行数据分析。与对照组相比，实施个性化、非药物干预后，干预组的总体激越程度从基线至治疗期间出现统计学显著性降低（F-1，F-164 = 10.22，p = .002）。此外，实施针对激越的个性化干预导致快乐和兴趣的统计学显著增加（F-1，F-164 = 24.22，p <0.001; F-1，F-164 = 20.66，p <0.001）。研究结果支持使用个性化的非药物干预措施来治疗痴呆症患者的躁动，并强调了临床医生寻找躁动行为潜在原因的重要性。
Objective. The objective of this study was to examine the efficacy of a systematic algorithm for providing individualized, nonpharmacological interventions for reducing agitated behaviors in nursing home residents with dementia.Methods. This placebo-controlled study combined nomothetic and ideographic methodologies. The study was conducted in 12 nursing home buildings in Maryland; 6 were used as treatment facilities, and 6 as control facilities. Participants were 167 elderly nursing home residents with dementia. Interventions were tailored to the individual profiles of agitated participants using a systematic algorithm that considered type of agitation and unmet needs. Interventions were then designed to fulfill the need in a manner that matched the person's cognitive, physical, and sensory abilities, and their lifelong habits and roles. Interventions were provided for 10 days during the 4 hours of greatest agitation. Direct observations of agitation were recorded by trained research assistants via the Agitated Behavior Mapping Instrument (ABMI). Evaluation of positive and negative affect was also based on direct observation and assessed via Lawton's Modified Behavior Stream. Data analysis was performed via SPSS software.Results. The implementation of personalized, nonpharmacological interventions resulted in statistically significant decreases in overall agitation in the intervention group relative to the control group from baseline to treatment (F-1,F-164 = 10.22, p = .002). In addition, implementation of individualized interventions for agitation resulted in statistically significant increases in pleasure and interest (F-1,F-164 = 24.22, p < .001; F-1,F-164 = 20.66, p < .001).Conclusions. The findings support the use of individualized nonpharmacological interventions to treat agitation in persons with dementia and underscore the importance for clinicians of searching for underlying reasons for agitated behaviors.