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Cited by 257Dementia and Cognitive Impairment ResearchNursing care and researchPalliative Care and End-of-Life Issues

Targeting and managing behavioral symptoms in individuals with dementia: a randomized trial of a nonpharmacological intervention

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Gitlin, Laura N., Winter, Laraine, Dennis, Marie P., Hodgson, Nancy, Hauck, Walter W.·2010·Journal of the American Geriatrics Society
DOI 10.1111/j.1532-5415.2010.02971.xPMC PMC2955191
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Abstract

OBJECTIVES: To test the effects of an intervention that helps families manage distressing behaviors in family members with dementia. DESIGN: Two-group randomized trial. SETTING: In home. PARTICIPANTS: Two hundred seventy-two caregivers and people with dementia. INTERVENTION: Up to 11 home and telephone contacts over 16 weeks by health professionals who identified potential triggers of patient behaviors, including communication and environmental factors and patient undiagnosed medical conditions (by obtaining blood and urine samples) and trained caregivers in strategies to modify triggers and reduce their upset. Between 16 and 24 weeks, three telephone contacts reinforced strategy use. MEASUREMENTS: Primary outcomes were frequency of targeted problem behavior and caregiver upset with and confidence managing it at 16 weeks. Secondary outcomes were caregiver well-being and management skills at 16 and 24 weeks and caregiver perceived benefits. Prevalence of medical conditions for intervention patients were also examined. RESULTS: At 16 weeks, 67.5% of intervention caregivers reported improvement in targeted problem behavior, compared with 45.8% of caregivers in a no-treatment control group (P=.002), and reduced upset with (P=.03) and enhanced confidence managing (P=.01) the behavior. Additionally, intervention caregivers reported less upset with all problem behaviors (P=.001), less negative communication (P=.02), less burden (P=.05), and better well-being (P=.001) than controls. Fewer intervention caregivers had depressive symptoms (53.0%) than control group caregivers (67.8%, P=.02). Similar caregiver outcomes occurred at 24 weeks. Intervention caregivers perceived more study benefits (P<.05), including ability to keep family members home, than controls. Blood and urine samples of intervention patients with dementia showed that 40 (34.1%) had undiagnosed illnesses requiring physician follow-up. CONCLUSION: Targeting behaviors upsetting to caregivers and modifying potential triggers improves symptomatology in people with dementia and caregiver well-being and skills.

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  • Current evidence suggests that non-pharmacologic strategies, such as family care giver interventions, show greater effect than most drug treatments.

    “With regard to management, current evidence suggests that non-pharmacologic strategies, such as family care giver interventions, show greater effect than most drug treatments.”

    From Assessment and management of behavioral and psychological symptoms of dementia (2015) · cites this paper as [36]

    The Discussion reports that the caregiver-focused ACT intervention had small-to-moderate effects, comparing favorably with pharmacologic interventions, most of which report small-to-no effects. But the Introduction says it remains unclear which nonpharmacologic approaches are effective. This trial supports a favorable comparison for ACT, not the broader claim that nonpharmacologic strategies generally have greater effects than most drug treatments. (LLM, conf=0.84)

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  • Dementia-specific adapted home environment and related assistive devices may be helpful for both the patient and the caregiver.

    “Dementia-specific adapted home environment and related assistive devices may be helpful for both the patient and the caregiver (300–302).”

    From The Multidisciplinary Approach to Alzheimer’s Disease and Dementia. A Narrative Review of Non-Pharmacological Treatment (2018) · cites this paper as [302]

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Research works printed but not linked: 2

  1. [13]American Psychiatric Association Work Group on Alzheimer's disease and other dementias American Psychiatric Association practice guideline for the treatment of patients with Alzheimer's disease and other dementias Am J Psychiatry 2007 164 Suppl. 12 5 56 Second edition 18340692
  2. [33]Little JT Molchan SE Cantillon M Lawlor BA Measurement of behavioral changes 1995 103 127 American Psychiatric Press, Inc Washington, DC

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Authors
Gitlin, L. N., Winter, L., Dennis, M. P., Hodgson, N., & Hauck, W. W.
Affiliations
Thomas Jefferson University (US)
ORCID
Venue
Journal of the American Geriatrics Society
Publisher
Wiley
Published
2010-08
Volume
58
Issue
8
Pages
1465-1474
ISSN
  • 0002-8614 (ISSN-L)
  • 1532-5415
DOI
10.1111/j.1532-5415.2010.02971.x
PMC
PMC2955191
OpenAlex
W1590691689
Cited by
257
References
51
Citations by year
2026: 11 · 2025: 8 · 2024: 14 · 2023: 7 · 2022: 14 · 2021: 21 · 2020: 13 · 2019: 21 · 2018: 18 · 2017: 19 · 2016: 27 · 2015: 25 · 2014: 20 · 2013: 20 · 2012: 8
FWCI
8.53
Type
journal article
Language
en
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • Journal of the American Geriatrics Society (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institute on Aging (R01AG022254, R01 AG22254)
  • National Institute of Nursing Research
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
  • Health Sciences › Health Professions › Pharmacy › Nursing care and research
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
Keywords
dementia, behavioral symptoms, non-pharmacological treatment, caregiver distress, caregiver well-being, caregiver education, telephone follow-up, caregiver burden, home care, family caregivers
MeSH terms
Adaptation, Psychological, Aged, Aged, 80 and over, Dementia, Depression, Environment, Female, Home Care Services, Humans, Male, Occupational Therapy, Stress, Psychological, Caregivers, Needs Assessment, Telenursing

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