Behavioral and Psychological Symptoms of Dementia (BPSD) include aggression, agitation, depression, anxiety, apathy and hallucinations and are exhibited by up to 90% of nursing home residents with dementia. For residents, BPSD contribute to negative health outcomes, a decline in physical functioning, and may increase the inappropriate use of antipsychotic drugs (AP) and physical restraints. BPSD also contribute to the high cost of long term care. We, and other researchers, have shown that behavioral approaches can reduce BPSD. The Centers for Medicare and Medicaid Services (CMS) in their National Partnership to Improve Dementia Care and Reduce Antipsychotic Use in Nursing Homes has now focused regulatory efforts during the nursing home survey on ensuring that care for residents with dementia is delivered using person-centered behavioral approaches. Person-centered care is focused on collaborative partnerships among individuals, their families and providers and emphasizes health and well-being by being responsive to an individual's priorities, goals and needs. Unfortunately, less than 2% of nursing homes have implemented these changes. The major barriers to use of behavioral approaches are limited knowledge, skills and motivation of staff to utilize these approaches. The proposed research responds to the need to implement a person-centered approach to management of BPSD by testing evidence-based practice for BPSD under conditions of an implementation strategy referred to as the Evidence Integration Triangle (EIT). We worked with CMS to advance the National Partnership and developed a comprehensive compendium of peer-reviewed/expert- endorsed resources for utilizing person-centered, behavioral approaches to BPSD (i.e., a Nursing Home Toolkit; nursinghometoolkit.com). To facilitate implementation of the person-centered behavioral management of BPSD we merged the Toolkit and our previously tested 4-step approach as a way to overcome the barriers to implementation. The steps include: Step 1. Assessment of the Environment and Policies; Step 2. Education of Staff; Step 3. Establishing Person Centered Care Plans; and Step 4. Mentoring and Motivating of Staff) with the EIT implementation strategy to develop the EIT-4- BPSD. We propose a cluster randomized trial with 50 nursing homes randomized to EIT-4-BPSD or Education Only (EO).
Our aims are to: 1: implement and test EIT-4-BPSD; and 2: evaluate use of the EIT strategy and our participatory implementation process with staff. The findings from this study will add to what is known about implementation of effective interventions in nursing homes, will serve as a model for other programs and care approaches, and will help facilities and staff implement quality person-centered care, the ultimate goal of the National Partnership.
This pragmatic trial focuses on implementation of an evidence based process to increase person-centered management of behavioral and psychological symptoms of dementia (BPSD) in nursing homes, referred to as EIT-4-BPSD. The findings from this study will add to what is known about implementation of effective interventions in nursing homes, will serve as a model for other programs and care approaches, and will help facilities and staff implement quality person-centered care, which is the goal of the National Partnership to Improve Dementia Care and Reduce Antipsychotic Use in Nursing Homes.
|Resnick, Barbara; Galik, Elizabeth; Kolanowski, Ann et al. (2018) Reliability and Validity of the Care Plan Checklist for Evidence of Person-Centered Approaches for Behavioral and Psychological Symptoms Associated With Dementia. J Am Med Dir Assoc 19:613-618|
|Massimo, Lauren; Kales, Helen C; Kolanowski, Ann (2018) State of the Science: Apathy As a Model for Investigating Behavioral and Psychological Symptoms in Dementia. J Am Geriatr Soc 66 Suppl 1:S4-S12|