Agitated behaviors impose one of the most onerous burdens on nursing home caregivers and residents. The investigators have utilized information derived from agitation research to develop a program termed """"""""Treatment Routes for Exploring Agitation"""""""" (TREA), an objective, systematic method for implementing individualized treatment plans for agitation. TREA first involves an assessment of the subtype of agitation, and its underlying causes. A research-driven treatment plan for addressing the underlying cause of the agitation would then be implemented. The proposed study involves conducting a controlled comparison of the efficacy of the TREA approach to placebo in nursing homes that meet or exceed usual levels of quality in resident treatment and medication monitoring. We hypothesize that, as compared to a placebo-controlled condition, TREA will be more effective in reducing levels of agitation among nursing home residents. Improved outcome in comparison to standard care will be determined via the following measures: (1) The frequency of agitation will be reduced; (2) Staff members will perceive a reduction in agitation-associated disruptiveness; (3) Residents' quality of life will be improved as estimated by reduced levels of depressed or anxious affect, and increased levels of interest in the environment; (4) Fewer psychotropic medications will be administered. During the study, process variables will be collected which will facilitate an estimation of the distribution of probable causes of agitation among residents with specific behavioral profiles; the rate of efficacy of specific interventions for each type of agitation, the distribution of perceived causes for failure of specific interventions for each type of agitation; and the relative cost-effectiveness of each intervention. If the proposed project proves successful, a systematic method for implementing individualized treatment plan for agitation would be demonstrated, a need which remains to be satisfactorily met. The quality of life agitated nursing home residents, residents who are exposed to the agitation, and nursing home caregivers would thereby be improved.
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