Psychiatric Clinic, Stavanger University Hospital, PO Box 8100, 4068 Stavanger, Norway.
J Clin Psychiatry. 2010 Jan;71(1):80-6. doi: 10.4088/JCP.09m05486oli.
Agitation is common in dementia and is associated with use of restraints and use of psychotropic drugs. The aim of this study was to determine whether an education and supervision intervention could reduce agitation and the use of restraints and antipsychotic drugs in nursing homes.
Four Norwegian nursing homes were randomly allocated to receive either treatment as usual or an intervention consisting of a 2-day educational seminar and monthly group guidance for 6 months. One hundred forty-five residents with dementia (based on medical records and corroborated with a Functional Assessment Staging score >or= 4) completed baseline and 6-month intervention assessments and were included in the analyses. The co-primary outcome measures were the proportion of residents subject to interactional restraint and the severity of agitation using the Cohen-Mansfield Agitation Inventory (CMAI). Patients were assessed at baseline, immediately after completion of the intervention at 6 months, and 12 months after baseline. Comparison of change in the 2 groups was made using repeated-measures analysis of variance (CMAI) and Mann-Whitney test (restraints). The study was conducted from 2003 to 2004.
The proportion of residents starting new restraint was lower in the intervention than in the control group at 6-month evaluation (P = .02), but no statistically significant differences were found at 12-month assessment (P = .57). The total CMAI score declined from baseline to 6 and 12 months' follow-up in the intervention homes compared to a small increase in the control homes (F2,176 = 3.46, P = .034). There were no statistically significant differences in use of antipsychotic drugs.
A brief 2-day staff education program followed by continued monthly guidance was able both to improve quality of care by reducing the frequency of interactional restraints and to reduce severity of agitation.
躁动是痴呆症中常见的症状，与约束的使用和精神药物的使用有关。本研究的目的是确定教育和监督干预是否可以减少疗养院中躁动、约束和抗精神病药物的使用。
4 家挪威疗养院被随机分配接受常规治疗或干预，干预措施包括为期 2 天的教育研讨会和 6 个月每月的小组指导。145 名患有痴呆症的居民（根据医疗记录，并与功能评估分期评分>或=4 相符）完成了基线和 6 个月干预评估，并纳入分析。主要结局指标是接受互动约束的居民比例和使用 Cohen-Mansfield 躁动量表（CMAI）评估的躁动严重程度。患者在基线、6 个月干预结束时和基线后 12 个月进行评估。使用重复测量方差分析（CMAI）和 Mann-Whitney 检验（约束）比较两组的变化。该研究于 2003 年至 2004 年进行。
在 6 个月评估时，干预组开始使用新约束的居民比例低于对照组（P =.02），但 12 个月评估时无统计学差异（P =.57）。与对照组相比，干预组的 CMAI 总分从基线到 6 个月和 12 个月随访均下降（F2,176 = 3.46，P =.034）。抗精神病药物的使用无统计学差异。
为期 2 天的员工教育计划后继续每月指导，既能通过减少互动约束的频率来提高护理质量，又能减轻躁动的严重程度。
