Division of Health Policy and Management, University of Minnesota, Minneapolis, Minnesota.
Minnesota Evidence-based Practice Center, University of Minnesota, Minneapolis, Minnesota.
J Am Geriatr Soc. 2016 Mar;64(3):477-88. doi: 10.1111/jgs.13936.
To evaluate the efficacy of nonpharmacological care-delivery interventions (staff training, care-delivery models, changes to the environment) to reduce and manage agitation and aggression in nursing home and assisted living residents.
Three bibliographic databases, references of systematic reviews, ClincalTrials.gov, and the International Controlled Trials Registry Platform were systematically searched for randomized controlled trials reporting behavioral outcomes for nonpharmacological care-delivery interventions in nursing homes and assisted living facilities. Five investigators independently assessed study eligibility, extracted data, rated risk of bias, and graded strength of evidence. Inclusion was limited to studies with low to moderate risk of bias.
Nursing homes and assisted living facilities.
Facility caregiving staff.
Agitation, aggression, antipsychotic and other psychotropic use, general behavior.
Nineteen unique studies met entry criteria, addressing several categories of facility caregiver training interventions: dementia care mapping (DCM; n = 3), person-centered care (PCC; n = 3), clinical protocols to reduce the use of antipsychotic and other psychotropic drugs (n = 3), and emotion-oriented care (n = 2). Eleven additional studies evaluated other unique interventions. Results were pooled for the effect of each type of intervention on agitation and aggression: DCM (standardized mean difference -0.12, 95% confidence interval (CI) = -0.66 to 0.42), PCC (standardized mean difference -0.15, 95% CI = -0.67 to 0.38), and protocols to reduce antipsychotic and other psychotropic use (Cohen-Mansfield Agitation Inventory mean difference -4.5, 95% C = -38.84 to 29.93). Strength of evidence was generally insufficient to draw conclusions regarding efficacy or comparative effectiveness.
Evidence was insufficient regarding the efficacy of nonpharmacological care-delivery interventions to reduce agitation or aggression in nursing home and assisted living facility residents with dementia.
评估非药物护理干预措施（员工培训、护理模式、环境改变）在减少和管理养老院和辅助生活居民的激越和攻击行为方面的疗效。
系统检索了三个文献数据库、系统评价的参考文献、ClinicalTrials.gov 和国际对照试验注册平台，以寻找报告养老院和辅助生活设施中非药物护理干预措施对行为结果的随机对照试验。五名调查员独立评估了研究的合格性、提取数据、评估偏倚风险，并对证据强度进行分级。纳入标准仅限于偏倚风险低至中度的研究。
养老院和辅助生活设施。
设施护理人员。
激越、攻击、抗精神病药和其他精神药物的使用、一般行为。
19 项独特的研究符合入选标准，涉及几种设施护理人员培训干预措施类别：痴呆护理图（DCM；n=3）、以患者为中心的护理（PCC；n=3）、减少抗精神病药和其他精神药物使用的临床方案（n=3）和情绪导向护理（n=2）。另外 11 项研究评估了其他独特的干预措施。汇总了每种干预措施对激越和攻击的效果：DCM（标准化均数差-0.12，95%置信区间（CI）=-0.66 至 0.42），PCC（标准化均数差-0.15，95% CI=-0.67 至 0.38），以及减少抗精神病药和其他精神药物使用的方案（Cohen-Mansfield 激越量表的平均差异-4.5，95%置信区间（CI）=-38.84 至 29.93）。证据的总体强度不足以得出关于疗效或比较有效性的结论。
关于非药物护理干预措施在减少痴呆养老院和辅助生活居民激越或攻击方面的疗效的证据不足。
