Nakanishi Miharu, Endo Kaori, Hirooka Kayo, Granvik Eva, Minthon Lennart, Nägga Katarina, Nishida Atsushi
Mental Health and Nursing Research Team, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan.
Mental Health Promotion Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan.
Int J Geriatr Psychiatry. 2018 Mar;33(3):495-503. doi: 10.1002/gps.4784. Epub 2017 Aug 31.
Little is known about the effectiveness of a psychosocial behaviour management programme on home-dwelling people with dementia. We developed a Behaviour Analytics & Support Enhancement (BASE) programme for care managers and professional caregivers of home care services in Japan. We investigated the effects of BASE on challenging behaviour of home-dwelling people with dementia.
A cluster-randomized controlled trial was conducted with home care providers from 3 different districts in Tokyo. Each provider recruited persons with dementia aged 65 years or older to receive home care in the BASE programme in August 2016. An online monitoring and assessment system was introduced to the intervention group for repeated measures of challenging behaviour with a total score of the Neuropsychiatric Inventory. Care professionals in both the intervention and control groups evaluated challenging behaviour of persons with dementia at baseline (September 2016) and follow-up (February 2017).
A majority of persons with dementia had Alzheimer disease (59.3%). One-hundred and forty-one persons with dementia were included in the intervention group and 142 in the control group. Multilevel modelling revealed a significant reduction in challenging behaviour in the intervention group after 6 months (mean score, 18.3 to 11.2) compared with that of the control group (11.6 to 10.8; P < .05).
The implementation of the BASE programme resulted in a reduction of challenging behaviour of home-dwelling people with dementia. Future research should examine the long-term effects of behaviour management programmes on behaviour, nursing home placement, and hospital admission of home-dwelling people with dementia.
关于心理社会行为管理计划对居家痴呆症患者的有效性，人们知之甚少。我们为日本居家护理服务的护理经理和专业护理人员开发了一个行为分析与支持强化（BASE）计划。我们调查了BASE计划对居家痴呆症患者挑战性行为的影响。
对来自东京3个不同地区的居家护理提供者进行了一项整群随机对照试验。每个提供者招募65岁及以上的痴呆症患者，于2016年8月在BASE计划中接受居家护理。干预组引入了一个在线监测和评估系统，以重复测量挑战性行为，并使用神经精神科问卷的总分。干预组和对照组的护理专业人员在基线（2016年9月）和随访（2017年2月）时评估痴呆症患者的挑战性行为。
大多数痴呆症患者患有阿尔茨海默病（59.3%）。干预组纳入了141名痴呆症患者，对照组纳入了142名。多层次模型显示，与对照组（从11.6降至10.8；P < 0.05）相比，干预组在6个月后挑战性行为显著减少（平均得分从18.3降至11.2）。
BASE计划的实施导致居家痴呆症患者的挑战性行为减少。未来的研究应考察行为管理计划对居家痴呆症患者的行为、入住养老院和住院情况的长期影响。
