Klapwijk Maartje S, Caljouw Monique A A, Pieper Marjoleine J C, Putter Hein, van der Steen Jenny T, Achterberg Wilco P
Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.
Marente, Leiden, The Netherlands.
Int J Geriatr Psychiatry. 2018 Jun 11. doi: 10.1002/gps.4912.
The objective of this study was to examine whether implementation of a stepwise multicomponent intervention (STA OP!) for challenging behavior and pain affects quality of life (QoL) of nursing home residents with moderate to severe dementia after 3 and 6 months.
A cluster randomized controlled trial was conducted in 12 nursing homes. Both control (n = 140) and intervention group (=148) received training, the intervention group was also treated using the STA OP!
At baseline, 3 and 6 months QoL was assessed using the 6 QUALIDEM domains applicable to moderate and severe dementia. Linear mixed models were used to compare changes in QoL domains between the 2 groups over time.
After both 3 and 6 months, there was no change, and no difference in change, between the 2 groups in the domains Care relationship, Positive affect, Negative affect, and Social relations. Between 0 and 3 months, a positive effect was seen in the domain Restless tense behavior with a regression coefficient of β: 0.95 (95% confidence interval [CI], 0.36-1.54). Between 3 and 6 months, a negative effect was seen on the domain Restless tense behavior β: -0.98 (95% CI, -1.60 to -0.36) and a positive effect in the domain Social isolation, β: 0.64 (95% CI, 0.12-1.17).
The stepwise intervention STA OP! affects the QUALIDEM domains in different ways: there was a lowering of Restless tense behavior in the short term, which reverted back to the initial level in the longer term, and a lowering of Social isolation in the longer term.
本研究旨在探讨针对具有挑战性的行为和疼痛实施逐步多成分干预措施（STA OP!）是否会在3个月和6个月后影响中重度痴呆养老院居民的生活质量（QoL）。
在12家养老院进行了一项整群随机对照试验。对照组（n = 140）和干预组（n = 148）均接受培训，干预组还采用STA OP!进行治疗。
在基线、3个月和6个月时，使用适用于中重度痴呆的6个QUALIDEM领域评估生活质量。采用线性混合模型比较两组随时间推移在生活质量领域的变化。
在3个月和6个月时，两组在护理关系、积极情感、消极情感和社会关系领域均无变化，变化情况也无差异。在0至3个月期间，在烦躁紧张行为领域观察到积极效果，回归系数β为0.95（95%置信区间[CI]，0.36 - 1.54）。在3至6个月期间，在烦躁紧张行为领域观察到消极效果，β为 -0.98（95%CI，-1.60至 -0.36），在社会隔离领域观察到积极效果，β为0.64（95%CI，0.12 - 1.17）。
逐步干预措施STA OP! 以不同方式影响QUALIDEM领域：短期内烦躁紧张行为减少，长期又恢复到初始水平，长期内社会隔离减少。
