Kosters Janouk, Janus Sarah I M, van den Bosch Kirsten A, Andringa Tjeerd C, Hoop E Oomen-de, de Boer Michiel R, Elburg Ronald A J, Warmelink Steven, Zuidema Sytse U, Luijendijk Hendrika J
Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
Department of Youth Studies, University of Groningen, Groningen, the Netherlands.
J Am Med Dir Assoc. 2023 Feb;24(2):192-198.e5. doi: 10.1016/j.jamda.2022.11.010. Epub 2022 Dec 14.
Auditory environments as perceived by an individual, also called soundscapes, are often suboptimal for nursing home residents. Poor soundscapes have been associated with neuropsychiatric symptoms (NPS). We evaluated the effect of the Mobile Soundscape Appraisal and Recording Technology sound awareness intervention (MoSART+) on NPS in nursing home residents with dementia.
A 15-month, stepped-wedge, cluster-randomized trial. Every 3 months, a nursing home switched from care as usual to the use of the intervention.
The 3-month MoSART+ intervention involved ambassador training, staff performing sound measurements with the MoSART application, meetings, and implementation of microinterventions. The goal was to raise awareness about soundscapes and their influence on residents.
We included 110 residents with dementia in 5 Dutch nursing homes. Exclusion criteria were palliative sedation and deafness.
The primary outcome was NPS severity measured with the Neuropsychiatric Inventory-Nursing Home version (NPI-NH) by the resident's primary nurse. Secondary outcomes were quality of life (QUALIDEM), psychotropic drug use (ATC), staff workload (workload questionnaire), and staff job satisfaction (Maastricht Questionnaire of Job Satisfaction).
The mean age of the residents (n = 97) at enrollment was 86.5 ± 6.7 years, and 76 were female (76.8%). The mean NPI-NH score was 17.5 ± 17.3. One nursing home did not implement the intervention because of staff shortages. Intention-to-treat analysis showed a clinically relevant reduction in NPS between the study groups (-8.0, 95% CI -11.7, -2.6). There was no clear effect on quality of life [odds ratio (OR) 2.8, 95% CI -0.7, 6.3], psychotropic drug use (1.2, 95% CI 0.9, 1.7), staff workload (-0.3, 95% CI -0.3, 0.8), or staff job satisfaction (-0.2, 95% CI -1.2, 0.7).
MoSART+ empowered staff to adapt the local soundscape, and the intervention effectively reduced staff-reported levels of NPS in nursing home residents with dementia. Nursing homes should consider implementing interventions to improve the soundscape.
个体所感知的听觉环境，也称为声景，对养老院居民而言往往并不理想。不良声景与神经精神症状（NPS）有关。我们评估了移动声景评估与记录技术声音意识干预（MoSART+）对患有痴呆症的养老院居民的神经精神症状的影响。
一项为期15个月的阶梯式楔形整群随机试验。每3个月，一家养老院从常规护理转为使用该干预措施。
为期3个月的MoSART+干预包括大使培训、工作人员使用MoSART应用程序进行声音测量、会议以及实施微干预。目标是提高对声景及其对居民影响的认识。
我们纳入了荷兰5家养老院的110名痴呆症患者。排除标准为姑息性镇静和失聪。
主要结局是由居民的责任护士使用养老院版神经精神科问卷（NPI-NH）测量的神经精神症状严重程度。次要结局包括生活质量（QUALIDEM）、精神药物使用情况（解剖治疗学及化学分类系统）、工作人员工作量（工作量问卷）以及工作人员工作满意度（马斯特里赫特工作满意度问卷）。
入组时居民（n = 97）的平均年龄为86.5±6.7岁，其中76名女性（76.8%）。NPI-NH平均得分为17.5±17.3。由于人员短缺，一家养老院未实施该干预措施。意向性分析显示，研究组之间神经精神症状有临床相关的减轻（-8.0，95%可信区间-11.7，-2.6）。对生活质量[优势比（OR）2.8，95%可信区间-0.7，6.3]、精神药物使用情况（1.2，95%可信区间0.9，1.7）、工作人员工作量（-0.3，95%可信区间-0.3，0.8）或工作人员工作满意度（-（此处原文有误，可能是-0.2，95%可信区间-1.2，0.7））均无明显影响。
MoSART+使工作人员有能力调整当地声景，该干预措施有效降低了工作人员报告的患有痴呆症的养老院居民的神经精神症状水平。养老院应考虑实施改善声景的干预措施。
