Abstract
Objectives
To evaluate the feasibility outcomes of implementing a multicomponent staff training
intervention (PROCUIDA-Demencia) to promote psychosocial interventions and reduce
antipsychotic prescription in Mexican care homes and study its effect on staff's care
experience and residents' quality of life.
Design
A mixed-methods 2-arm cluster randomized controlled pilot study of a 2-day staff training
program with baseline, 12 weeks, and 24 weeks of the PROCUIDA-Demencia intervention
vs treatment as usual (TAU).
Setting and Participants
Eight care homes in Mexico City were selected, from which 55 residents and 126 staff
were recruited.
Intervention
In situ staff training consisting of evidence-based manualized psychosocial interventions
of person-centered activities, reminiscence therapy, doll therapy, psychomotor dance
therapy, and antipsychotic prescription review. Fidelity to protocol was supervised
once a week.
Methods
Cluster-level feasibility measures included views of staff, residents, and relatives
on acceptability, satisfaction, adherence, and fidelity to the intervention. Staff
outcome measures were Maslach Burnout Inventory (MBI), Approaches to Dementia Questionnaire,
and Sense of Competence in Dementia Care Staff. Residents' outcome measures included
Quality of Life–Alzheimer's Disease scale (QoL-AD), and Neuropsychiatric Inventory–Nursing
Home Version (NPI-NH). Staff distress was measured using the NPI-NH occupational disturbance
scale. Feasibility was elicited through a focus group, and hierarchical linear mixed
effects models were used to assess the adjusted effects of the respective measures.
Results
Observed medical practice showed the prescription of at least 1 antipsychotic in 41%
of participants in the intervention group. Overall, 39% of residents reported discontinuation,
and 15% reduction of antipsychotics, following the 12-week medical review in parallel
with psychosocial interventions. Clinical outcomes contributed positively to the reduction
in baseline staff burden according to the MBI after the intervention [mean difference −8.9,
95% confidence interval (CI) −17.7, −0.1, P = .049] and to the reduction in severity and frequency of behavior as per NPI-NH
in residents (mean difference −9.4, 95% CI –17.5, −1.3, P = .025).
Conclusions and Implications
PROCUIDA-Demencia is a feasible intervention for Mexican care homes. Results contribute
to the Mexican Dementia Plan optimizing dementia care by supporting the need for staff
training to implement psychosocial interventions prior to prescribing antipsychotic
medication.
Keywords
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References
- Systematic review of the effective components of psychosocial interventions delivered by care home staff to people with dementia.BMJ Open. 2017; 7: e014177
- Staff training using STAR: A pilot study in UK care homes.Int Psychogeriatr. 2012; 24: 911-920
- Impact of antipsychotic review and nonpharmacological intervention on antipsychotic use, neuropsychiatric symptoms, and mortality in people with dementia living in nursing homes: A factorial cluster-randomized controlled trial by the Well-Being and Health for People With Dementia (WHELD) Program.Am J Psychiatry. 2016; 173: 252-262
- Impact of person-centred care training and person-centred activities on quality of life, agitation, and antipsychotic use in people with dementia living in nursing homes: A cluster-randomised controlled trial.PLoS Med. 2018; 15: e1002500
- The association between quality improvement initiatives in dementia care and supportive psychosocial work environments in nursing homes.Healthcare (Basel). 2018; 6: 44
- Effectiveness of educational program using printed educational material on care burden distress among staff of residential aged care facilities without medical specialists and/or registered nurses: Cluster quasi-randomization study.Geriatr Gerontol Int. 2018; 18: 487-494
- Evaluation of the ‘Ladder to the Moon, Culture Change Studio Engagement Programme’ staff training: Two quasi-experimental case studies.Int J Older People Nurs. 2017; 12
- The disconnect between evidence and practice: A systematic review of person-centred interventions and training manuals for care home staff working with people with dementia.Int J Geriatr Psychiatry. 2014; 29: 797-807
- Positive attitudes and person-centred care predict of sense of competence in dementia care staff.Aging Ment Health. 2016; 20: 407-414
- Life review and life story books for people with mild to moderate dementia: A randomised controlled trial.Aging Ment Health. 2014; 18: 363-375
- A systematic review and meta-analysis on the effect of reminiscence therapy for people with dementia.Int Psychogeriatr. 2019; 31: 1581-1597
- Reminiscence therapy for dementia.Cochrane Database Syst Rev. 2018; 3: CD001120
- Reminiscence therapy improves cognitive functions and reduces depressive symptoms in elderly people with dementia: A meta-analysis of randomized controlled trials.J Am Med Dir Assoc. 2015; 16: 1087-1094
- Ethical considerations of doll therapy for people with dementia.Nurs Ethics. 2014; 21: 720-730
- Doll therapy: An intervention for nursing home residents with dementia.J Psychosoc Nurs Ment Health Serv. 2015; 53: 13-18
- Psychomotor Dance Therapy Intervention (DANCIN) for people with dementia in care homes: A multiple-baseline single-case study.Int Psychogeriatr. 2016; 28: 1695-1715
- A process evaluation of a Psychomotor Dance Therapy Intervention (DANCIN) for behavior change in dementia: Attitudes and beliefs of participating residents and staff.Int Psychogeriatr. 2017; 29: 313-322
- Dancing as a psychosocial intervention in care homes: A systematic review of the literature.Int J Geriatr Psychiatry. 2013; 28: 914-924
- Understanding Behaviour in Dementia That Challenges: A Guide to Assessment and Intervention.Jessica Kingsley Publishers, 2011
- Census of Social Assistance Institutions. National Data.(Available at:)http://www3.inegi.org.mx/rnm/index.php/catalog/217/datafile/F4/V6912015Date accessed: January 1, 2021
- FDA position statement “Early Alzheimer's disease: Developing drugs for treatment, Guidance for Industry”.Alzheimers Dement. 2019; 5: 13-19
- Antipsychotics: Initiative to reduce prescribing to older people with dementia.(Available at:)https://www.gov.uk/drug-safety-update/antipsychotics-initiative-to-reduce-prescribing-to-older-people-with-dementiaDate accessed: January 1, 2021
- Effects of psychosocial interventions for behavioral and psychological symptoms in dementia on the prescription of psychotropic drugs: A systematic review and meta-analyses.J Am Med Dir Assoc. 2018; 19: 276.e1-276.e9
- FITS into practice: Translating research into practice in reducing the use of anti-psychotic medication for people with dementia living in care homes.Aging Ment Health. 2016; 20: 709-718
- Quetiapine and rivastigmine and cognitive decline in Alzheimer’s disease: Randomised double blind placebo controlled trial.BMJ. 2005; 330: 874
- Polypharmacy and potentially inappropriate medication in people with dementia: A nationwide study.J Alzheimers Dis. 2018; 63: 383-394
- Institutional context of family eldercare in Mexico and the United States.J Cross Cult Gerontol. 2016; 31: 327-336
- Aging and dependency care in Mexico. Technical Note 1614.Inter-American Development Bank, 2019
- Dependency and long-term care.in: Gutiérrez-Robledo L.M. García-Peña M.C. Jiménez-Bolón J.E. Aging and Dependence. Realities and Forecast for the Next Years. National Academy of Medicine, 2014
- Alzheimer's and other dementias Action Plan Mexico. National Institute of Geriatrics. Mexico.
- Pilot study and key feasibility factors of a staff training intervention and reduction of antipsychotic prescription practice in Mexican urban care homes: Study protocol.J Ment Health Aging. 2018; 2: 47-55
- The Clinical Dementia Rating (CDR): Current version and scoring rules.Neurology. 1993; 43: 2412-2414
- Valores de referencia de la Short Physical Performance Battery para pacientes de 70 y más años en atención primaria de salud [Short physical performance battery reference values for patients 70 years-old and over in primary health care].Aten Primaria. 2012; 44: 540-548
- The measurement of experienced burnout.J Occup Behav. 1981; 2: 99-113
- Approaches to Dementia Questionnaire.University of Wales, 2001
- Sense of competence in dementia care staff (SCIDS) scale: Development, reliability, and validity.Int Psychogeriatr. 2012; 24: 1153-1162
- Validación de la escala Quality of Life in Alzheimer’s Disease (QOL-AD) en pacientes mexicanos con demencia tipo Alzheimer, vascular y mixta [Validation of the Quality of Life in Alzheimer’s Disease (QOL-AD) scale in Mexican patients with Alzheimer, vascular and mixed-type dementia].Rev Neurol. 2010; 51: 72-80
- Neuropsychiatric Inventory-Nursing Home version (NPI-NH): validación española [Neuropsychiatric Inventory-Nursing Home version (NPI-NH): Spanish validation].Neurologia. 2005; 20: 665-673
- R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria.(Available at:)
- DescTools: Tools for descriptive statistics. R package version 0.99.37.(Available at:)https://cran.r-project.org/web/packages/DescTools/DescTools.pdfDate: 2020Date accessed: September 1, 2020
- nlme: Linear and Nonlinear Mixed Effects Models. R package version 3.1-144.(Available at:)
- MuMIn: Multi-Model Inference. R package version 1.43.15.(Available at:)
- Using the framework method for the analysis of qualitative data in multi-disciplinary health research.BMC Med Res Methodol. 2013; 13: 117
- The consequences of ignoring therapist effects in trials with longitudinal data: A simulation study.J Consult Clin Psychol. 2018; 86: 711-725
- An Introduction to Group work, A Group-Analytic Perspective.Palgrave Macmillan, 1999
Article info
Publication history
Published online: November 08, 2021
Footnotes
This work was supported by the British Academy Newton Fellowship, United Kingdom (Grant: AF150230). The views and opinions expressed herein are those of the authors and do not necessarily reflect those of the funder.
The authors declare no conflicts of interest.
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© 2021 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
