Randomized Controlled Trial of Different Models of Care for Nursing Home Residents With Dementia Complicated by Depression or Psychosis. [CME]
J Clin Psychiatry 2003;64(1):63-72
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Objective: To compare the outcomes of 3
interventions for the management of dementia complicated by
depression or psychosis: psychogeriatric case management, general
practitioners with specialist psychogeriatric consultation, and
standard care for nursing home residents.
Method: The sample for this 12-week randomized
controlled trial consisted of 86 subjects with dementia from 11
Sydney, Australia, nursing homes, of whom 34 had depression, 33
had depression and psychosis, and 19 had psychosis. All
participants received full psychiatric assessments and physical
examinations. Information was obtained from the residents'
families and nursing home staff. Depression measures included the
Even Briefer Assessment Scale for Depression, Hamilton Rating
Scale for Depression, Cornell Scale for Depression in Dementia,
and Geriatric Depression Scale. Psychosis measures included the
Behavioral Pathology in Alzheimer's Disease Rating Scale,
Neuropsychiatric Inventory, and Scale for the Assessment of
Positive Symptoms. Data were obtained from nursing home records
on prescription of psychotropic medication and demographic
information. Management plans were formulated by a
multidisciplinary team before random assignment to interventions.
Results: All 3 groups improved from pretreatment
to posttreatment on depression scales for depression groups and
psychosis scales for psychosis groups. Mode of management
appeared to make no difference in rate or amount of improvement;
neither of the treatment group-by-time interactions were
significant. Neither use of antidepressants nor use of
antipsychotics predicted depression or psychosis outcomes.
Conclusion: Participation in the study was
associated with improvement in depression and psychosis, perhaps
because of the presence of a psychogeriatric team, the increased
attention focused on residents, or the generalization of active
intervention techniques to control subjects. A formula-driven
psychogeriatric team case management approach was not
significantly more effective than a consultative approach or
standard care. This study demonstrates the difficulties and
feasibility of conducting service-oriented research in nursing