The Effect of Staff Training on Agitation and Use of Restraint in Nursing Home Residents With Dementia: A Single-Blind, Randomized Controlled Trial

Introduction: Agitation is common in dementia and is associated with use of restraints and use of psychotropic drugs. The aim of this study was to determine whether an education and supervision intervention could reduce agitation and the use of restraints and antipsychotic drugs in nursing homes.

Method: Four Norwegian nursing homes were randomly allocated to receive either treatment as usual or an intervention consisting of a 2-day educational seminar and monthly group guidance for 6 months. One hundred forty-five residents with dementia (based on medical records and corroborated with a Functional Assessment Staging score‘ ‰≥‘ ‰4) completed baseline and 6-month intervention assessments and were included in the analyses. The co-primary outcome measures were the proportion of residents subject to interactional restraint and the severity of agitation using the Cohen-Mansfield Agitation Inventory (CMAI). Patients were assessed at baseline, immediately after completion of the intervention at 6 months, and 12 months after baseline. Comparison of change in the 2 groups was made using repeated-measures analysis of variance (CMAI) and Mann-Whitney test (restraints). The study was conducted from 2003 to 2004.

Results: The proportion of residents starting new restraint was lower in the intervention than in the control group at 6-month evaluation (P‘ ‰=‘ ‰.02), but no statistically significant differences were found at 12-month assessment (P‘ ‰=‘ ‰.57). The total CMAI score declined from baseline to 6 and 12 months’ follow-up in the intervention homes compared to a small increase in the control homes (F2,176‘ ‰=‘ ‰3.46, P‘ ‰=‘ ‰.034). There were no statistically significant differences in use of antipsychotic drugs.

Conclusions: A brief 2-day staff education program followed by continued monthly guidance was able both to improve quality of care by reducing the frequency of interactional restraints and to reduce severity of agitation.

Submitted: June 18, 2009; accepted September 23, 2009

Corresponding author: Ingelin Testad, RN, Psychiatric Clinic, Stavanger University Hospital, PO Box 8100, 4068 Stavanger, Norway (itestad@gmail.com).