Treatment Routes for Exploring Agitation

NCT ID: NCT00820859

Last Updated: 2009-07-03

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

NA

Total Enrollment

200 participants

Study Classification

INTERVENTIONAL

Study Start Date

2006-06-30

Study Completion Date

2011-06-30

Brief Summary

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The purpose of this study is to examine the efficacy of non-pharmacological ways to treat agitated behaviors in nursing home residents with dementia. The hypothesis is that non-pharmacological interventions will be more effective than placebo in decreasing such behaviors.

Detailed Description

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Clinicians often refer to elderly persons under their care as "agitated." However, agitation is not a diagnosis, but rather, a descriptive term pertaining to a group of behavioral signs and symptoms, defined as socially inappropriate verbal, vocal, or motor (physical) activity that is not judged by an outside observer to result directly from the needs or confusion of the agitated individual. While the literature reports positive effects of non-pharmacological interventions, most studies tend to be based on small samples and do not yield statistically significant results. This study examines the impact of non-pharmacologic interventions tailored through an algorithm labeled TREA (Treatment Routes for Exploring Agitation) using a large, well-controlled, systematic research design.

TREA is an objective, systematic method for developing individualized non-pharmacological treatment plans based on an analysis of the agitated person's unmet needs, past and current preferences, past role-identity, cognitive, mobility, and sensory abilities/limitations, and possible causes for particular agitated behaviors. The methodology calls for ascertaining the type of agitated behavior and the most likely etiology, and then matching the intervention to the etiology and to the participant's characteristics.

The protocol involves the following steps:

* Baseline assessment - using standardized assessments (e.g., MMSE, ABMI, CMAI, Self-identity in dementia), collecting background demographic and medical information as well as systematic observations of the agitated resident
* Intervention exploration - after analyzing potential unmet needs as well as preferences, abilities and identities of each participant, investigators develop a list of potentially successful interventions, examining the effectiveness of a wide range of interventions, from family videos to manipulatives (e.g., puzzles, a tool kit)
* Intervention (treatment) phase - Interventions are systematically provided during the hours of highest agitation (determined at baseline) and observations are conducted at the same time. The treatment phase lasts for 10 days. The placebo control group includes a presentation to staff members as to how to intervene with behavior problems and similar observations of residents.
* Follow-up phase includes repeated assessments without interventions.

Conditions

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Dementia Behavior Problems

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Participants

Study Groups

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1

Group Type EXPERIMENTAL

TREA (Treatment Routes for Exploring Agitation)

Intervention Type BEHAVIORAL

Individualized non-pharmacological treatment plan for agitation

2

Group Type ACTIVE_COMPARATOR

Placebo Control Group

Intervention Type BEHAVIORAL

A presentation on the treatment of behavior problems in dementia given to the staff caregivers of the comparison group

Interventions

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TREA (Treatment Routes for Exploring Agitation)

Individualized non-pharmacological treatment plan for agitation

Intervention Type BEHAVIORAL

Placebo Control Group

A presentation on the treatment of behavior problems in dementia given to the staff caregivers of the comparison group

Intervention Type BEHAVIORAL

Eligibility Criteria

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Inclusion Criteria

* Age 60 or older
* Diagnosis of dementia derived from the resident's medical chart at the facility or from an attending physician, as based on DSM-IV criteria and the Report of the NINCDS-ADRDA
* Resident of the facility for at least three weeks so that nursing staff members know the resident well enough to accurately assess him or her
* Identified by nursing staff to exhibit either verbal agitation or physical non-aggressive agitation at least several times a day

Exclusion Criteria

* Lifelong diagnosis of schizophrenia
* Bipolar disorder diagnosed prior to onset of dementia
* Diagnosis of premorbid mental retardation
* Judged by direct-care nursing staff to have a life expectancy of less than 3 months
* Expected to leave the nursing home (either to enter the hospital or to go home) within the next 4 months
* Agitation manifested less than 6 times a day
Minimum Eligible Age

60 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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National Institute on Aging (NIA)

NIH

Sponsor Role lead

Responsible Party

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Research Institute on Aging

Principal Investigators

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Jiska Cohen-Mansfield, PhD

Role: PRINCIPAL_INVESTIGATOR

Research Institute on Aging

Locations

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Research Institute on Aging

Rockville, Maryland, United States

Site Status RECRUITING

Countries

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United States

Central Contacts

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Jiska Cohen-Mansfield, PhD

Role: CONTACT

301-770-8453

Marcia S. Marx, PhD

Role: CONTACT

301-770-8451

Facility Contacts

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Jiska Cohen-Mansfield, PhD, ABPP

Role: primary

301-770-8453

Marcia Marx, PhD

Role: backup

301-770-8451

References

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Cohen-Mansfield J. Agitated behavior in persons with dementia: the relationship between type of behavior, its frequency, and its disruptiveness. J Psychiatr Res. 2008 Nov;43(1):64-9. doi: 10.1016/j.jpsychires.2008.02.003. Epub 2008 Apr 3.

Reference Type BACKGROUND
PMID: 18394647 (View on PubMed)

Cohen-Mansfield J, Libin A, Marx MS. Nonpharmacological treatment of agitation: a controlled trial of systematic individualized intervention. J Gerontol A Biol Sci Med Sci. 2007 Aug;62(8):908-16. doi: 10.1093/gerona/62.8.908.

Reference Type BACKGROUND
PMID: 17702884 (View on PubMed)

Cohen-Mansfield J, Marx MS, Rosenthal AS. A description of agitation in a nursing home. J Gerontol. 1989 May;44(3):M77-84. doi: 10.1093/geronj/44.3.m77.

Reference Type BACKGROUND
PMID: 2715584 (View on PubMed)

Cohen-Mansfield J, Thein K, Marx MS, Dakheel-Ali M, Freedman L. Efficacy of nonpharmacologic interventions for agitation in advanced dementia: a randomized, placebo-controlled trial. J Clin Psychiatry. 2012 Sep;73(9):1255-61. doi: 10.4088/JCP.12m07918.

Reference Type DERIVED
PMID: 23059151 (View on PubMed)

Related Links

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http://www.researchinstituteonaging.org/

Research Institute on Aging

Other Identifiers

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5R01AG010172-11

Identifier Type: NIH

Identifier Source: secondary_id

View Link

IA0144

Identifier Type: -

Identifier Source: org_study_id

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