Training and support for nursing home staff reduced neuroleptic drug use and did not increase aggression in residents with dementia

摘要

Psychological and social interventions should be attempted before initiating pharmacological treatment for behavioural symptoms in patients with dementia. However, evidence supporting the use of such interventions has come mainly from case reports and observational studies. The randomised trial by Fossey etal has addressed the need to employ more rigorous study designs in this area.' Many studies have focused on targeting challenging behaviours with individualised behavioural interventions,' but Fossey ef al's approach transformed the facilities' cultures by targeting the knowledge, skills, and attitudes of staff in a multifaceted way, with ongoing training and support. Presumably, challenging behaviours were not only managed, but also prevented in residents who might otherwise have been pvescribed neuroleptics to achieve the same outcome. Given that nurses collaborate with physicians on treatment decisions in long term care, it would be beneficial for prescribing physicians to participate in the educational intervention reported in the study. In doing so, they might be more likely to recommend and support staff in seeking non-pharmacological alternatives when consulted. Provision of support to staff, along with the comprehensive package of interventions, although not explicitly described, are surely consistent with practice guidelines.The intervention might be too ambitious for many homes that lack the resources to deliver them. The typical facility size in this study was small (-30 raids), and the same results might not be achieved in larger homes where consistency in staffing is difficult to guarantee. Given the comprehensive intervention and support, it is somewhat disappointing that the intervention did not influence falls, quality of life, or agitation and aggressive episodes. With the elimination of antipsychotic drug use, dedicated resources are required to identify and further test psychosocial and behavioural interventions.