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Nonpharmacological Treatment of Agitation: A Controlled Trial of Systematic Individualized Intervention

¹ Research Institute on Aging, Charles E. Smith Life Communities, Rockville, Maryland.
² Herczeg Center on Aging and Department of Health Promotion, Sackler Faculty of Medicine, Tel Aviv University.
³ George Washington University Medical Center, Washington, DC.
⁴ Georgetown University Department of Psychology, Washington, DC.

Address correspondence to Jiska Cohen-Mansfield, PhD, Research Institute on Aging of the Charles E. Smith Life Communities, 6121 Montrose Road, Rockville, MD 20852. E-mail: cohen-mansfield{at}hebrew-home.org

Objective. The objective of this study was to examine the efficacy of a systematic algorithm for providing individualized, nonpharmacological interventions for reducing agitated behaviors in nursing home residents with dementia.

Methods. This placebo-controlled study combined nomothetic and ideographic methodologies. The study was conducted in 12 nursing home buildings in Maryland; 6 were used as treatment facilities, and 6 as control facilities. Participants were 167 elderly nursing home residents with dementia. Interventions were tailored to the individual profiles of agitated participants using a systematic algorithm that considered type of agitation and unmet needs. Interventions were then designed to fulfill the need in a manner that matched the person's cognitive, physical, and sensory abilities, and their lifelong habits and roles. Interventions were provided for 10 days during the 4 hours of greatest agitation. Direct observations of agitation were recorded by trained research assistants via the Agitated Behavior Mapping Instrument (ABMI). Evaluation of positive and negative affect was also based on direct observation and assessed via Lawton's Modified Behavior Stream. Data analysis was performed via SPSS software.

Results. The implementation of personalized, nonpharmacological interventions resulted in statistically significant decreases in overall agitation in the intervention group relative to the control group from baseline to treatment (F_1,164 = 10.22, p =.002). In addition, implementation of individualized interventions for agitation resulted in statistically significant increases in pleasure and interest (F_1,164 = 24.22, p <.001; F_1,164 = 20.66, p <.001).

Conclusions. The findings support the use of individualized nonpharmacological interventions to treat agitation in persons with dementia and underscore the importance for clinicians of searching for underlying reasons for agitated behaviors.