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Effect of need-based care on behavioural and psychological symptoms in residents with dementia and formal caregivers’ distress in nursing homes: a three-arm cluster randomized controlled trial

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Key summary points

AbstractSection Aim

To evaluate to what extent the standardized concept of need-based care on Behavioural and Psychological Symptoms of Dementia (BPSD), and formal caregiver distress, is superior when compared to spending more time or standard care with residents with BPSD.

AbstractSection Findings

Need-based interventions had a significant effect on residents’ levels of pain behaviour. In the need-based care group, scores on overall BPSD (agitation and aggression, depression, euphoria, irritability, sleep and night-time behaviour) improved significantly from baseline when compared to other timepoints.

AbstractSection Message

Tailored non-pharmacological interventions in the residential care for people with dementia reduce the level of BPSD and formal caregivers’ distress.

Abstract

Purpose

To evaluate to what extent the standardized concept of need-based care on Behavioural and Psychological Symptoms of Dementia (BPSD), and formal caregiver distress, is superior when compared to spending more time or standard care with residents with BPSD.

Methods

A longitudinal cluster randomized controlled study in 23 nursing homes in Belgium with 3 parallel groups was set up. A total of 481 residents with dementia participated. Formal caregivers in the need-based care group treated residents who displayed agitated or aggressive behaviour with a non-pharmacological intervention, tailored to unmet needs, twice a week with re-evaluation every 8 weeks. In the time group, formal caregivers spent ‘extra time’. In the standard care group, it was ‘care as usual’. Outcomes were measured at four different time points with the Doloplus-2 (to assess pain behaviour), Cohen-Mansfield Agitation Inventory (CMAI) for agitation, the Neuropsychiatric Inventory (NPI-NH) for BPSD and formal caregivers’ distress.

Results

Need-based interventions had a significant effect on residents’ levels of pain behaviour. In the need-based care group, scores on overall BPSD (agitation and aggression, depression, euphoria, irritability, sleep and night-time behaviour) improved significantly from baseline when compared to other timepoints. No significant different interactions over time were found between all three groups for categorized versions of NPI scores (ever versus never).

Conclusion

Need-based care reduced the level of BPSD in residents with dementia as well as formal caregivers’ distress. The study supports the importance of tailored non-pharmacological interventions in the residential care for people with dementia.

Trial Registry

Trial registration number B300201942084 (18/11/2019).

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Data availability

Data sets generated during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

The authors thank Dirk Jacobs for the methodological advises, Liesbet Decuypere and Kate Meier for the translation of the non-pharmacological treatments’ definitions and Leen Verduyckt and Sandra Vande Voorde for practical support during data collection. Special thanks to all caregivers from the 23 nursing homes for their extraordinary commitment.

Author information

Authors and Affiliations

  1. Research Group Health for Older People (HOPE), Odisee University College, Hospitaalstraat 23, 9100, Sint-Niklaas, Belgium

    Katrin Gillis, Hilde Lahaye, Marianne De Witte & Yentl De Wit

  2. Centre for Research and Innovation in Care, Antwerp University, Universiteitsplein 1, 2600, Wilrijk, Belgium

    Katrin Gillis & Peter Van Bogaert

  3. Department of Psychiatry, Faculty of Medicine and Health Sciences, Collaborative Antwerp Psychiatric Research Institute (CAPRI), Antwerp University, Campus Drie Eiken, Universiteitsplein 1, 2610, Wilrijk, Belgium

    Linda van Diermen

  4. Curando Vzw, Pensionaatstraat 58A, Ruiselede, Belgium

    Marianne De Witte & Dirk Lips

  5. Department of Geriatrics, Ghent University Hospital, C. Heymanslaan, 10, 9000, Ghent, Belgium

    Yentl De Wit

  6. Center for Statistics, StatUa, University of Antwerp, Prinsstraat 13, Antwerp, Belgium

    Ella Roelant

  7. Clinical Trial Center (CTC), CRC Antwerp, Antwerp University Hospital, University of Antwerp, Drie Eikenstraat 655, Edegem, Belgium

    Ella Roelant

  8. R&D Department, Pranarôm International S.A. 37, Avenue des Artisans, 7822, Ghislenghien, Belgium

    Abdesselam Zhiri

  9. Plant Biotechnology Research Unit, Université Libre de Bruxelles (ULB), Plant Biotechnology Research Unit, CP 300, Rue Prof. Jeener & Brachet 12, 6041, Gosselies, Belgium

    Abdesselam Zhiri

  10. Primary Palliative Care Research Group, University of Edinburgh, Edinburgh, EH8 9AG, Scotland, UK

    Jo Hockley

  11. Psychiatric Centre Bethanië, Andreas Vesaliuslaan 39, 2980, Zoersel, Belgium

    Linda van Diermen

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  1. Katrin Gillis
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Correspondence to Katrin Gillis.

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Gillis, K., van Diermen, L., Lahaye, H. et al. Effect of need-based care on behavioural and psychological symptoms in residents with dementia and formal caregivers’ distress in nursing homes: a three-arm cluster randomized controlled trial. Eur Geriatr Med 14, 1083–1096 (2023). https://doi.org/10.1007/s41999-023-00825-7

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