Life In The Slower Lane

Here is the structured PICO analysis for the sixty-eighth article you uploaded:

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Full Title (verbatim and exact):

“Agitation in Nursing Home Residents With Dementia (VIDEANT Trial): Effects of a Cluster-Randomized, Controlled, Guideline Implementation Trial”

Rapp MA, Mell T, Majic T, et al.

Journal of the American Medical Directors Association (JAMDA) (2013); 14(9):690–695

DOI: 10.1016/j.jamda.2013.05.017

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Type of Article:

Cluster-randomised controlled trial (VIDEANT study)

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PICO Analysis:

Population:

• 304 nursing home residents with moderate-to-severe dementia in 18 nursing homes in Berlin, Germany
• Mean age: 81.6 years; 72.7% women
• Inclusion criteria: dementia diagnosis, behavioral symptoms
• Cluster randomisation: 9 homes assigned to intervention (n = 163), 9 to control (n = 141) 

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Intervention:

A complex, guideline-based intervention based on the American Geriatrics Society and American Association of Geriatric Psychiatry guidelines, including:

1. Training of nursing home staff
   • 8-person sessions, 2×4-hour blocks
   • Topics: dementia symptomatology, behavioural interventions, pharmacology
   • Case vignette practice
2. Non-pharmacological therapy implementation
   • Individual activity therapy (2×/week for 45 minutes), tailored to resident biography
   • Participation increased significantly from baseline (from 32.5% to 78.5%)
3. Pharmacological prescribing optimisation
   • 4-hour training of prescribing physicians on appropriate use of neuroleptics, antidepressants, and ChEIs 

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Comparator:

• Usual care in control homes, including group-based activity sessions but no structured guideline implementation or physician/nurse training
• Group activity participation at baseline: 29.8%

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Outcome:

1. Person-centred outcomes:

• Primary outcome:
  • Agitation, measured by the Cohen-Mansfield Agitation Inventory (CMAI)
  • At 10 months:
    • Intervention group: mean CMAI = 46.2
    • Control group: mean CMAI = 56.4
    • Adjusted mean difference: –6.24 (95% CI: –14.14 to –2.03), p = 0.009, Cohen’s d = 0.43
  • Largest improvements seen in physically aggressive behaviours (p = 0.012) 

2. Process outcomes:

• Activity therapy participation increased significantly in intervention homes
• Raters blinded to group allocation for objective outcomes; interviews for CMAI with staff not fully blinded

3. Health system outcomes:

• Psychotropic prescribing (Defined Daily Doses, DDDs):
  • Neuroleptics: decreased in intervention group (adjusted difference –0.03 DDDs, p = 0.04)
  • Antidepressants: increased (adjusted difference +0.03 DDDs, p = 0.04)
  • ChEIs: increased (adjusted difference +0.09 DDDs, p = 0.01)
  • Effect sizes ranged from small (neuroleptics, d = 0.13) to moderate (ChEIs, d = 0.29) 
• No differences in hospitalisations, mortality, or adverse events between groups

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Summary Conclusion:

The VIDEANT trial demonstrated that a multicomponent guideline-based intervention (including staff training, individualised activity therapy, and GP prescribing education) significantly reduced agitation, particularly physically aggressive behaviour, in dementia patients in nursing homes. It also modestly shifted prescribing patterns toward increased use of ChEIs and antidepressants and decreased neuroleptic use, aligning more closely with clinical guidelines. While the effect on psychotropic prescribing was small, the findings support implementing interdisciplinary, system-level approaches to behavioural symptom management in long-term care dementia settings.

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