Life In The Slower Lane

Here is the PICO analysis for the article:

Full Article Title:

Behavior Problems in Demented Nursing Home Residents: A Multifaceted Approach to Assessment and Management

Author: Bruce Sutor, MD

Journal: Complementary Therapies (Comp Ther) (2002); 28(4):183–188

DOI: Not listed, stable URL via JSTOR: www.jstor.org/stable/4483295

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✅ PICO Analysis

Type of Study:

Expert narrative review / clinical practice guidance

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P – Population

• Setting:Dementia patients residing in nursing homes
• Population Characteristics:
  • Older adults with Alzheimer’s disease or other dementias
  • High rates of behavioural or affective disturbances (up to 80%)
  • Often cognitively impaired and non-verbal
  • Many with comorbid physical and psychiatric conditions

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I – Intervention

Multifaceted, individualised management approach to behavioural disturbances in nursing home residents with dementia, including:

1. Comprehensive Assessment:
   • Medical causes (e.g., pain, infection, medication side effects)
   • Psychiatric syndromes (e.g., depression, psychosis, anxiety)
   • Environmental and caregiver-related factors
   • Behaviour as a form of unmet communication need
2. Pharmacologic Interventions:
   • Antipsychotics (haloperidol, risperidone, olanzapine, quetiapine)
   • Anticonvulsants (carbamazepine, valproic acid)
   • Antidepressants (trazodone, citalopram)
   • Benzodiazepines (e.g., lorazepam)
   • Emerging agents (e.g., gabapentin, lamotrigine)
   • Electroconvulsive therapy (ECT) as a last resort
3. Non-Pharmacologic Interventions:
   • Sensory stimulation, structured activity, increased social interaction
   • Environmental adaptation (e.g., reducing stimuli, consistent routines)
   • Behavioural reinforcement strategies
   • Pain control and physical comfort
   • Family and caregiver education

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C – Comparison

• No formal comparator group.The review contrasts targeted, multifactorial assessment-based interventions with common default approaches, such as:
  • Trial-and-error prescribing
  • Overreliance on antipsychotics
  • Inadequate behavioural evaluation

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O – Outcomes

Person-Centred Outcomes:

• Improved quality of life for residents
• Reduction in distress, agitation, aggression
• Enhanced communication and symptom recognition
• Reduced physical and chemical restraint use

Process Outcomes:

• More accurate diagnosis of behavioural symptoms
• Improved prescribing practices (targeted and lower-risk agents)
• Greater staff awareness of non-pharmacological strategies
• Better collaboration among interdisciplinary care teams

Health System Outcomes (Inferred):

• Potential reduction in adverse events and hospital transfers
• Decreased polypharmacy risks
• Fewer falls, less sedation, improved functional maintenance

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Summary Conclusion

This article promotes a thorough, integrated approach to managing behavioural problems in nursing home residents with dementia. Rather than defaulting to pharmacological restraint, clinicians are urged to conduct multidimensional assessments (medical, psychiatric, environmental) and use tailored interventions, with an emphasis on non-pharmacological methods wherever possible. When medications are used, they should be targeted, evidence-based, and monitored carefully. The article underscores that behavioural expressions often reflect unmet needs, and addressing these thoughtfully can reduce suffering and improve care outcomes .

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