In the Journals

Personalized care plus social interaction benefits patients with dementia

Increasing the amount of social interaction for people with dementia living in nursing homes by as little as 1 hour per week improved quality of life, agitation and neuropsychiatric symptoms when combined with a person-centered care intervention, according to data published in PLOS Medicine.

“To date, interventions to promote person-centered care have not achieved a significant improvement in [quality of life] for people with dementia,” Clive Ballard, MBChB, MRCPsych, Exeter University Medical School, U.K., and colleagues wrote. “The exception is a recently published intensive proof-of-concept study that confirmed the added benefits of combining [person-centered care] training for care staff, antipsychotic review and social interaction — the WHELD intervention — and demonstrated significant benefits in [quality of life], as well as a significant reduction in antipsychotic use.”

To examine the efficacy of the WHELD intervention on quality of life, agitation and antipsychotic use in older adults with dementia living in nursing homes, as well as its cost, researchers conducted a randomized controlled, cluster trial between Jan. 1, 2013, and Sept. 30, 2015.

In their study, Ballard and colleagues compared the WHELD intervention with treatment as usual in people with dementia living in 69 nursing homes in the U.K. Each nursing home performing the intervention received staff training in person-centered care, social interaction and antipsychotic review followed by ongoing delivery through a care staff champion model. The researchers measured quality of life, agitation, neuropsychiatric symptoms, antipsychotic use, global deterioration, mood, unmet needs, mortality, quality of interactions, pain and cost over a 9-month period.

Overall, 553 people completed the trial. Analysis showed that that patients who received the WHELD intervention showed statistically significant improvement in quality of life compared with treatment as usual over 9 months (mean difference, 2.54; P = .0042). In addition, there were statistically significant benefits in agitation (mean difference, 4.27; P = .0076) and overall neuropsychiatric symptoms (mean difference, 4.55; P < .001). Notably, participants with moderately severe dementia saw the greatest benefits.

Researchers also observed a significant benefit in positive care interactions (19.7% increase; P = .03) among people receiving WHELD compared to treatment as usual; however, there were no statistically significant differences for the other outcomes. The intervention did not reduce use antipsychotic drug, but it did reduce cost compared to treatment as usual and the benefits in quality of life, agitation and neuropsychiatric symptoms were associated with cost-effectiveness.

“Our approach improves care and saves money. We must roll out approaches that work to do justice to some of the most vulnerable people in society,” Ballard said in a press release. “Incredibly, of 170 career training manuals available on the market, only four are based on evidence that they really work. That is simply not good enough — it has to change.” – by Savannah Demko

Disclosures: Ballard reports grants and personal fees from Acadia and Lundbeck. He also reports personal fees from Bial, Bristol Myer Squibb, Napp, Novartis, Orion, Otusaka, Roche, Sunovion. Please see the study for all other authors’ relevant financial disclosures.

Increasing the amount of social interaction for people with dementia living in nursing homes by as little as 1 hour per week improved quality of life, agitation and neuropsychiatric symptoms when combined with a person-centered care intervention, according to data published in PLOS Medicine.

“To date, interventions to promote person-centered care have not achieved a significant improvement in [quality of life] for people with dementia,” Clive Ballard, MBChB, MRCPsych, Exeter University Medical School, U.K., and colleagues wrote. “The exception is a recently published intensive proof-of-concept study that confirmed the added benefits of combining [person-centered care] training for care staff, antipsychotic review and social interaction — the WHELD intervention — and demonstrated significant benefits in [quality of life], as well as a significant reduction in antipsychotic use.”

To examine the efficacy of the WHELD intervention on quality of life, agitation and antipsychotic use in older adults with dementia living in nursing homes, as well as its cost, researchers conducted a randomized controlled, cluster trial between Jan. 1, 2013, and Sept. 30, 2015.

In their study, Ballard and colleagues compared the WHELD intervention with treatment as usual in people with dementia living in 69 nursing homes in the U.K. Each nursing home performing the intervention received staff training in person-centered care, social interaction and antipsychotic review followed by ongoing delivery through a care staff champion model. The researchers measured quality of life, agitation, neuropsychiatric symptoms, antipsychotic use, global deterioration, mood, unmet needs, mortality, quality of interactions, pain and cost over a 9-month period.

Overall, 553 people completed the trial. Analysis showed that that patients who received the WHELD intervention showed statistically significant improvement in quality of life compared with treatment as usual over 9 months (mean difference, 2.54; P = .0042). In addition, there were statistically significant benefits in agitation (mean difference, 4.27; P = .0076) and overall neuropsychiatric symptoms (mean difference, 4.55; P < .001). Notably, participants with moderately severe dementia saw the greatest benefits.

Researchers also observed a significant benefit in positive care interactions (19.7% increase; P = .03) among people receiving WHELD compared to treatment as usual; however, there were no statistically significant differences for the other outcomes. The intervention did not reduce use antipsychotic drug, but it did reduce cost compared to treatment as usual and the benefits in quality of life, agitation and neuropsychiatric symptoms were associated with cost-effectiveness.

“Our approach improves care and saves money. We must roll out approaches that work to do justice to some of the most vulnerable people in society,” Ballard said in a press release. “Incredibly, of 170 career training manuals available on the market, only four are based on evidence that they really work. That is simply not good enough — it has to change.” – by Savannah Demko

Disclosures: Ballard reports grants and personal fees from Acadia and Lundbeck. He also reports personal fees from Bial, Bristol Myer Squibb, Napp, Novartis, Orion, Otusaka, Roche, Sunovion. Please see the study for all other authors’ relevant financial disclosures.