Intervention Improves Quality of Life, Agitation in Nursing Home Patients With Dementia

The WHELD (Well-Being and Health for People With Dementia) approach, which combines staff training, social interaction, and guidance on use of antipsychotic medication, was beneficial in patients with dementia living in care homes in the United Kingdom, according to an article published in PLOS Medicine.

Clive Ballard, MB, ChB, MRCPsych, MMedSci, MD, a professor at Exeter University Medical School in the United Kingdom, and colleagues conducted a randomized controlled cluster trial between January 1, 2013 and September 30, 2015 that compared the WHELD intervention with treatment as usual in people with dementia living in 69 UK nursing homes, using an intention-to-treat analysis. All nursing homes in the intervention group received staff training in person-centered care, social interaction, and education regarding antipsychotic medications followed by ongoing delivery through a care staff champion model.

The primary outcome measure was quality of life, whereas secondary outcomes included agitation, neuropsychiatric symptoms, antipsychotic use, global deterioration, mood, unmet needs, mortality, quality of interactions, pain, and cost.

In all, 847 people were randomly assigned to WHELD or treatment as usual, with 553 completing the 9-month trial. Patients randomly assigned to the intervention experienced a statistically significant improvement in quality of life (P =.0042), agitation (P =.0076), and overall neuropsychiatric symptoms (P <.001). There was also a statistically significant benefit in positive care interactions (19.7% increase; P =.03). The benefits were greatest in those with moderately severe dementia.

There was no statistically significant difference between WHELD and treatment as usual for other outcomes. Antipsychotic medication was at a low stable level in both treatment groups, and the intervention did not reduce use. However, the WHELD intervention did reduce costs compared with treatment as usual. Participants receiving the intervention showed a significant health and social care cost advantage. Taking into account the cost of the intervention and the total health and social care costs, there was cost advantage for the WHELD treatment.

The authors noted that agitation is a common challenging symptom affecting large numbers of people with dementia and affecting quality of life. Social interaction and pleasant events, components of the WHELD intervention, have previously demonstrated efficacy in improving agitation in randomized controlled trials. The authors argue that incorporating them within a coherent framework such as WHELD enables straightforward and affordable implementation of these approaches in clinical and care practice.

Reference

Ballard C, Corbett A, Orrell M, et al. Impact of person-centred care training and person-centred activities on quality of life, agitation, and antipsychotic use in people with dementia living in nursing homes: a cluster-randomised controlled trial [published online February 6, 2018]. PLOS Med. doi:10.1371/journal.pmed.1002500