Related Experiment Video
Updated: Jun 16, 2025
Community-based Adapted Tango Dancing for Individuals with Parkinson's Disease and Older Adults
Published on: December 9, 2014
A Cluster Randomized Trial: Mixed Methods Comparison of 2 Approaches to Promote Nonpharmacologic, Resident-Centered
Victoria Shier1, Yuna H Bae-Shaaw2, Neeraj Sood1
1Sol Price School of Public Policy, University of Southern California, Los Angeles, CA, USA; Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, CA, USA.
Objectives:
Nursing home dementia care initiatives have prioritized nonpharmacologic approaches to manage behavioral symptoms. This study compares the effectiveness of 2 nonpharmacologic approaches on resident outcomes.
Design And Intervention:
Cluster randomized controlled trial using a convergent mixed methods design to compare the team-based and problem-based approaches to dementia care. The team-based arm received facility-wide training, providing a shared language and knowledge across staff. The problem-based arm received discipline-specific web-based training for certain staff.
Setting And Participants:
Residents living with dementia (n = 2728) in 53 nursing homes; 327 staff.
Methods:
Outcomes were antipsychotic medication use, behavioral symptoms, rejection of care, and wandering captured with the Minimum Data Set. Exploratory quantitative analysis compared change in outcomes between baseline and 6-month follow-up, across arms using a difference-in-difference model. Qualitative data were collected via staff interviews. Integration of quantitative and qualitative data determined whether these sources provided confirmatory, emergent, or contradictory information on outcomes.
Results:
Resident wandering increased 3.51 percentage points (95% CI 0.6, 6.4) in the team-based arm compared to the problem-based arm, without increase in adverse events. Data integration confirmed this finding. Staff in the team-based arm described wandering as a positive coping strategy for the resident. We found mixed results for the other 3 outcomes. There was no statistically significant difference in antipsychotic medication use across arms, but staff interviews did reveal differences. There were trends of increased behavioral symptoms in the team-based arm and increased rejection of care in the problem-based arm (neither statistically significant), which were confirmed by qualitative findings.
Conclusions And Implications:
Integration results suggest a benefit for resident wandering in the team-based approach, compared with the problem-based approach. Although findings are exploratory, training for all nursing home staff that accounts for diverse education and training needs may influence care delivery and have benefits for residents living with dementia.
Related Concept Videos
01:29Documentation in Long-Term and Home Healthcare Setting
Long-Term Care Facilities
01:22Alzheimer's Disease: Treatment
01:19Restorative Care
01:30Specialized Care Centers and Settings-II
Rural health centers are specialized care facilities in remote locations with very few medical personnel. The primary care providers who run the centers are mostly Registered Nurse Practitioners. Here, emergency treatment is provided to critically ill or injured patients before they are transferred to the closest hospital. Fortunately, due to advancement in technology, many rural healthcare facilities and professionals have easy access to diagnostic and treatment...
01:30Specialized Care Centers and Settings-I
Daycare centers
They provide several functions. Some facilities care for healthy newborns and children whose parents work, while others are medically focused and care for...
01:24Nursing Process for Patient and Caregiver Teaching II: Planning and Implementation