Dataset Information

Implementation of the Evidence Integration Triangle for behavioral and psychological symptoms of dementia (EIT-4-BPSD) in care communities.

ABSTRACT:

Background

Federal regulations stipulate that behavioral interventions be used for behavioral and psychological symptoms of distress in dementia (BPSD). Care community staff have difficulty implementing these approaches.

Purpose

This study tested an implementation strategy, the Evidence Integration Triangle for BPSD (EIT-4-BPSD), for assisting staff in the use of evidence-based behavioral approaches for BPSD.

Methods

About 55 care communities were randomized to EIT-4-BPSD or usual care; 553 residents were enrolled. The implementation strategy was delivered by research facilitators, staff, stakeholders, and champions over 12 months. It involved four components: Environment and policy assessments; Staff education; Establishment of person-centered care plans; and Mentoring and motivating staff. The implementation strategy was evaluated using the Reach, Effectiveness, Adoption, Implementation, Maintenance model.

Findings

There was no evidence for resident or care community effectiveness. There was evidence of adoption and implementation.

Discussion

EIT-4-BPSD was helpful as an implementation strategy and staff altered how care was provided.

SUBMITTER: Resnick B

PROVIDER: S-EPMC8678150 | biostudies-literature | 2021 Nov-Dec

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Implementation of the Evidence Integration Triangle for behavioral and psychological symptoms of dementia (EIT-4-BPSD) in care communities.

Resnick Barbara B Van Haitsma Kimberly K Kolanowski Ann A Galik Elizabeth E Boltz Marie M Zhu Shijun S Ellis Jeanette J Behrens Liza L Eshraghi Karen K

Nursing outlook 20210728 6

<h4>Background</h4>Federal regulations stipulate that behavioral interventions be used for behavioral and psychological symptoms of distress in dementia (BPSD). Care community staff have difficulty implementing these approaches.<h4>Purpose</h4>This study tested an implementation strategy, the Evidence Integration Triangle for BPSD (EIT-4-BPSD), for assisting staff in the use of evidence-based behavioral approaches for BPSD.<h4>Methods</h4>About 55 care communities were randomized to EIT-4-BPSD o ...[more]

PMID: 34332762

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Project description:BackgroundBehavioral and psychological symptoms of distress in dementia (BPSD) are major drivers of poor quality of life, caregiver burden, institutionalization, and cost of care in nursing homes. The Evidence Integration Triangle (EIT)-4-BPSD in nursing homes was a pragmatic Hybrid III trial of an implementation strategy to help staff use evidence-based non-pharmacological interventions to prevent and manage BPSD. This study aimed to describe and explore the stakeholders' perceptions of the process to implement the EIT-4-BPSD strategy including its utility, and the barriers and facilitators to implementation in real-world settings.MethodsEIT-4-BPSD was a multi-layer implementation strategy that engaged nursing home stakeholder groups to define community specific goals towards reducing BPSD over a 12-month period. Stakeholder groups from nursing homes that completed all 12-months of the implementation strategy were invited to participate in this process evaluation study. Qualitative data from focus group transcripts were analyzed using a conventional content analysis. Emerging codes were sorted into categories, then organized in meaningful clusters based on the domains of the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework.ResultsThe EIT-4-BPSD implementation strategy was completed in 21 nursing homes; 93 stakeholders participated in focus groups. Over half of participating nursing homes reported meeting their BPSD goals as expected or more. Challenges, facilitators, and contextual factors reported by stakeholder members explains variability in the implementation of EIT-4-BPSD strategy in 11 key categories: family; staff; organizational; staff, environmental, and resident outcomes; utility of EIT resources; adoption barriers and facilitators; care process adaptations; and future planning.ConclusionStakeholders offered guidance on salient factors influencing the feasibility and utility of EIT-4-BPSD adoption and implementation to consider in future implementation research that aims to improve behavioral well-being in NH residents living with dementia. Engagement of family and staff at all levels of the organization (Management, leadership, and direct care); and measurement of staff, environmental, and resident outcomes were perceived as critical for future implementation success. While regulations, finances, and competing demands on staff time were perceived as reducing implementation success.Trial registrationThe Testing the Implementation of EIT-4-BPSD study was registered in the ClinicalTrials.gov ( NCT03014570 ) January 9, 2017.

Project description:BackgroundBehavioral and Psychological Symptoms of Dementia (BPSD) are core and highly detrimental symptoms of dementia. Previous research has suggested a potential association between pain and BPSD, but pieces of evidence are lacking.ObjectiveThis study aimed to investigate the association between pain and BPSD in patients with dementia.MethodsSeven databases were searched from inception to February 2024, including PubMed, Web of Science, Embase, CINAHL, Cochrane Library, China National Knowledge Infrastructure (CNKI), and WanFang Data. Cross-sectional and longitudinal studies were included. We included studies that involved older adults with dementia and assessed the pain and BPSD by using validated tools. The quality of cohort studies was assessed using the Newcastle-Ottawa Scale, and the quality of cross-sectional studies was evaluated using AHRQ criteria. Two researchers independently screened the articles, extracted the data, and assessed the quality of the studies. A meta-analysis was conducted using Stata 15.0. Data not suitable for meta-analysis was analyzed through a qualitative synthesis to provide a comprehensive overview of the findings.ResultsA total of 12 studies were included, comprising nine cross-sectional studies and three longitudinal studies. All studies were of medium to high quality. Studies reported that pain was associated with 13 different types of BPSD, including agitation, aggression, abnormal thought process, anxiety, care refusal, delirium, depression, delusions, hallucinations, sexual disinhibition, sleep disturbances, socially inappropriate behavior, and wandering. A pooled odds ratio (OR) of 1.25 (95%CI [1.17,1.33], p < 0.001) indicated a significant positive association between pain and BPSD. Specifically, pain was positively associated with aggression (OR = 1.07, 95%CI [1.00,1.13], p = 0.035), agitation (OR = 1.17, 95%CI [1.14, 1.21], p < 0.001), and depression (OR = 2.11, 95%CI [1.76,2.52], p < 0.001). However, pain was significantly negatively associated with wandering (OR = 0.77, 95%CI [0.73, 0.81], p < 0.001).ConclusionsPain was significantly positively associated with BPSD in patients with dementia, specifically with aggression, depression, and agitation. However, pain was negatively associated with wandering. This emphasizes the importance of further research in this area and improved interventions for pain and BPSD management.Trial registrationwww.crd.york.ac.uk CRD42023432320, registered 08/08/2024.

Dataset Information

Implementation of the Evidence Integration Triangle for behavioral and psychological symptoms of dementia (EIT-4-BPSD) in care communities.

Background

Purpose

Methods

Findings

Discussion

Publications

Implementation of the Evidence Integration Triangle for behavioral and psychological symptoms of dementia (EIT-4-BPSD) in care communities.

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