In order to offer a non-drug intervention for caregivers in nursing home to respond promptly to a behavioral crisis with an appropriate response to each patient, a chariot has been developed by the Institute of Ageing Well Korian (Institut du Bien Vieillir Korian) to bring together eleven mediation activities. These activities lasting about 15 minutes are based on emotion (reminiscent, games) and sensory interventions (music, massage, touch) to decentralize patient stimulus that disturbs and focus on a subject not disruptive. This emergency intervention should provide a reduction in Behavioral and Psychological Symptom of Dementia (BPSD) of nursing home patients. The main objective is to measure its immediate effect on productive symptoms (agitation, aberrant motor behavior and disinhibition). The secondary objectives are to measure its immediate impact on the well-being and psychotropic treatments, and measure its effect after two months and after four months on all BPSD with a focus on agitation, the administration of psychotropic drugs, the hospitalizations and the number of falls.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Enrollment
241
The control condition is to propose the usual procedures for the management of productive symptoms during the emergence or increase of these symptoms. The "chariot-flash" condition is a chariot with eleven drawers. Each drawer contains an activity (lasting about 15 minutes): * Boards of known photographs to recall autobiographical memories * Newspapers to read, talk, associate memories around an article * Massage Oil, refreshing wipes, cream to reconnect with the body * Clay, cookie pieces, washable felt and paper to create shapes, draw. * Walk with a person of the healthcare team the case of behavioral disorders in type of ambulation and untimely exit . * Listening to music * Relaxation-Breathing * Cushion, foam balls to vent his energy on secure hardware. * Plush doll or to invest a vector object of affection and empathy * Sensory flash balls that the patient can squeeze, throw, roll. * Games with which the patient can play according to its possibilities.
The control condition is to propose the usual procedures for the management of productive symptoms during the emergence or increase of these symptoms. The "chariot-flash" condition is a chariot with eleven drawers. Each drawer contains an activity (lasting about 15 minutes): * Boards of known photographs to recall autobiographical memories * Newspapers to read, talk, associate memories around an article * Massage Oil, refreshing wipes, cream to reconnect with the body * Clay, cookie pieces, washable felt and paper to create shapes, draw. * Walk with a person of the healthcare team the case of behavioral disorders in type of ambulation and untimely exit . * Listening to music * Relaxation-Breathing * Cushion, foam balls to vent his energy on secure hardware. * Plush doll or to invest a vector object of affection and empathy * Sensory flash balls that the patient can squeeze, throw, roll. * Games with which the patient can play according to its possibilities.
Hôpital des Charpennes Centre de Recherche Clinique "Vieillissement-Cerveau-Fragilité"
Lyon, France
Change in number of disorders
the number of disorders are evaluated with Cohen Mansfield Agitation Inventory (CMAI) before and 30 minutes after each intervention. The original version of the CMAI is initially planned to study the frequency of these disorders. However, the goal being to study the decrease in productive symptoms, after using the "chariot-flash", only the number of this item will be considered (between 0 and 29). For example in this modified version, for the item "pace, aimless wandering" nursing team can answer "present" or "absent" instead of (never, less than once a week, once or twice per week, a few times over week, one to two times daily, several times a day, several times per hour)
Time frame: until 4 months
Change in score of well-being
the score of well-being is assessed using the Instant Well-Being scale (Evaluation Instantané du Bien-Etre : EVIBE) before and 30 minutes after each intervention . The EVIBE is a visual analogue scale for reporting the status of well-being of the patient at a specific time. On a graduated scale from 0 to 5, the caregiver should position a cursor position to the left corresponding to the feeling of well-being the lowest and the right position to the feeling of well-being the highest.
Time frame: until 4 months
change in psychotropic drugs prescribed
The caregiver or doctor will check on a board what are the treatments that have been added or modified (compared to the usual treatment) in response to behavioral disorder
Time frame: until 4 months
change in score of BPSD
the score of BPSD is assessed using the neuropsychiatric inventory nursing home version (NPI-NH). Each of the 12 BPSD (delusions, hallucinations, agitation, depression, anxiety, excitement, apathy, disinhibition, depression, motor aberrant behavior, sleep and appetite) is evaluated on 12 depending on its frequency and severity (global score =144).
Time frame: before the beginning of the study, at 2 months, 4 months and 6 months
change in level of agitation
the level of agitation is assessed using the original version of CMAI. The CMAI lists 29 agitation and aggressive behaviors by frequency (0: not evaluable 1: never, 2: less than once a week 3 : once or twice per week, 4 : a few times over week, 5: one to two times daily, 6 : several times a day, 7 : several times per hour) to obtain a score ranging from 0-203.
Time frame: before the beginning of the study, at 2 months, 4 months and 6 months
change in the number of administered psychotropic drugs.
The caregiver or doctor will check on a board on which is written all psychotropic treatments that the patient takes and the dosage
Time frame: before the beginning of the study, at 2 months, 4 months and 6 months
The number of hospitalization
The caregiver or doctor will refer in a table the different hospitalizations during the study and their date
Time frame: at 2 months, 4 months and 6 months
The number of fall
The caregiver or doctor will refer in a table the different falls during the study and their date.
Time frame: at 2 months, 4 months and 6 months
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