An interventional study of transdisciplinary approach and multidisciplinary approach in Alzheimer Disease, sponsored by University of Pittsburgh. Completed at 1 site in United States. Per ClinicalTrials.gov, last updated 2024-08-19.
Sponsored by University of Pittsburgh · Not applicable, Interventional, and Health services research
Of the 1.4 million nursing home (NH) residents in long term care facilities, more than half have Alzheimer's disease or dementia. Due to changes in their familiar daily routines, difficulty expressing their thoughts or asking for what they need, and overstimulation (such as noise) or under stimulation (such as lack of activity), individuals with dementia often display disruptive behaviors like resisting help or continually repeating the same phrases. Medications are often prescribed to reduce agitation and aggressive behavior; however, these medications may not be effective and can have a negative impact on the individual. Therefore, families and other stakeholders strongly advocate the use of other types of approaches that focus on minimizing the cause of the behavior. Two facility-based methodologies include the transdisciplinary approach for integrated dementia care, which combines the expertise of all NH staff, who work together to build a common language and approach for each resident, and the multidisciplinary approach for problem-based dementia care, in which each staff member conducts individual assessments and makes discipline-specific recommendations. While prior research suggests that both of these facility-based approaches are useful, the circumstances under which each approach is most effective are not clear. This project will prospectively randomize 80 nursing homes to one of the two treatment arms to compare the effect of the transdisciplinary approach versus the multidisciplinary approach.
This study will examine the difference between the two comparators with respect to facility rates of medications dispensed to residents with dementia, leading to enhanced quality of life for the resident.
This project is important because it will address a key clinical dilemma NH staff face as they strive to optimize the use of alternative approaches to reduce disruptive behaviors in residents with dementia. Transforming the quality of dementia care in NHs and enhancing the quality of life of residents with dementia are high priorities for families and other advocates.
Eligible nursing home facilities will
Exclusion Criteria:
Facilities will be excluded if they have
The transdisciplinary approach that is integrated across disciplines and provides core training for all providers, staff members, and stakeholders, using a common language to address care concerns and support continuity and sustainability
Other: transdisciplinary approach
The multidisciplinary approach that is problem-based and draws on the expertise of individual healthcare providers (e.g., occupational therapy) to address care concerns.
Other: multidisciplinary approach
This approach is integrated across disciplines and provides core training for all providers, staff members, and stakeholders, using a common language to address care concerns and support continuity and sustainability;
This is a problem-based approach that draws on the expertise of individual healthcare providers (e.g., occupational therapy) to address care concerns.
Dispensing of Psychotropic Medications
Percentage of nursing home residents with dementia who received one or more antipsychotic medication over Months 1-6 of Intervention.
Time frame: 6-month period (months 1-6)
Dispensing of Psychotropic Medications
Percentage of nursing home residents with dementia who received one or more antipsychotic medication over Months 7-12 of Intervention.
Time frame: 12-month period (months 7-12)
Dispensing of Psychotropic Medications
Percentage of nursing home residents with dementia who received one or more antipsychotic medication over Months 13-18 of Intervention.
Time frame: 18-month period (months 13-18)
Behavioral Symptoms
Percentage of nursing home residents with dementia who had behavioral symptoms over Months 1-6 of Intervention.
Time frame: 6-month period (months 1-6)
Behavioral Symptoms
Percentage of nursing home residents with dementia who had behavioral symptoms over Months 7-12 of Intervention.
Time frame: 12-month period (months 7-12)
Behavioral Symptoms
Percentage of nursing home residents with dementia who had behavioral symptoms over Months 13-18 of Intervention.
Time frame: 18-month period (months 13-18)
Wandering
Percentage of nursing home residents with dementia who had wandering over Months 1-6 of Intervention.
Time frame: 6-month period (months 1-6)
Wandering
Percentage of nursing home residents with dementia who had wandering over Months 7-12 of Intervention.
Time frame: 12-month period (months 7-12)
Wandering
Percentage of nursing home residents with dementia who had wandering over Months 13-18 of Intervention.
Time frame: 18-month period (months 13-18)
Rejection of Care
Percentage of nursing home residents with dementia who had rejection of care over Months 1-6 of Intervention.
Time frame: 6-month period (months 1-6)
Rejection of Care
Percentage of nursing home residents with dementia who had rejection of care over Months 7-12 of Intervention.
Time frame: 12-month period (months 7-12)
Rejection of Care
Percentage of nursing home residents with dementia who had rejection of care over Months 13-18 of Intervention.
Time frame: 18-month period (months 13-18)
Unintended Weight Loss
Percentage of nursing home residents with dementia who had unintended weight loss over Months 1-6 of Intervention.
Time frame: 6-month period (months 1-6)
Unintended Weight Loss
Percentage of nursing home residents with dementia who had unintended weight loss over Months 7-12 of Intervention.
Time frame: 12-month period (months 7-12)
Unintended Weight Loss
Percentage of nursing home residents with dementia who had unintended weight loss over Months 13-18 of Intervention.
Time frame: 18-month period (months 13-18)
Falls
Percent of nursing home residents with dementia who had falls over Months 1-6 of Intervention.
Time frame: 6-month period (months 1-6)
Falls
Percent of nursing home residents with dementia who had falls over Months 7-12 of Intervention.
Time frame: 12-month period (months 7-12)
Falls
Percent of nursing home residents with dementia who had falls over Months 13-18 of Intervention.
Time frame: 18-month period (months 13-18)
Depressive Symptoms
Percent of nursing home residents with dementia who had depressive symptoms over Months 1-6 of Intervention
Time frame: 6-month period (months 1-6)
Depressive Symptoms
Percent of nursing home residents with dementia who had depressive symptoms over Months 7-12 of Intervention.
Time frame: 12-month period (months 7-12)
Depressive Symptoms
Percent of nursing home residents with dementia who had depressive symptoms over Months 13-18 of Intervention.
Time frame: 18-month period (months 13-18)
Physical Restraints Use
Percent of nursing home residents with dementia who had physical restraint use over Months 1-6 of Intervention.
Time frame: 6-month period (months 1-6)
Physical Restraints Use
Percent of nursing home residents with dementia who had physical restraint use over Months 7-12 of Intervention.
Time frame: 12-month period (months 7-12)
Physical Restraints Use
Percent of nursing home residents with dementia who had physical restraint use over Months 13-18 of Intervention.
Time frame: 18-month period (months 13-18)
| Milestone | Transdisciplinary Approach | Multidisciplinary Approach |
|---|---|---|
| Started | 1291 | 3206 |
| 6-month outcome | 793 | 1905 |
| 12-month outcome | 658 | 1693 |
| Completed | 526 | 1420 |
| Not completed | 765 | 1786 |
Percentage of nursing home residents with dementia who received one or more antipsychotic medication over Months 1-6 of Intervention.
| Participants | Transdisciplinary Approach | Multidisciplinary Approach |
|---|---|---|
| Dispensing of Psychotropic Medications | 161 | 315 |
Percentage of nursing home residents with dementia who received one or more antipsychotic medication over Months 7-12 of Intervention.
| Participants | Transdisciplinary Approach | Multidisciplinary Approach |
|---|---|---|
| Dispensing of Psychotropic Medications | 125 | 289 |
Percentage of nursing home residents with dementia who received one or more antipsychotic medication over Months 13-18 of Intervention.
| Participants | Transdisciplinary Approach | Multidisciplinary Approach |
|---|---|---|
| Dispensing of Psychotropic Medications | 107 | 227 |
Percentage of nursing home residents with dementia who had behavioral symptoms over Months 1-6 of Intervention.
| Participants | Transdisciplinary Approach | Multidisciplinary Approach |
|---|---|---|
| Behavioral Symptoms | 143 | 334 |
Percentage of nursing home residents with dementia who had behavioral symptoms over Months 7-12 of Intervention.
| Participants | Transdisciplinary Approach | Multidisciplinary Approach |
|---|---|---|
| Behavioral Symptoms | 104 | 299 |
Percentage of nursing home residents with dementia who had behavioral symptoms over Months 13-18 of Intervention.
| Participants | Transdisciplinary Approach | Multidisciplinary Approach |
|---|---|---|
| Behavioral Symptoms | 68 | 232 |
Percentage of nursing home residents with dementia who had wandering over Months 1-6 of Intervention.
| Participants | Transdisciplinary Approach | Multidisciplinary Approach |
|---|---|---|
| Wandering | 88 | 117 |
Percentage of nursing home residents with dementia who had wandering over Months 7-12 of Intervention.
| Participants | Transdisciplinary Approach | Multidisciplinary Approach |
|---|---|---|
| Wandering | 52 | 116 |
Percentage of nursing home residents with dementia who had wandering over Months 13-18 of Intervention.
| Participants | Transdisciplinary Approach | Multidisciplinary Approach |
|---|---|---|
| Wandering | 38 | 98 |
Percentage of nursing home residents with dementia who had rejection of care over Months 1-6 of Intervention.
| Participants | Transdisciplinary Approach | Multidisciplinary Approach |
|---|---|---|
| Rejection of Care | 131 | 302 |
Percentage of nursing home residents with dementia who had rejection of care over Months 7-12 of Intervention.
| Participants | Transdisciplinary Approach | Multidisciplinary Approach |
|---|---|---|
| Rejection of Care | 75 | 282 |
Percentage of nursing home residents with dementia who had rejection of care over Months 13-18 of Intervention.
| Participants | Transdisciplinary Approach | Multidisciplinary Approach |
|---|---|---|
| Rejection of Care | 59 | 217 |
Percentage of nursing home residents with dementia who had unintended weight loss over Months 1-6 of Intervention.
| Participants | Transdisciplinary Approach | Multidisciplinary Approach |
|---|---|---|
| Unintended Weight Loss | 125 | 302 |
Percentage of nursing home residents with dementia who had unintended weight loss over Months 7-12 of Intervention.
| Participants | Transdisciplinary Approach | Multidisciplinary Approach |
|---|---|---|
| Unintended Weight Loss | 132 | 395 |
Percentage of nursing home residents with dementia who had unintended weight loss over Months 13-18 of Intervention.
| Participants | Transdisciplinary Approach | Multidisciplinary Approach |
|---|---|---|
| Unintended Weight Loss | 137 | 294 |
Percent of nursing home residents with dementia who had falls over Months 1-6 of Intervention.
| Participants | Transdisciplinary Approach | Multidisciplinary Approach |
|---|---|---|
| Falls | 326 | 750 |
Percent of nursing home residents with dementia who had falls over Months 7-12 of Intervention.
| Participants | Transdisciplinary Approach | Multidisciplinary Approach |
|---|---|---|
| Falls | 274 | 700 |
Percent of nursing home residents with dementia who had falls over Months 13-18 of Intervention.
| Participants | Transdisciplinary Approach | Multidisciplinary Approach |
|---|---|---|
| Falls | 246 | 614 |
Percent of nursing home residents with dementia who had depressive symptoms over Months 1-6 of Intervention
| Participants | Transdisciplinary Approach | Multidisciplinary Approach |
|---|---|---|
| Depressive Symptoms | 37 | 90 |
Percent of nursing home residents with dementia who had depressive symptoms over Months 7-12 of Intervention.
| Participants | Transdisciplinary Approach | Multidisciplinary Approach |
|---|---|---|
| Depressive Symptoms | 24 | 95 |
Percent of nursing home residents with dementia who had depressive symptoms over Months 13-18 of Intervention.
| Participants | Transdisciplinary Approach | Multidisciplinary Approach |
|---|---|---|
| Depressive Symptoms | 20 | 59 |
Percent of nursing home residents with dementia who had physical restraint use over Months 1-6 of Intervention.
| Participants | Transdisciplinary Approach | Multidisciplinary Approach |
|---|---|---|
| Physical Restraints Use | 3 | 102 |
Percent of nursing home residents with dementia who had physical restraint use over Months 7-12 of Intervention.
| Participants | Transdisciplinary Approach | Multidisciplinary Approach |
|---|---|---|
| Physical Restraints Use | 4 | 91 |
Percent of nursing home residents with dementia who had physical restraint use over Months 13-18 of Intervention.
| Participants | Transdisciplinary Approach | Multidisciplinary Approach |
|---|---|---|
| Physical Restraints Use | 0 | 70 |
Collected over This pragmatic clinical trial was embedded into the workflow of the nursing homes. Our intervention was about training staff about dementia knowledge. We were not intervening at patient level, thus adverse outcomes were not relevant.. Non-serious events are listed at a 0% frequency threshold.
| Group | Deaths | Serious | Other |
|---|---|---|---|
| Transdisciplinary Approach | 0/1,291 (0%) | 0/1,291 (0%) | 0/1,291 (0%) |
| Multidisciplinary Approach | 0/3,206 (0%) | 0/3,206 (0%) | 0/3,206 (0%) |
This was a nursing home-level analysis, therefore not all participants were in the sample during the baseline period. Participants (i.e., nursing home residents) were included if they met the study criteria based on age, dementia status, and long-term nursing home residence, but could be included in the sample at any point of the study. Thus, there were participants who were in the study sample (and reflected in the flow overview), but were not in the study sample during the baseline period.
| Age, Continuous(years) | Transdisciplinary Approach | Multidisciplinary Approach | Total |
|---|---|---|---|
| Mean | 84.2 ± 8.1 | 84.9 ± 8.4 | 84.7 ± 8.3 |
| Sex: Female, Male(Participants) | Transdisciplinary Approach | Multidisciplinary Approach | Total |
|---|---|---|---|
| Female | 532 | 1469 | 2001 |
| Male | 227 | 500 | 727 |
| Race/Ethnicity, Customized(Participants) | Transdisciplinary Approach | Multidisciplinary Approach | Total |
|---|---|---|---|
| White, non-Hispanic | 622 | 1589 | 2211 |
| Black, non-Hispanic | 45 | 244 | 289 |
| Hispanic | 69 | 91 | 160 |
| Asian | 9 | 6 | 15 |
| Other | 14 | 39 | 53 |
| Cognitive Function Scale(Participants) | Transdisciplinary Approach | Multidisciplinary Approach | Total |
|---|---|---|---|
| Cognitively Intact | 80 | 219 | 299 |
| Mildly impaired | 123 | 369 | 492 |
| Moderately impaired | 427 | 1138 | 1565 |
| Severely impaired | 129 | 243 | 372 |
| Number of Nursing Home Beds(certified beds) | Transdisciplinary Approach | Multidisciplinary Approach | Total |
|---|---|---|---|
| Mean | 118.6 ± 50.2 | 119.9 ± 38.0 | 119.5 ± 41.8 |
| Nursing Home Occupancy Rate(# of occupied beds/ # of certified beds) | Transdisciplinary Approach | Multidisciplinary Approach | Total |
|---|---|---|---|
| Mean | 0.87 ± 0.1 | 0.87 ± 0.1 | 0.87 ± 0.1 |
| CMS Nursing Home Rating(units on a scale) | Transdisciplinary Approach | Multidisciplinary Approach | Total |
|---|---|---|---|
| State Survey | 2.6 ± 1.2 | 2.7 ± 1.2 | 2.7 ± 1.2 |
| Staffing Levels | 3.1 ± 0.7 | 2.7 ± 1.0 | 2.8 ± 0.9 |
| Quality of Care | 3.5 ± 1.1 | 3.6 ± 1.1 | 3.5 ± 1.1 |
| Quality Measures(percentage of long-stay residents) | Transdisciplinary Approach | Multidisciplinary Approach | Total |
|---|---|---|---|
| increased in need for help with ADL | 18.3 ± 6.7 | 17.3 ± 5.4 | 17.6 ± 5.8 |
| had pressure ulcer | 8.8 ± 3.7 | 8.3 ± 3.7 | 8.5 ± 3.7 |
| lost too much weight | 5.6 ± 2.5 | 7.3 ± 3.5 | 6.8 ± 3.3 |
| had catheter inserted and left in bladder | 1.4 ± 1.2 | 1.3 ± 1.4 | 1.3 ± 1.3 |
| had urinary tract infection | 2.9 ± 2.5 | 2.1 ± 1.6 | 2.4 ± 1.9 |
| have depressive symptoms | 4.6 ± 5.7 | 3.6 ± 4.1 | 3.8 ± 4.6 |
| were physically restrained | 0.1 ± 0.3 | 0.2 ± 0.5 | 0.1 ± 0.4 |
| had fall(s) with injury | 4.2 ± 1.9 | 3.1 ± 2.5 | 3.5 ± 2.4 |
| received antipsychotic medication | 12.7 ± 3.9 | 13.4 ± 6.4 | 13.2 ± 5.7 |
| ability to move independently worsened | 21.2 ± 9.9 | 21.3 ± 7.8 | 21.2 ± 8.4 |
| received antianxiety/hypnotic medication | 22.4 ± 7.3 | 21.4 ± 11.5 | 21.7 ± 10.3 |
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