Purpose: To address the problems of physical and affective pain in people with late-stage dementia, the effectiveness of an innovative clinical protocol, the Serial Trial Intervention (STI), for comfort assessment and management was studied. Theoretical/Conceptual Framework: Recognizing behaviors of people with dementia as symptoms of unmet need, as described in the Need-Driven Dementia-Compromised Behavior (NDB) model provides the framework for the STI intervention. Subjects: The study was conducted in 14 nursing homes with 114 subjects obtained through nonprobability sampling. Method: A pretest-posttest experimental design with double-blinded procedures was utilized. In order to control treatment crossover effects, random assignment of facilities was used with the facilities stratified based on size, for-profit/not-for profit status, geographic location, and percentage of residents receiving Medicaid benefits. Process variables measured were scope of assessment and intervention and nurse persistence to intervene. Outcome measures were discomfort and return of behavioral symptoms to baseline. Results: Using mixed models for repeated measures, a significant group X time interaction indicated the treatment group had less discomfort (p < .001). More subjects in the treatment group had behavioral symptoms return to baseline (p=.003), and received a broader scope of physical (p < .001) and affective (p < .001) assessment at post testing than the control group. The group of nurses utilizing the STI also showed more persistence to assess and intervene than control group nurses (p < .001).There was not a statistically significant difference in the use of nonpharmacological comfort treatments between the treatment and control groups (p=.422). There was a statistically significant difference in the use of pharmacological comfort treatments between the groups (p < .001). Conclusions: The results of this study support that the STI is more effective than current care in decreasing discomfort and returning behaviors to baseline. The effect size of the intervention was large (.89) and adds to the growing body of evidence that effective treatment of discomfort is possible for this population.
Session #1183 - Cognitive Impairment
The 29th Annual MNRS Research Conference (April 1-4, 2005)