Bridging Disciplinary Boundaries (January 11 - 14, 2007)

Purpose: The purpose of this study was to evaluate the effectiveness of Advanced Illness Care Teams (AICTs) as a multidisciplinary approach for improving the comfort, care and well-being of nursing home residents with advanced dementia. The AICTs met regularly to develop and monitor individualized care plans. These plans focused on six domains; medical, psychological, psychosocial, meaningful activities, behavioral, and familial. An AICT treatment manual is available upon request. Methods: This study used a 2 x 2 x 2 randomized partial crossover design with two intervention conditions, two nursing homes, and assessments at baseline and two months. A total of 118 residents were screened and randomly assigned to AICT or usual care (UC) and measured for symptoms of pain, agitation, and depression using standardized instruments. Pain was measured with two instruments; the Faces, Legs, Activity, Cry and Consolability (FLACC) and Pain in Advanced Dementia (PAINAD) scales. Agitation was measured with the Cohen-Mansfield Agitation Inventory (CMAI), and depression was measured with the Cornell Scale for Depression in Dementia (CSDD). Random effects regression models were used to analyze the data. Results: An analysis of the outcome measures showed that AICT was significantly more effective than UC in reducing one type of agitated behavior, but no more effective than UC in reducing other forms of agitation, depression or pain. A decrease in the mean scores on most of the outcome measures for both AICT and UC residents suggests that the treatment effect for AICT residents may have spilled over to control participants who were on the same units as residents assigned to AICT. The implications of this spill over or contamination effects for nursing home research will be discussed. Implications for practice: Multidisciplinary teams are commonly used to inform and shape care planning in nursing homes as well as other health care settings. Teams that function effectively can improve the comfort, care, and well-being of nursing home residents with advanced dementia who have been neglected in previous research. Clinical practice issues in forming teams and training staff in the care of nursing home residents with advanced dementia will be discussed (Funded by the New York State Department of Health, Dementia Grants Program).