Proctor R., Burns A., Stratton-Powell, H., Tarrier, N., Faragher, B., Richardson, G., Davis, L. and South, B.,

1999,

Reviewed by Professor Alistair Burns,
Department of Old Age Psychiatry,
Wythenshawe Hospital, Manchester

Method

This was a randomised controlled trial in 12 nursing and residential homes in South Manchester which were randomised to receive either a training and education package over a 6 month period directed at care staff or to be in a group where no specific help and education was provided. The intervention consisted of staff training in psychosocial management of the residents behavioural problems. The staff in the homes selected 10 residents of each home in which they felt there was a behavioural problem with which the staff thought they could do with some advice about managing. Examples of behavioural problems for which the staff requested help included screaming, frequent and unnecessary toilet request, aggressive behaviour, refusal to eat and low motivation. 7 one hour seminars were given by members of the hospital team on subject which the staff identified, eg management of dementia, aggression, screaming. An individual goal planning strategy was developed for each of the residents and a community nurse visited the home every week to give advice and support for the management of the behaviour. In total 120 residents were recruited to the study (10 residents in each home). 105 residents completed the study. Measures assessing the mental state of the residents and their behaviour were carried out.

Key findings

Residents in the intervention group had statistically significantly improved scores for depression and for cognitive impairment but no difference on a behavioural rating scale or an assessment of functioning. The education package was found to be very acceptable to care staff.

Critical appraisal

The study did not specifically target residents with a diagnosis of dementia or depression, simply those in whom the care staff thought were “a problem”, most of whom had a psychiatric problem.

There were no detailed ratings of how the staff viewed the intervention and if they felt it was helpful (in a companion paper, it was found that staff in the intervention group had less of a decline in measures of psychological stress compared to those in the control group over the period of the study).

The main reason for referral into the study was for behaviour problems and yet there was no improvement in the behaviour ratings of the residents in the intervention group.

No analysis was made as to which component of the intervention (the seminars or the individual work) was effective.

Social work practice/policy implications

Social workers should be aware that when home staff say that an elderly resident is a problem, that sometimes involving a specialist team in the assessment and management of that problem may help. Generally speaking, this study supports the notion that specialist care should be made routinely available to those in nursing and residential homes. The benefit of the intervention was independent of whether a person had a psychiatric diagnosis or not and so any person with a behavioural problem, from whatever cause, could potentially benefit from specialist input.