Individualized Cognition-Action intervention to prevent behavioral disturbances and functional decline in institutionalized older adults: a randomized pilot trial

Objective: To evaluate the effectiveness of an individualized Cognition-Action (CA) intervention to reduce behavioral disturbances in severely deconditioned institutionalized old adults. Design: 12 weeks randomized pilot trial of either individualized Cognition-Action program (n = 24) or routine medical care as control (C, n = 25). Setting: Long-term care (LTC) of the Geriatric Department from the University State Hospital in Bordeaux, France. Participants: 49 institutionalized old patients with at least one Neuropsychiatric symptoms >= 4. Intervention: The CA rationale was a non-preconceived ideas approach over the patient's abilities and discourse. Patients received short bouts of 5-15 min and accumulated 50 min of interaction per week. CA intervention used five standardized exercises as tools to enhance communication and social interactions. CA was compared to usual care. Measurements: Primary outcomes were the Neuropsychiatric inventory (NPI) total and symptoms scores. Secondary outcomes were the BERG balance scale, the Geriatric Depression Scale (GDS), Quality of life AM-PAC-CAT and Muscle strength. Results: The CA group had a clinically significant NPI total score reduction compared to C, -7, 95%CI [-10.8 to -3], eta(2)(p) = 0.24. CA group showed a risk reduction of NPI total score worsening, OR = 0.09, 95%CI [0.02-0.3]. BERG total score was clinically improved in the CA group compared to C, 4.9 95%CI [0.7-9.2], eta(2)(p) = 0.11. CA patients reduced their GDS score and improved their Quality of life and Strength. Conclusions: The combination of tailored guidance and simple standardized exercises was an effective behavioral management approach for behavioral disturbances reduction and functional autonomy improvement in institutionalized old adult populations. Copyright (C) 2009 John Wiley & Sons, Ltd.