Effect of a Pain Protocol on Discomfort in Dementia
Christine R. Kovach, Project Director
Relevance The overall goal of this program of study is to improve assessment and treatment of discomfort in people with advanced dementia. This study is a test of two interventions designed to meet that goal.
Description The purpose of this competing continuation is to compare the effect of the Serial Trial Intervention plus Discomfort Burden Reduction intervention (STI plus DBR) to the STI alone on five outcomes: discomfort, behavioral symptoms, stress (cortisol), discomfort comorbidities, and use of acute care services. The STI was developed to assist in the differential diagnosis and treatment process: the focus is on early identification and correction of problems associated with discomfort. Our recent CT demonstrated that use of the STI was effective in decreasing discomfort. Despite the effectiveness of the STI, we found limitations in directing treatment that sustained improvements in comfort. Thus, we have developed the DBR intervention to supplement the STI. The DBR focuses on minimizing the clinically preventable and treatable burden of discomfort over a longer time period. We will examine group differences in process variables (scope of assessment, scope of treatment, stabilization of treatment, treatments added, treatment stopped, static cares and reactive cares); and plan to evaluate the efficacy of interventions in relation to dose. In addition, we propose to examine the effect of organizational characteristics on care received by measuring the interaction of staffing level, turnover level, and nursing home culture on group differences in resident care and resident outcomes. A two group repeated measures experimental design with double blinding procedures will be used to compare the two study conditions. Twelve long-term care facilities will be stratified based on size, location, and % Medicaid reimbursement, and then randomly assigned to one of the groups. A total sample of 122 (61 subjects/group) will provide at least 80% power to detect an effect size of 0.63 between any two groups. Use of the STI will be initiated when a subject exhibits behavioral/verbal symptoms of possible discomfort that are not ameliorated by basic care interventions. Nurses caring for subjects in the STI plus DBR group will initiate the DBR based upon information regarding effective treatment gained by using the STI. Inferential analyses planned include: mixed models for repeated measures, analysis of variance, Chi square and regression models for testing dose response.
PERFORMANCE SITES:
College of Nursing, University of Wisconsin–Milwaukee; Milwaukee, WI.
Alexian Village of Milwaukee; Milwaukee, WI.
Clement Manor Health Care Center; Greenfield, WI.
Franciscan Villa; South Milwaukee, WI.
Franciscan Woods; Brookfield, WI.
Jewish Home and Care Center; Milwaukee, WI.
Lasata Care Center; Cedarburg, WI.
Lutheran Home; Wauwatosa, WI.
Luther Manor, Wauwatosa, WI.
Mount Carmel Health and Rehabilitation; Milwaukee, WI.
St. Anne's Home for the Elderly; Milwaukee, WI.
Sunrise Care Center; Milwaukee, WI.
The Terrace at St. Francis; Milwaukee, WI.
Christine R. Kovach, Project Director
Relevance The overall goal of this program of study is to improve assessment and treatment of discomfort in people with advanced dementia. This study is a test of two interventions designed to meet that goal.
Description The purpose of this competing continuation is to compare the effect of the Serial Trial Intervention plus Discomfort Burden Reduction intervention (STI plus DBR) to the STI alone on five outcomes: discomfort, behavioral symptoms, stress (cortisol), discomfort comorbidities, and use of acute care services. The STI was developed to assist in the differential diagnosis and treatment process: the focus is on early identification and correction of problems associated with discomfort. Our recent CT demonstrated that use of the STI was effective in decreasing discomfort. Despite the effectiveness of the STI, we found limitations in directing treatment that sustained improvements in comfort. Thus, we have developed the DBR intervention to supplement the STI. The DBR focuses on minimizing the clinically preventable and treatable burden of discomfort over a longer time period. We will examine group differences in process variables (scope of assessment, scope of treatment, stabilization of treatment, treatments added, treatment stopped, static cares and reactive cares); and plan to evaluate the efficacy of interventions in relation to dose. In addition, we propose to examine the effect of organizational characteristics on care received by measuring the interaction of staffing level, turnover level, and nursing home culture on group differences in resident care and resident outcomes. A two group repeated measures experimental design with double blinding procedures will be used to compare the two study conditions. Twelve long-term care facilities will be stratified based on size, location, and % Medicaid reimbursement, and then randomly assigned to one of the groups. A total sample of 122 (61 subjects/group) will provide at least 80% power to detect an effect size of 0.63 between any two groups. Use of the STI will be initiated when a subject exhibits behavioral/verbal symptoms of possible discomfort that are not ameliorated by basic care interventions. Nurses caring for subjects in the STI plus DBR group will initiate the DBR based upon information regarding effective treatment gained by using the STI. Inferential analyses planned include: mixed models for repeated measures, analysis of variance, Chi square and regression models for testing dose response.
PERFORMANCE SITES:
College of Nursing, University of Wisconsin–Milwaukee; Milwaukee, WI.
Alexian Village of Milwaukee; Milwaukee, WI.
Clement Manor Health Care Center; Greenfield, WI.
Franciscan Villa; South Milwaukee, WI.
Franciscan Woods; Brookfield, WI.
Jewish Home and Care Center; Milwaukee, WI.
Lasata Care Center; Cedarburg, WI.
Lutheran Home; Wauwatosa, WI.
Luther Manor, Wauwatosa, WI.
Mount Carmel Health and Rehabilitation; Milwaukee, WI.
St. Anne's Home for the Elderly; Milwaukee, WI.
Sunrise Care Center; Milwaukee, WI.
The Terrace at St. Francis; Milwaukee, WI.
