Michelle Simpson

This study tested the effectiveness of the Serial Trial Intervention (STI), an innovative clinical protocol for assessment and management of unmet needs in people with late-stage dementia. A double-blinded randomized experiment was conducted in 14 nursing homes with 114 subjects. The treatment group had significantly less discomfort than the control group at posttesting and more frequently had behavioral symptoms return to baseline. The group of nurses using the STI also showed more persistence in assessing and intervening than control group nurses did. There was a statistically significant difference between the groups in the use of pharmacological, but not nonpharmacological, comfort treatments. Results suggest that the STI is effective and that effective treatment of discomfort is possible for people with late-stage dementia.

<blockquote>This article is a companion piece to an article that appeared in the April issue of the <cite>Journal of Gerontological Nursing</cite> entitled “The Serial Trial Intervention: An Innovative Approach to Meeting Needs of Individuals with Dementia” (Vol. 32, No. 4, pp. 18-25). The first article, by Christine R. Kovach, PhD, RN, Patricia E. Noonan, MSN, APRN, BC, Andrea Matovina Schlidt, MSN, GNP, Sheila Reynolds, MS, APRN, BC, and Thelma Wells, PhD, RN, FAAN, FRCN, describes the Serial Trial Intervention (STI)—an innovative approach to assessing and treating unmet needs of individuals with dementia. In this month’s article, the authors examine whether recurring behaviors were predicted by variations in approaches to nursing care. The research was part of a larger study of the effectiveness of the STI as an approach to behaviors associated with advanced dementia.</blockquote> <h4>EXCERPT</h4> <p>More than half of individuals with advanced dementia exhibit behaviors that have been described as challenging, disruptive, or problematic (Allen-Burge, Stevens, & Burgio, 1999; Burgio, Scilley, Hardin, & Hsu, 2001; Jackson, Spector, & Rabins, 1997). Approximately half of these behaviors involve problematic vocalizations or physical aggression (Ballard et al., 2001; Beck & Vogelpohl, 1999). Caregivers are commonly taught to respond to such behaviors using psychosocial and environmental treatments (Burgener & Twigg, 2002), based on the assumption that the source of the behavior is not unmet physical needs. However, these psychosocial and environmental treatments are not preceded by a systematic assessment to rule out physical needs, and the assumption therefore may be faulty.</p>

OBJECTIVES: To describe the Bundled Hospital Elder Life Program (HELP and HELP in Home Care), an adaptation of HELP, and examine the association of 30-day all-cause unplanned hospital readmission risk among older adults discharged to home care with and without Bundled HELP. DESIGN: Matched case-control study. SETTING: Two medical-surgical units within two midwestern rural hospitals and patient homes (home health). PARTICIPANTS: Hospitalized patients, aged 65 years and older, discharged to home healthcare with and without Bundled HELP exposure between January 1, 2015, and September 30, 2017. Each case (Bundled HELP, n = 148) was matched to a control (non-Bundled HELP, n = 148) on Charlson Comorbidity Index, primary hospital diagnosis of orthopedic condition or injury, and cardiovascular disease using propensity score matching. MEASUREMENTS: The primary study outcome was 30-day all-cause unplanned hospital readmission. Additional outcomes measured were 30-day emergency department (ED) visit, hospital length of stay (LOS), and total number of skilled home care visits. RESULTS: Fewer cases (16.8%) than controls (28.4%) had a 30-day all-cause unplanned hospital readmission. The fully adjusted model showed significantly lower risk of 30-day hospital readmission for case (Bundled HELP) patients (0.41; 95% confidence interval = 0.22-0.77; P < .01). The difference between case (10.8%) and control (15.5%) 30-day ED visit was not significant (P = .23). A lower LOS for the case group was shown (P < .01), while the number of skilled home care visits was not significantly different between groups (P = .28). CONCLUSION: HELP protocol implementation during a patient's hospital stay and as a continued component of home care among older adults at risk for cognitive and/or functional decline appears to be associated with favorable outcomes. Our initial evaluation supports continued study of the Bundled HELP. Further research is needed to confirm the initial findings and to evaluate the impact of the adapted model on functional outcomes and delirium incidence in the home. J Am Geriatr Soc 67:1730-1736, 2019.