Management of apathy in nursing homes using a teaching program for care staff: the STIM-EHPAD study

Authors

  • Elsa Leone,

    Corresponding author
    • Memory Center of Nice (Centre Mémoire de Ressources et de Recherche), Centre Hospitalier Universitaire de Nice, France
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  • Audrey Deudon,

    1. Memory Center of Nice (Centre Mémoire de Ressources et de Recherche), Centre Hospitalier Universitaire de Nice, France
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  • Murielle Bauchet,

    1. Memory Center of Nice (Centre Mémoire de Ressources et de Recherche), Centre Hospitalier Universitaire de Nice, France
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  • Mathilde Laye,

    1. Memory Center of Nice (Centre Mémoire de Ressources et de Recherche), Centre Hospitalier Universitaire de Nice, EA CoBTeK, France
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  • Nathalie Bordone,

    1. Memory Center of Nice (Centre Mémoire de Ressources et de Recherche), Centre Hospitalier Universitaire de Nice, France
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  • Ji-Hyun Lee,

    1. Memory Center of Nice (Centre Mémoire de Ressources et de Recherche), Centre Hospitalier Universitaire de Nice, EA CoBTeK, France
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  • Julie Piano,

    1. Memory Center of Nice (Centre Mémoire de Ressources et de Recherche), Centre Hospitalier Universitaire de Nice, EA CoBTeK, France
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  • Leah Friedman,

    1. Sierra-Pacific Mental Illness Research, Education, and Clinical Center, Division of Psychiatry, VA Palo Alto Health Care System, Palo Alto, CA, USA
    2. Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
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  • Renaud David,

    1. Memory Center of Nice (Centre Mémoire de Ressources et de Recherche), Centre Hospitalier Universitaire de Nice, EA CoBTeK, France
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  • Fleur Delva,

    1. Université Bordeaux, ISPED, Bordeaux, France
    2. Memory Center of Bordeaux (Centre Mémoire de Ressources et de Recherche), Centre Hospitalier Universitaire de Bordeaux, France
    3. INSERM U897, France
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  • Patrice Brocker,

    1. Centre Hospitalier Universitaire de Nice, France
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  • Jerome Yesavage,

    1. Sierra-Pacific Mental Illness Research, Education, and Clinical Center, Division of Psychiatry, VA Palo Alto Health Care System, Palo Alto, CA, USA
    2. Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
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  • Philippe Henri Robert

    1. Memory Center of Nice (Centre Mémoire de Ressources et de Recherche), Centre Hospitalier Universitaire de Nice, EA CoBTeK, France
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Correspondence to: Elsa Leone, E-mail: leone.e@chu-nice.fr

Abstract

Objective

This study aimed to evaluate the effectiveness of a nursing home (NH) staff education to manage apathy in older individuals with a diagnosis of dementia.

Methods

Sixteen NHs agreed to participate, and 230 demented apathetic residents were randomly assigned to the reference group (RG) or the intervention group (IG). IG received a month of weekly 4-h training. Qualitative evaluation was performed through interviews and questionnaires regarding work practices and knowledge about dementia. Quantitative evaluation was at baseline, at the end of the training program (week 4), and 3 months after the end of it with the use of the Neuropsychiatric Inventory (NPI), the Apathy Inventory, and two observation scales.

Results

In the qualitative evaluation, very few staff responded to the questionnaire. Concerning the difficulty that managing residents' behavioral symptoms presented, aggressiveness was ranked as the most difficult behavior to manage and apathy as the least difficult. In the quantitative evaluation, the results are as follows. NPI: the IG scores increased from baseline to week 4 more than the RG for symptoms belonging to the affective and the psychotic NPI item subgroup. Apathy Inventory: there was a significant decrease of the emotional blunting score dimension in the IG. Group Observation Scale: significant improvement was observed for the emotional blunting dimension in the IG only.

Conclusions

Apathy is rarely identified as a problem in NH. Emotional blunting was the only dimension sensitive to change. Failure to improve residents' level of interest could be explained by the difficulties encountered in accessing information regarding the subjects' personal interests. But it remains possible to modify residents' emotional reactivity and staff's perceptions of residents' behaviors and emotions. Copyright © 2012 John Wiley & Sons, Ltd.

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