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A randomized clinical trial of theory-based activities for the behavioral symptoms of dementia in nursing home residents


Kolanowski, Ann, Litaker, Mark, Buettner, Lin, Moeller, Joyel, Costa, Paul T., Jr.


Journal Of The American Geriatrics Society, Volume: 59, No.: 6, Pages.: 1032-1041

Year of Publication



Objectives: To test the main and interactive effects of activities derived from the Need-Driven Dementia-Compromised Behavior model for responding to behavioral symptoms in nursing home residents.; Design: Randomized double-blind clinical trial.; Setting: Nine community-based nursing homes.; Participants: One hundred twenty-eight cognitively impaired residents randomly assigned to activities adjusted to functional level (FL) (n=32), personality style of interest (PSI) (n=33), functional level and personality style of interest (FL+PSI) (n=31), or active control (AC) (n=32).; Intervention: Three weeks of activities provided twice daily.; Measurements: Agitation, passivity, engagement, affect, and mood assessed from video recordings and real-time observations during baseline, intervention, random times outside of intervention, and 1 week after intervention.; Results: All treatments improved outcomes during intervention except mood, which worsened under AC. During intervention the PSI group demonstrated greater engagement, alertness, and attention than the other groups; the FL+PSI group demonstrated greater pleasure. During random times, engagement returned to baseline levels except in the FL group in which it decreased. There was also less agitation and passivity in groups with a component adjusted to PSI. One week after the intervention, mood, anxiety, and passivity improved over baseline; significantly less pleasure was displayed after withdrawal of treatment.; Conclusion: The hypothesis that activities adjusted to FL+PSI would improve behavioral outcomes to a greater extent than partially adjusted or nonadjusted activities was partially supported. PSI is a critical component of individualized activity prescription.; © 2011, Copyright the Authors. Journal compilation © 2011, The American Geriatrics Society.

Bibtex Citation

@article{Kolanowski_2011, doi = {10.1111/j.1532-5415.2011.03449.x}, url = {}, year = 2011, month = {jun}, publisher = {Wiley-Blackwell}, volume = {59}, number = {6}, pages = {1032--1041}, author = {Ann Kolanowski and Mark Litaker and Lin Buettner and Joyel Moeller and Paul T. Costa Jr.}, title = {A Randomized Clinical Trial of Theory-Based Activities for the Behavioral Symptoms of Dementia in Nursing Home Residents}, journal = {Journal of the American Geriatrics Society} }


activities, activities of daily living, affect, aged, aged, 80 and over, apathy, arousal, cognition disorders, dementia, diagnosis, female, homes for the aged, humans, individuality, male, mental disorders, motor activity, nursing homes, occupational therapy, passivity, personality assessment, psychology, psychomotor agitation, rehabilitation

Countries of Study


Types of Dementia

Dementia (general / unspecified)

Types of Study

Randomised Controlled Trial

Type of Outcomes

Behaviour, Other


Nursing Homes

Type of Interventions

Non-pharmacological Treatment

Non-Pharmaceutical Interventions