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Agitation in nursing home residents with dementia (VIDEANT trial): effects of a cluster-randomized, controlled, guideline implementation trial


Rapp, Michael A., Mell, Thomas, Majić, Tomislav, Treusch, Yvonne, Nordheim, Johanna, Niemann-Mirmehdi, Mechthild, Gutzmann, Hans, Heinz, Andreas


Journal Of The American Medical Directors Association, Volume: 14, No.: 9, Pages.: 690-695

Year of Publication



Objective: To test the effect of a complex guideline-based intervention on agitation and psychotropic prescriptions.; Design, Setting, Participants: Cluster randomized controlled trial (VIDEANT) with blinded assessment of outcome in 18 nursing homes in Berlin, Germany, comprising 304 dementia patients.; Intervention: Training, support, and activity therapy intervention, delivered at the level of each nursing home, focusing on the management of agitation in dementia. Control group nursing homes received treatment as usual.; Measurements: Levels of agitated and disruptive behavior (Cohen-Mansfield agitation inventory [CMAI]) as the primary outcome. Number of neuroleptics, antidepressants, and cholinesterase inhibitors (ChEIs) prescribed in defined daily dosages (DDDs).; Results: Of 326 patients screened, 304 (93.3%) were eligible and cluster-randomized to 9 intervention (n = 163) and 9 control (n = 141) nursing homes. Data were collected from 287 (94.4%) patients at 10 months. At 10 months, compared with controls, nursing home residents with dementia in the intervention group exhibited significantly less agitation as measured with the CMAI (adjusted mean difference, 6.24; 95% CI 2.03-14.14; P = .009; Cohen’s d = 0.43), received fewer neuroleptics (P < .05), more ChEIs (P < .05), and more antidepressants (P < .05).; Conclusion: Complex guideline-based interventions are effective in reducing agitated and disruptive behavior in nursing home residents with dementia. At the same time, increased prescription of ChEIs and antidepressants together with decreased neuroleptic prescription suggests an effect toward guideline-based pharmacotherapy.; Copyright © 2013 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.

Bibtex Citation

@article{Rapp_2013, doi = {10.1016/j.jamda.2013.05.017}, url = {}, year = 2013, month = {sep}, publisher = {Elsevier {BV}}, volume = {14}, number = {9}, pages = {690--695}, author = {Michael A. Rapp and Thomas Mell and Tomislav Majic and Yvonne Treusch and Johanna Nordheim and Mechthild Niemann-Mirmehdi and Hans Gutzmann and Andreas Heinz}, title = {Agitation in Nursing Home Residents With Dementia ({VIDEANT} Trial): Effects of a Cluster-Randomized, Controlled, Guideline Implementation Trial}, journal = {Journal of the American Medical Directors Association} }


aged, 80 and over, agitation, and, antidepressive agents, antipsychotic agents, based, behavior therapy, cholinesterase inhibitors, cluster analysis, complications, dementia, drug therapy, etiology, female, geriatric assessment, germany, guideline, humans, implementation, intervention, intervention studies, male, nursing home, nursing homes, on, practice guidelines as topic, prescriptions, psychology, psychomotor agitation, psychotropic, therapeutic use, treatment outcome, trial

Countries of Study


Types of Dementia

Dementia (general / unspecified)

Types of Study

Cost and service use study, Randomised Controlled Trial

Type of Outcomes

Behaviour, Service use or cost reductions (incl. hospital use reduction, care home admission delay)


Nursing Homes

Type of Interventions

Non-pharmacological Treatment, Workforce oriented interventions

Non-Pharmaceutical Interventions


Workforce Interventions

Professional Training / Continuing Professional Development