Dementia: MARQUE intervention fails to reduce agitation in nursing home residents

  • Lancet Psychiatry

  • International Clinical Digest
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Takeaway

  • The Managing Agitation and Raising Quality of Life (MARQUE) intervention was feasible but did not significantly alleviate agitation among nursing home residents with dementia.

Why this matters

  • Agitation symptoms are distressing for patients and family, costly to manage.

Key results

  • At 8 months, intervention and usual care groups not significantly different on:
    • Mean Cohen-Mansfield Agitation Inventory score (adjusted difference, −0.40; P=.8226).
    • Clinically significant agitation (OR, 1.14; P=.6828).
  • Also no significant difference in secondary outcomes:
    • Cost (mean difference, £204; P=.320).
    • Quality-adjusted life-years (mean difference, 0.015; P=.127).
    • Mortality (14% vs 19%; P=nonsignificant).
    • Prescription of antipsychotic drugs (OR, 0.66; P=.3880).

Expert comment

  • In a Comment, Frances Bunn, PhD, MSc, and Melanie Handley, MSc, write, “… the MARQUE study indicates that education and training for care home staff is unlikely to reduce agitation in residents with dementia. Multicomponent interventions that include social and sensory activities might be needed to reduce agitation. Interventions should focus on improving the quality and quantity of interventions between care home staff and people with dementia,…and providing opportunities for one to one interaction…. Interventions need to consider contextual factors and align with the priorities and responsibilities of care home staff who care for people with dementia.”

Study design

  • Cluster-randomized controlled trial in 20 care homes across England among 404 residents with dementia.
  • Randomization: MARQUE intervention vs treatment as usual.
  • Intervention: evidence- and manual-based intervention on agitation-management skills and strategies, delivered by supervised graduate psychologists to staff in 6 interactive sessions.
  • All individuals except care home staff blinded to group assignment.
  • Main outcome: Cohen-Mansfield Agitation Inventory score at 8 months.
  • Funding: UK Economic and Social Research Council; National Institute of Health Research.

Limitations

  • Possible recruitment bias.
  • Trial not powered for cost-effectiveness.
  • Unknown long-term efficacy.

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