Please select the eligibility criteria that correspond to the clinical trial below.
Title: Educational Video to Improve Nursing Home Care in End-stage Dementia
Brief Summary: This is a 5-year cluster RCT of a video Advance Care Planning intervention vs. control among 360 nursing home residents with advanced dementia (N=180/arm) in 20 matched nursing homes (10 intervention/10 control). Clinical outcomes will be collected at baseline, and quarterly (up to 12-months) regarding goals of care preferences, advance care planning, and treatments received. The primary outcome is decisions not to be hospitalized at 6 months.


Options:
A: Inclusion Criteria:

* Vascular- or Alzheimer Dementia
* Nursing Homes resident for 3 months or more
* Given antipsychotics or antidepressants for 3 months or more
* Clinical Dementia rating 1, 2 or 3

Exclusion Criteria:

* Dementia of other origin
* Psychiatric disease
* Life expectancy less than 3 months
* Acute infection last 10 days
* Unstable Diabetes Mellitus
* Terminal disease
B: Inclusion Criteria:

* Facilities are within Genesis HealthCare or PruittHealth health care systems
* Facilities have facility identifiers that indicate that they are Medicare/Medicaid-certified nursing facilities in the U.S.
* Facilities serve both short and long-stay patients
* Facilities have \>50 beds
* Facilities have an electronic medical records system
* Facilities had at least 20 admissions and 20 annual Minimum Data Set (MDS) assessments (regardless of whether they were discharged alive) in 2013

Exclusion Criteria:

* Facilities excluded per corporate leaders in health care system because of recent turnover in NH administrator or Director of Nursing
* Facilities excluded per corporate leaders in health care system because of recent bad state or federal quality assurance survey (e.g. restriction on admissions, levied large civil monetary penalty, etc.)
* Facilities excluded per corporate leaders in health care system because of current new initiatives/competing demands
C: Inclusion Criteria:

* Dementia, either sex, age 50-95 years
* Probable Alzheimer's disease
* Intellectual impairment present for at least 6 months
* Mini Mental State Exam (MMSE) score of 5-26 for outpatients and 2-26 for nursing home patients
* Availability of informant who has had direct contact with the patient for an average of at least once every week during the 3 months prior to study entry
* Meets Neuropsychiatric Inventory (NPI) criteria for either (1) psychosis, or (2) agitation/aggression
* Able to mobilize independently (if wheelchair-bound, the patient must be able to self-propel)
* Free of psychotropic medication (or able to tolerate washout) for at least 1 week prior to study entry. Low dose antidepressants and sedative/hypnotics allowed if they cannot be washed out and the dose remains stable for the study duration
* Expected to complete the study (including all efficacy evaluations) and be without major sensory impairment that would prevent participation in any aspect of the study

Exclusion Criteria:

* Current primary Axis I psychiatric disorder other than AD
* Substance abuse or dependence currently, or within the past year
* Dementia due to head trauma
* History of allergy to risperidone or intolerance to risperidone
* Diffuse Lewy body disease
* History of seizure disorder, infectious encephalitis, Parkinson's disease, central nervous system (CNS) neoplasm, tardive dyskinesia, stroke, transient ischemic attack (TIA) or uncontrolled atrial fibrillation
* Use of monoamine oxidase inhibitors (MAOIs) and unable to undergo 3-week washout; patients also may not take MAOIs for 2 weeks after completing the study
* In treatment with (a) depot antipsychotic within 2 weeks of the screening visit
* Untreated or incompletely treated hypothyroidism
* Active, unstable medical condition that requires active medication adjustment or surgery
* Need for electroconvulsive treatment (ECT)
* Significant risk for harm to themselves or others as a result of randomization to placebo
* History of malignant neoplasm during the last 5 years
D: Inclusion Criteria:

* Age \> 65
* A diagnosis of dementia (any type)
* Global Deterioration Scale (GDS) score of 7
* Nursing home length of stay \> 30 days
* Proxy is available who can speak in English
* Proxy must either live within a 60 mile radius of Boston or be available to come to the residents nursing home within 2 weeks of recruitment in order to conduct the in-person baseline interview.

Exclusion Criteria:

* Residents with cognitive impairment due to causes other than dementia (e.g. head trauma) and in short-term, sub-acute SNFs will be excluded

Answer: D