Preventing Aggression in Veterans With Dementia
Condition: Dementia; Aggression; Pain
MeSH terms: Dementia; Aggression
Intervention: PAVeD Intervention; Enhanced Usual Care
Intervention description: In the PAVeD Intervention, the caregiver will receive six to eight 45-minute visits to teach caregiver about pain and memory problems. The person with dementia will also be able to learn from these visits. These visits will take place over three months.; In Enhanced Usual Care, the caregiver will receive information in the mail about memory problems and pain; and the caregiver will receive eight short telephone calls to check on how the person with dementia is doing.
Primary Care providers will be notified through electronic medical records about any significant behavioral problems or pain.
Phase: Phase 3
Study type: Interventional
Primary purpose: Health Services Research
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Enrollment: 203.0
Sex: All
Minimum age: 60 Years
Healthy volunteers: Accepts Healthy Volunteers

Summary:

      This study tests whether education about memory and pain might help to prevent aggression in
      persons with dementia who have pain. The overall goal of this intervention is to reduce the
      risk of aggressive behavior by improving several areas of patient life that are known causes
      of aggression: pain, depression, lack of pleasurable activities, caregiver stress and
      difficulty in caregiver-patient communication.
    

Eligibility criteria:

        Inclusion Criteria:

        Patients will be eligible to participate in the study if they meet the following criteria:

          -  have a documented diagnosis of dementia

          -  receive primary care from the VA

          -  reside outside a long-term care facility

          -  live within 45 minutes of the MEDVAMC

          -  have mild-to-moderate dementia

          -  have no history of aggression in the past year

          -  have no evidence of aggression on the CMAI at baseline (i.e., do not score 2 or higher
             on both frequency and disruptiveness for any of 13 behaviors listed).

          -  have a caregiver who is directly involved with the patient:

               -  at least 8 hours per week

               -  sees the patient at least twice a week

               -  and speaks English

          -  report clinically significant pain (either directly or through the caregiver as a
             proxy)

        Exclusion Criteria:

        Patients will be excluded if they have had history of aggression in the past year

          -  The investigators will administer the aggression subscale of the Cohen-Mansfield
             Agitation Inventory (CMAI)

          -  Aggression will be considered present if any of the following items are endorsed as
             having occurred over the prior year:

               -  spitting

               -  cursing/verbal aggression

               -  hitting

               -  kicking

               -  grabbing

               -  pushing

               -  throwing

               -  biting

               -  scratching

               -  hurting self/others

               -  tearing things/destroying property

               -  making inappropriate verbal sexual advances

               -  or making inappropriate physical sexual advances

        Participants that scored 2 or higher for both frequency and disruptiveness on any of the 13
        behaviors listed on the CMAI at baseline were considered aggressive and were excluded from
        the study.