NR 531-Evidence Review 1: Evidence Search

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Making a significant focus on the PICO (T) question review, a single aspect would be considered and discussed. This is; in patients with dementia, is using medications more effective than alternative therapies (i.e. art, music, tasks) for a reduction in agitation within one to three hours? This PICOT question is an interventional question. It addresses agitation in dementia patients, and which interventions are most effective.

The clinical issue of agitation in dementia patients is important. Much of the time, medications are used for a reduction in agitation. This method has pros and cons. By using a medication, it is considered a chemical restraint, and proper documentation needs to be implemented to ensure that the facility is in compliance with state regulations. Another issue, too, with the use of these medications in the elderly is the way the body processes them.

The elderly have physiological changes that affect the way their body processes medications. There is a lowering of hepatic blood flow – which slows down the rate of which the body uses and metabolizes the drug (Wooten, 2012). Another factor to consider is that many of these medications can increase the risk of falls in the elderly. Not only are the elderly more susceptible to the sedative effect, hypotension can be induced – both of which can elicit more falls in said population (Lindsey, 2009). That being said, there is a use, as well as evidence based practice, that alternative therapies can be effective to reduce agitation in the elderly.

There is evidence that alternative therapies can be used to reduce agitation. Some examples of alternative therapies include: art therapy, aromatherapy, music therapy, and activity therapy. There is even something called bright-light therapy that is used for those with sundowning, and this has shown some effect in studies. (Douglas, James, Ballard, 2004). In Hong Kong, a study was performed using aromatherapy in Chinese dementia patients. Lavender inhalation was used, and found to be effective in reducing anxiety in these patients (Lin, Chan, Ng, Lam, 2007).

Of course, this does not in any way disregard the effectiveness and necessity of using medications to address agitation. Unfortunately, alternative therapies do not always work and then the use of an anti-anxiety medication is warranted. It is important, though, to ensure that alternative interventions are attempted in order to reach the best possible outcome with the least side effects.

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Nurses are quite busy throughout their day, and do not always have the time to intervene using alternative modalities. Therefore, it is important that auxiliary staff – such as recreational staff and nursing assistants are taught how to utilize these alternative modalities, as it is proven in evidence-based practice that there are better outcomes for the patient by using alternative therapies in dementia patients. Agitation in dementia patients can be decreased in a reasonable amount of time by utilizing strategies of alternative therapies and are just as, if not more, effective than the use of psychotropic medication. Evidence Review 1: Evidence Search

References:

Biese, K., LaMantia, M., Shofer, M., McCall, B., Roberts, E., Stearns, S. C., Principe, S., Kizer, J. S., Cairns, C. B., & Busby-Whitehead, J. (2014): A randomized trial exploring the effect of a telephone call follow-up on care plan compliance among older adults discharged home from the emergency department. Academic Emergency Medicine, 21(2), 188-195. doi:10.1111/acem.12308

Cossette, S., Frasure-Smith, N., Vadeboncoeur, A., McCusker, & Guertin, M. C. (2015). The impact of an emergency department nursing intervention on continuity of care, self-care capacities and psychological symptoms: Secondary outcomes of a randomized controlled trial. International Journal of Nursing Studies, 52, 666-676. http://dx.doi.org/10.1016/j.ijnurstu.2014.12.007

Cossette, S., Vadeboncoeur, A., Frasure-Smith, N., McCusker, J., Perreault, D., & Guertin, M. C. (2015). Randomized controlled trial of a nursing intervention to reduce emergency department revisits. Canadian Journal of Emergency Medicine, 17(1), 13-20. doi:10.2310/8000.2013.131291

Franzen, C., Brulin, C., Stenlund, H., & Bjornstig, U. (2008). Injured road users’ health-related quality of life after telephone intervention: a randomized controlled trial. Journal of Clinical Nursing, 18, 108-116. doi:10.1111/j.1365-2702.2008.02436.x

Guss, D. A., Leland, H., & Castillo, E. M. (2013). The impact of post-discharge patient call back on patient satisfaction in two academic emergency departments. The Journal of Emergency Medicine, 44(1), 236-241. http://dx.doi.org/10.1016/j.jemermed.2012.07.074

Wong, F. K., Chow, S., Chang, K., Lee, A., & Liu, J. (2004). Effects of nurse follow-up on emergency room revisits: a randomized controlled trial. Social Science & Medicine, 59(11), 2207-2218. doi:10.1016/j.socscimed.2004.03.028

Douglas, S., James, I., Ballard, C. (2004): Non-pharmacological interventions in dementia. Advances in Psychiatric Treatment. Retrieved July 9, 2014 from http://apt.rcpsych.org/content/10/3/171.full

Lin, P., Chan, W., Ng, B., Lam, L. (2007). Efficacy of aromatherapy (Lavender angustifolia) as an intervention for agitated behaviours in Chinese older persons with dementia: A cross-over randomized trial. University of Hong Kong. Retrieved July 10, 2014, from http://hub.hku.hk/handle/10722/174236

Lindsey, P.L. (2009). Psychotropic Medication Use among Older Adults: What All Nurses Need to Know. Journal of Gerontological Nursing. Retrieved July 9, 2014, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3128509/

Wooten, J. M. (2012). Pharmacotherapy Considerations in Elderly Adults. National Center for Biotechnology Information. Retrieved July 9, 2014, from http://www.ncbi.nlm.nih.gov/pubmed/22864103 Evidence Review 1: Evidence Search