Health Care Team Interventions to Reduce Distress Behaviors in Older Adults: A Systematic Review

ABSTRACT

Objectives

This review examines health care team-focused interventions on managing persistent or recurrent distress behaviors among older adults in long-term residential or inpatient health care settings.

Methods

We searched interventions addressing health care worker (HCW) knowledge and skills related to distress behavior management using Ovid MEDLINE, Elsevier Embase, and Ovid PsycINFO from December 2002 through December 2022.

Results

We screened 6,582 articles; 29 randomized trials met inclusion criteria. Three studies on patient-facing HCW interactions (e.g. medication management, diagnosing distress) showed mixed results on agitation; one study found no effect on quality of life. Six HCW-focused studies suggested short-term reduction in distress behaviors. Quality-of-life improvement or decreased antipsychotic use was not evidenced. Among 17 interventions combining HCW-focused and patient-facing activities, 0 showed significant distress reduction, 8 showed significant antipsychotic reduction (OR = 0.79, 95%CI [0.69, 0.91]) and 9 showed quality of life improvements (SMD = 0.71, 95%CI [0.39, 1.04]). One study evaluating HCW, patient-, and environmental-focused intervention activities showed short-term improvement in agitation.

Conclusions and Clinical Implications

Novel health care models combining HCW training and patient management improve patient quality of life, reduce antipsychotic use, and may reduce distress behaviors. Evaluation of intervention’s effects on staff burnout and utilization is needed.

KEYWORDS:

• Distress behaviors
• health care workers
• institutional settings
• older adults
• patient-centered interventions

Acknowledgments

The authors thank the following key stakeholders and technical expert panel members for their feedback and guidance, Maureen Haske-Palomino, DNP, MSN, GNP-BC, Scott Hutton, PhD, RN, MBA, FAAN, Steve Weintraub, MD, MS and Michele Karel PhD for nominating the topic. Additionally, we would like to thank Liz Wing, MA and Stacy Lavin, PhD, for editorial assistance, and Jessica Fulton, PhD for reference screening.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

Data will be made available upon reasonable request and in accordance with organizational policy.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/07317115.2024.2372424

Additional information

Funding

This work was supported in part by the National Cancer Institute (Katherine Ramos, K08CA258947), the VA (Megan Shepherd-Banigan, HSR&D Career Development Award [CDA-17-006]). This project was also funded by the Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development (ESP 09- 010). This work was also supported by the Durham Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) (CIN 13-410) at the Durham VA Health Care System. The US Department of Veterans Affairs was not involved in the design, conduct, or analysis interpretation.