RecruitingNot ApplicableNCT05950607

Trial to Reduce Antimicrobial Use in Nursing Home Residents With Alzheimer's Disease and Other Dementias 2.0

Trial to Reduce Antimicrobial Use In Nursing Home Residents With Alzheimer's Disease and Other Dementias 2.0 (TRAIN-AD 2.0)

Sponsor

Hebrew SeniorLife

Enrollment

750 participants

Start Date

Nov 13, 2023

Study Type

INTERVENTIONAL

Conditions

Dementia Infections Alzheimer Disease

Summary

The goal of this pragmatic cluster randomized clinical trial is to compare management of suspected infection in nursing home residents with dementia The main questions it aims to answer whether residents with dementia in nursing homes randomized to use a multicomponent intervention to optimize suspected infection management ( versus usual care) use less antibiotics and fewer burdensome interventions.

Eligibility

Min Age: 60 YearsMax Age: 106 Years

Inclusion Criteria5

Age \> 60
A diagnosis of dementia (any type)
Cognitive Functional Scale (CFS) \> 1
NH length of stay \>90 days
The CFS score categorizes cognitive impairment status based on data in the electronic health record into: 1. None, 2. Mild, 3. Moderate, and 4. Severe (advanced). For the primary outcome, the analysis will be restricted to residents with a CFS score of 3 or 4.

Exclusion Criteria4

Less than 60 years of age
Living in nursing home for less than 90 days
Does not have diagnosis of dementia
Does not meet CFS \>1 score

Interventions

BEHAVIORALTRAIN AD 2.0

The study intervention is a multi-component training program targeting direct care providers and healthcare proxies for NH residents with moderate to advanced dementia intended to improve the management of urinary tract infections (UTIs) and lower respiratory tract infections (LRIs). The components include: A. Provider Orientation: At NH start-up and q2 months providers will be offered orientations sessions involving two 15-minute presentations, one focused on the background and rationale for the program and one focused on describing the program components. B. A case-based on-line course, "Infection Management in Moderate to Advanced Dementia," C. Posters and pocket cards for providers displaying algorithms guiding appropriate antimicrobial initiation for suspected UTIs and LRIs that integrate patient preferences, and D. Proxies of ALL residents in the facility will be sent a booklet related to infection management for persons with moderate to advanced dementia. .