Commentary on: Effective behavioral interventions for decreasing dementia-related challenging behavior in nursing homes

✍ Scribed by Brian Lawlor

• Publisher: John Wiley and Sons
• Year: 1999
• Tongue: English
• Weight: 52 KB
• Volume: 14
• Category: Article
• ISSN: 0885-6230
• DOI: 10.1002/(sici)1099-1166(199903)14:3<230::aid-gps976>3.0.co;2-1

✦ Synopsis

dierent ways. Also, while commissioners and managers of services increasingly insist on research-based evidence, it is questionable how research-capable they are in discriminating between the levels of evidence. The mantra of evidencebased research can begin to sound hollow. It can provide support for further resources or not. Research inevitably is part of the political process.

DRUG AND NON-DRUG INTERVENTIONS

Due to the general low status of elderly care and the lack of (dementia) knowledge, drug interventions are common. Resistance to alternative non-drug interventions will remain until there is a general will to change and until structural changes are addressed. As a member of the Scottish Intercollegiate Guidelines Network group (SIGN) (1998), which produced a national guideline for local practice, I observed that what was brought to the force was the predominance of drug interventions at an academic level. The remit of the group, whose members included geriatricians, psychogeriatricians, a psychologist, a pharmacist, a social worker, and a general practitioner, was to look at the types of evidence available. The evidence was rated according to the US Agency for Health Care Policy and Research, with grades of recommendations provided. On the basis of the evidence available, recommendations were made by the SIGN group. The highest rating was given to randomized, double-blind control trials, which for the most part were drug trials. The evidence submitted was heavily weighted to drug interventions. Quantitative research was the gold standard, with few papers on non-drug interventions achieving the mark. This is the diculty, as because there has been so little of it carried out to date, non-drug research fails when challenged by this gold standard.