Effectiveness of Expanded Implementation of STAR-VA for Managing Dementia-Related Behaviors Among Veterans

• Published in: The Gerontologist Vol. 56; no. 1; pp. 126 - 134
• Main Authors: Karel, Michele J, Teri, Linda, McConnell, Eleanor, Visnic, Stephanie, Karlin, Bradley E
• Format: Journal Article
• Language: English
• Published: United States Oxford University Press 01-02-2016
• Subjects: Aged; Aged, 80 and over; Aggressiveness; Anxiety; Behavior problems; Community mental health services; Counseling; Dementia; Dementia - psychology; Dementia - rehabilitation; Follow-Up Studies; Health; Health behavior; Health problems; Health services; Home health care; Homes for the Aged; Humans; Interdisciplinary aspects; Intervention; Long term health care; Male; Management; Medical personnel; Mental depression; Mental health; Mental health services; Nurses; Pilot Projects; Program evaluation; Psychotherapy - methods; Resistance; Retrospective Studies; Senility; Symptoms; Training; Treatment methods; Treatment outcomes; United States; United States Department of Veterans Affairs; Veterans; Veterans - psychology; Nursing homes; Challenging behaviors; Interdisciplinary training; Veterans; Dementia
• ISSN: 0016-9013; 1758-5341
• DOI: 10.1093/geront/gnv068

Nonpharmacological, psychosocial approaches are first-line treatments for managing behavioral symptoms in dementia, but they can be challenging to implement in long-term care settings. The Veterans Health Administration implemented STAR-VA, an interdisciplinary behavioral approach for managing challenging dementia-related behaviors in its Community Living Center (CLCs, nursing home care) settings. This study describes how the program was implemented and provides an evaluation of Veteran clinical outcomes and staff feedback on the intervention.
One mental health professional and registered nurse team from 17 CLCs completed STAR-VA training, which entailed an experiential workshop followed by 6 months of expert consultation as they worked with their teams to implement STAR-VA with Veterans identified to have challenging dementia-related behaviors. The frequency and severity of target behaviors and symptoms of depression, anxiety, and agitation were evaluated at baseline and at intervention completion. Staff provided feedback regarding STAR-VA feasibility and impact.
Seventy-one Veterans completed the intervention. Behaviors clustered into 6 types: care refusal or resistance, agitation, aggression, vocalization, wandering, and other. Frequency and severity of target behaviors and symptoms of depression, anxiety, and agitation all significantly decreased, with overall effect sizes of 1 or greater. Staff rated both benefits for Veterans and program feasibility favorably.
This evaluation supports the feasibility and effectiveness of STAR-VA, an interdisciplinary, behavioral intervention for managing challenging behaviors among residents with dementia in CLCs.