{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T15:21:09Z","timestamp":1788967269651,"version":"build-2803163510"},"reference-count":49,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,5,4]],"date-time":"2022-05-04T00:00:00Z","timestamp":1651622400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001646","name":"Robert Bosch Stiftung","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001646","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pain Res."],"abstract":"<jats:sec><jats:title>Purpose<\/jats:title><jats:p>Responsive behavior, often referred to as behavioral and psychological symptoms of dementia (BPSD), is among the most critical disorders in dementia whereby nursing personnel in hospitals are increasingly confronted with such symptoms. The purpose was to reduce the level of BPSD in an acute hospital environment through a stepwise procedure followed by the initiation of a needs-oriented treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>An open, prospective, interventional study with before-after comparisons was used to implement \u201cSerial Trial Intervention\u201d (STI) in three hospital wards (internal medicine, surgery, geriatric) after its adaption for hospital setting which was supplemented with a detailed pain assessment. Participants were 65 years and older. Potential causes of BPSD were clarified in a stepwise procedure and, if possible, eliminated. The primary outcome was the reduction in BPSD measured by the Neuropsychiatric Inventory (NPI-Q-12) while secondary outcomes were through the use of non-pharmacological and pharmacological interventions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>No significant reduction in NPI-Q-12 could be found. However, significantly more mobilizations and changes of position were carried out. Higher antipsychotic use was seen in the after-groups presumably due to the higher rates of delirium and cognitive impairment. Furthermore, the data showed no increase in analgesic use.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>No significant reduction in NPI-Q-12 was observed in the before-after study. The use of antipsychotics even increased most probably due to a higher incidence of deliriousness in the after-group. However, STI seemed to improve attention to underlying causes of BPSD as well as pain. Proof that STI leads to NPI-Q-12 reduction in hospitals is still pending.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpain.2022.810804","type":"journal-article","created":{"date-parts":[[2022,5,4]],"date-time":"2022-05-04T07:46:46Z","timestamp":1651650406000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Responsive Behaviors and Pain Management in Hospital Dementia Care: A Before and After Comparison of the \u201cSerial Trial Intervention\u201d"],"prefix":"10.3389","volume":"3","author":[{"given":"Albert","family":"Lukas","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melanie","family":"Bienas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Mayer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lukas","family":"Radbruch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irmela","family":"Gnass","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,5,4]]},"reference":[{"key":"B1","volume-title":"World Alzheimer Report 2019: Attitudes to Dementia","year":"2019"},{"key":"B2","doi-asserted-by":"publisher","first-page":"278","DOI":"10.1017\/S2045796016001098","article-title":"Behavioural and psychological symptoms in general hospital patients with dementia, distress for nursing staff and complications in care: results of the general hospital study","volume":"27","author":"Hessler","year":"2018","journal-title":"Epidemiol Psychiatr Sci."},{"key":"B3","doi-asserted-by":"publisher","first-page":"212","DOI":"10.1007\/s00482-019-0360-8","article-title":"[Challenging behavior and pain in dementia : experiences of nursing staff in an acute care hospital]","volume":"33","author":"Bienas","year":"2019","journal-title":"Schmerz."},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1017\/S1041610297003943","article-title":"Behavioral and psychological signs and symptoms of dementia: a consensus statement on current knowledge and implications for research and treatment","author":"Finkel","year":"1996","journal-title":"Int Psychogeriatr."},{"key":"B5","doi-asserted-by":"publisher","first-page":"562","DOI":"10.1002\/gps.4037","article-title":"Grouping of behavioural and psychological symptoms of dementia","volume":"29","author":"van der Linde","year":"2014","journal-title":"Int J Geriatr Psychiatry."},{"key":"B6","doi-asserted-by":"publisher","first-page":"2377960819834127","DOI":"10.1177\/2377960819834127","article-title":"Nurses' experiences in caring for older adults with responsive behaviors of dementia in acute care","volume":"5","author":"Yous","year":"2019","journal-title":"SAGE Open Nurs."},{"key":"B7","volume-title":"Person-Centred Language Guidlines.","year":"2017"},{"key":"B8","doi-asserted-by":"publisher","first-page":"842","DOI":"10.1016\/S0140-6736(21)01452-5","article-title":"Responding to responsive behaviour in Alzheimer's disease","volume":"398","author":"O'Neill","year":"2021","journal-title":"Lancet."},{"key":"B9","doi-asserted-by":"publisher","first-page":"244","DOI":"10.1159\/000381800","article-title":"Relationship between dementia severity and behavioral and psychological symptoms of dementia in dementia with lewy bodies and Alzheimer's disease patients","volume":"5","author":"Hashimoto","year":"2015","journal-title":"Dement Geriatr Cogn Disord Extra."},{"key":"B10","doi-asserted-by":"publisher","first-page":"1875","DOI":"10.1017\/S1041610214001240","article-title":"Correlates of objective and subjective measures of caregiver burden among dementia caregivers: influence of unmet patient and caregiver dementia-related care needs","volume":"26","author":"Hughes","year":"2014","journal-title":"Int Psychogeriatr."},{"key":"B11","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1177\/153331759601100603","article-title":"Need-driven dementia-compromised behavior: an alternative view of disruptive behavior","volume":"5","author":"Algase","year":"1996","journal-title":"Am J Alzheimers Dis."},{"key":"B12","doi-asserted-by":"publisher","first-page":"305","DOI":"10.1016\/j.pain.2011.10.007","article-title":"Association of pain with behavioral and psychiatric symptoms among nursing home residents with cognitive impairment: results from the shelter study","volume":"153","author":"Tosato","year":"2012","journal-title":"Pain."},{"key":"B13","doi-asserted-by":"publisher","first-page":"1042","DOI":"10.1016\/j.arr.2013.05.002","article-title":"Interventions targeting pain or behaviour in dementia: a systematic review","volume":"12","author":"Pieper","year":"2013","journal-title":"Ageing Res Rev."},{"key":"B14","doi-asserted-by":"publisher","first-page":"1215","DOI":"10.1016\/j.jpainsymman.2020.10.011","article-title":"Pain in dementia: prevalence and association with neuropsychiatric behaviours","volume":"61","author":"Atee","year":"2020","journal-title":"J Pain Symptom Manage."},{"key":"B15","doi-asserted-by":"publisher","first-page":"d4065","DOI":"10.1136\/bmj.d4065","article-title":"Efficacy of treating pain to reduce behavioural disturbances in residents of nursing homes with dementia: cluster randomised clinical trial","volume":"343","author":"Husebo","year":"2011","journal-title":"BMJ."},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.3928\/00989134-20060401-05","article-title":"The serial trial intervention: an innovative approach to meeting needs of individuals with dementia","author":"Kovach","year":"2006","journal-title":"J Gerontol Nurs."},{"key":"B17","doi-asserted-by":"publisher","first-page":"147","DOI":"10.1177\/1533317506288949","article-title":"Effects of the serial trial intervention on discomfort and behavior of nursing home residents with dementia","volume":"21","author":"Kovach","year":"2006","journal-title":"Am J Alzheimers Dis Other Demen."},{"key":"B18","doi-asserted-by":"publisher","first-page":"463","DOI":"10.1002\/gps.5280","article-title":"The effectiveness of interventions to improve the care and management of people with dementia in general hospitals: a systematic review","volume":"35","author":"Feast","year":"2020","journal-title":"Int J Geriatr Psychiatry."},{"key":"B19","doi-asserted-by":"publisher","first-page":"2308","DOI":"10.1212\/WNL.44.12.2308","article-title":"The neuropsychiatric inventory: comprehensive assessment of psychopathology in dementia","volume":"44","author":"Cummings","year":"1994","journal-title":"Neurology."},{"key":"B20","doi-asserted-by":"publisher","first-page":"233","DOI":"10.1176\/jnp.12.2.233","article-title":"Validation of the Npi-Q, a brief clinical form of the neuropsychiatric inventory","volume":"12","author":"Kaufer","year":"2000","journal-title":"J Neuropsychiatry Clin Neurosci."},{"key":"B21","doi-asserted-by":"publisher","first-page":"607","DOI":"10.1016\/j.jagp.2012.10.027","article-title":"Subscale validation of the neuropsychiatric inventory questionnaire: comparison of Alzheimer's disease neuroimaging initiative and National Alzheimer's Coordinating Center Cohorts","volume":"21","author":"Trzepacz","year":"2013","journal-title":"Am J Geriatr Psychiatry."},{"key":"B22","volume-title":"Individuelle Pflege Von Menschen Mit Demenz: Ein Praxishandbuch Zum Umgang Mit Herausforderndem Verhalten.","author":"Fischer","year":"2019"},{"key":"B23","doi-asserted-by":"publisher","first-page":"199","DOI":"10.1024\/1011-6877.21.3.199","article-title":"Die Deutsche Fassung Der \u201cserial trial intervention\u201d (Sti-D) - Entwicklung Und Testung Eines Pflegerischen Ansatzes Zur Reduktion Von Herausfordernden Verhalten Bei Menschen Mit Demenz","volume":"21","author":"Fischer","year":"2008","journal-title":"Zeitschrift f\u00fcr Gerontopsychologie Psychiatrie."},{"key":"B24","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1097\/01.JAM.0000043422.31640.F7","article-title":"Development and psychometric evaluation of the pain assessment in advanced dementia (painad) scale","volume":"4","author":"Warden","year":"2003","journal-title":"J Am Med Dir Assoc."},{"key":"B25","doi-asserted-by":"publisher","first-page":"214","DOI":"10.1007\/s00391-013-0475-y","article-title":"Self- and proxy report for the assessment of pain in patients with and without cognitive impairment: experiences gained in a geriatric hospital","volume":"46","author":"Lukas","year":"2013","journal-title":"Z Gerontol Geriatr."},{"key":"B26","doi-asserted-by":"publisher","first-page":"1216","DOI":"10.1016\/S1474-4422(14)70103-6","article-title":"Pain assessment in elderly adults with dementia","volume":"13","author":"Hadjistavropoulos","year":"2014","journal-title":"Lancet Neurol."},{"key":"B27","doi-asserted-by":"publisher","first-page":"384","DOI":"10.1016\/j.jamda.2011.04.002","article-title":"Which score most likely represents pain on the observational painad pain scale for patients with dementia?","volume":"13","author":"Zwakhalen","year":"2012","journal-title":"J Am Med Dir Assoc."},{"key":"B28","doi-asserted-by":"publisher","first-page":"1558","DOI":"10.1002\/j.1532-2149.2013.00336.x","article-title":"Observer-rated pain assessment instruments improve both the detection of pain and the evaluation of pain intensity in people with dementia","volume":"17","author":"Lukas","year":"2013","journal-title":"Eur J Pain."},{"key":"B29","doi-asserted-by":"publisher","first-page":"189","DOI":"10.1016\/0022-3956(75)90026-6","article-title":"\u201cMini-mental state\u201d. a practical method for grading the cognitive state of patients for the clinician","volume":"12","author":"Folstein","year":"1975","journal-title":"J Psychiatr Res."},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD011145.pub2","article-title":"Mini-mental state examination (MMSE) for the detection of dementia in clinically unevaluated people aged 65 and over in community and primary care populations","author":"Creavin","year":"2016","journal-title":"Cochr Database Syst Rev."},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1017\/S1041610292001157","article-title":"Functional assessment staging (Fast) in Alzheimer's disease: reliability, validity, and ordinality","author":"Sclan","year":"1992","journal-title":"Int Psychogeriatr."},{"key":"B32","doi-asserted-by":"publisher","first-page":"653","DOI":"10.1037\/t08620-000","article-title":"Functional assessment staging (Fast)","volume":"24","author":"Reisberg","year":"1988","journal-title":"Psychopharmacol Bull."},{"key":"B33","doi-asserted-by":"publisher","first-page":"421","DOI":"10.1017\/S1041610207005261","article-title":"Global Measures: utility in defining and measuring treatment response in dementia","volume":"19","author":"Reisberg","year":"2007","journal-title":"Int Psychoger."},{"key":"B34","doi-asserted-by":"publisher","first-page":"494","DOI":"10.1002\/jhm.2580","article-title":"Validation of the delirium observation screening scale in a hospitalized older population","volume":"11","author":"Gavinski","year":"2016","journal-title":"J Hosp Med."},{"key":"B35","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1891\/rtnp.17.1.31.53169","article-title":"The delirium observation screening scale: a screening instrument for delirium","volume":"17","author":"Schuurmans","year":"2003","journal-title":"Res Theory Nurs Pract."},{"key":"B36","doi-asserted-by":"crossref","first-page":"858","DOI":"10.1002\/(SICI)1099-1166(199910)14:10<858::AID-GPS35>3.0.CO;2-8","article-title":"Short versions of the geriatric depression scale: a study of their validity for the diagnosis of a major depressive episode according to Icd-10 and Dsm-Iv","volume":"14","author":"Almeida","year":"1999","journal-title":"Int J Geriatr Psychiatry."},{"key":"B37","doi-asserted-by":"publisher","first-page":"1066","DOI":"10.1097\/JGP.0b013e3181f60f81","article-title":"Which version of the geriatric depression scale is most useful in medical settings and nursing homes? Diagnostic validity meta-analysis","volume":"18","author":"Mitchell","year":"2010","journal-title":"Am J Geriatr Psychiatry."},{"key":"B38","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1037\/t02366-000","article-title":"Functional evaluation: the barthel index","volume":"14","author":"Mahoney","year":"1965","journal-title":"Md State Med J."},{"key":"B39","doi-asserted-by":"publisher","first-page":"261","DOI":"10.1111\/jgs.13868","article-title":"Effects of a stepwise multidisciplinary intervention for challenging behavior in advanced dementia: a cluster randomized controlled trial","volume":"64","author":"Pieper","year":"2016","journal-title":"J Am Geriatr Soc."},{"key":"B40","doi-asserted-by":"publisher","first-page":"83","DOI":"10.1017\/S1041610218000534","article-title":"Management of behavioral and psychological symptoms in people with Alzheimer's disease: an international delphi consensus","volume":"31","author":"Kales","year":"2019","journal-title":"Int Psychogeriatr."},{"key":"B41","doi-asserted-by":"publisher","first-page":"66","DOI":"10.1007\/s11920-019-1049-5","article-title":"Management of behavioral and psychological symptoms of dementia","volume":"21","author":"Bessey","year":"2019","journal-title":"Curr Psychiatry Rep."},{"key":"B42","doi-asserted-by":"publisher","first-page":"295","DOI":"10.1017\/S1041610217002344","article-title":"An overview of systematic reviews of pharmacological and non-pharmacological interventions for the treatment of behavioral and psychological symptoms of dementia","volume":"30","author":"Dyer","year":"2018","journal-title":"Int Psychogeriatr."},{"key":"B43","doi-asserted-by":"crossref","DOI":"10.1007\/978-3-319-96065-4_15","article-title":"Non-Pharmacological Interventions for People with Dementia: Design Recommendations from an Ergonomics Perspective","author":"Wang","year":"2019"},{"key":"B44","doi-asserted-by":"publisher","first-page":"412","DOI":"10.1016\/S0885-3924(99)00094-9","article-title":"Assessment and treatment of discomfort for people with late-stage dementia","volume":"18","author":"Kovach","year":"1999","journal-title":"J Pain Symptom Manage."},{"key":"B45","doi-asserted-by":"publisher","first-page":"1168","DOI":"10.3389\/fphar.2020.01168","article-title":"Pharmacotherapy of behavioral and psychological symptoms of dementia: state of the art and future progress","volume":"11","author":"Magierski","year":"2020","journal-title":"Front Pharmacol."},{"key":"B46","doi-asserted-by":"publisher","first-page":"269216316689237","DOI":"10.1177\/0269216316689237","article-title":"Effects on pain of a stepwise multidisciplinary intervention (Sta Op!) that targets pain and behavior in advanced dementia: a cluster randomized controlled trial","volume":"2017","author":"Pieper","year":"2017","journal-title":"Palliat Med."},{"key":"B47","doi-asserted-by":"publisher","first-page":"245","DOI":"10.1038\/nrneurol.2009.39","article-title":"Management of agitation and aggression associated with Alzheimer disease","volume":"5","author":"Ballard","year":"2009","journal-title":"Nat Rev Neurol."},{"key":"B48","doi-asserted-by":"publisher","first-page":"1043","DOI":"10.1213\/ANE.0000000000000861","article-title":"Clinical research methodology 2: observational clinical research","volume":"121","author":"Sessler","year":"2015","journal-title":"Anesth Analg."},{"key":"B49","doi-asserted-by":"publisher","first-page":"315","DOI":"10.1159\/000351009","article-title":"Risk factors for behavioral abnormalities in mild cognitive impairment and mild Alzheimer's disease","volume":"37","author":"Apostolova","year":"2014","journal-title":"Dement Geriatr Cogn Disord."}],"container-title":["Frontiers in Pain Research"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpain.2022.810804\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,5,6]],"date-time":"2022-05-06T14:00:32Z","timestamp":1651845632000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpain.2022.810804\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,5,4]]},"references-count":49,"alternative-id":["10.3389\/fpain.2022.810804"],"URL":"https:\/\/doi.org\/10.3389\/fpain.2022.810804","relation":{},"ISSN":["2673-561X"],"issn-type":[{"value":"2673-561X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,5,4]]},"article-number":"810804"}}