Feasibility and baseline findings of an educational intervention in a randomized trial to optimize drug treatment among residents in assisted living facilities

Abstract Purpose To describe the baseline findings and feasibility of a cluster randomized controlled trial of staff training to optimize the use of drugs among older residents in assisted living facilities. Methods Participants ( n =227) were recruited from assisted living facilities in Helsinki, Finland. Their wards were randomized into two arms: 1) intervention wards in which staff received training (2×4hours) to identify prescribing of harmful drugs; 2) control wards in which staff received training after completion of the intervention. Cognition, health-related quality-of life (HRQoL) by 15D and psychological well-being (PWB) were assessed of all participants. Demographics, diagnoses and drug use were verified from medical records. Drugs were categorized using anatomical therapeutic chemical (ATC) codes. The prevalence of anticholinergic, multiple psychotropic and Beers Criteria drugs was computed. Results The mean age of participants was 83years, 71% were females and 93% had dementia. The intervention and comparison groups did not differ with respect to cognition or PWB. However, the proportion of females and HRQoL was lower, and the Charlson comorbidity index higher in the intervention than in the control group. In addition, the prevalence of pro re nata (PRN) drugs, and the proportion using any harmful drug was higher in the intervention than in the control group. Staff training was received favourably by staff participants in the intervention wards. However, not all nurses participated in the training sessions, and there was some resistance to change working habits. Conclusions We have successfully randomized wards of assisted living facilities and trained staff in the intervention arm.