Hostname: page-component-7d8f8d645b-clzrd Total loading time: 0 Render date: 2023-05-28T14:17:29.969Z Has data issue: false Feature Flags: { "useRatesEcommerce": true } hasContentIssue false

Physicians’ practice and familiarity with treatment for agitation associated with dementia in Israeli nursing homes

Published online by Cambridge University Press:  30 October 2012

Jiska Cohen-Mansfield*
Department of Health Promotion, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel Herczeg Institute on Aging, Tel Aviv University, Tel Aviv, Israel Minerva Center for the Interdisciplinary Study of End of Life, Tel Aviv University, Tel Aviv, Israel
Atarah Juravel-Jaffe
Maccabi Health Services, Jerusalem and the Surrounding Region, Israel
Aaron Cohen
Geriatric Division, Israel Ministry of Health, Tel Aviv, Israel Department of Geriatrics and Rehabilitation, Mount Scopus Hadassah University Hospital, Jerusalem, Israel
Iris Rasooly
Community Services Department, Geriatric Division, Israel Ministry of Health
Hava Golander
Herczeg Institute on Aging, Tel Aviv University, Tel Aviv, Israel Department of Nursing, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
Correspondence should be addressed to: Professor Jiska Cohen-Mansfield, PhD, Tel Aviv University, P.O.B. 39040, Tel Aviv 69978, Israel. Phone: +972-3-6409544, +972-3-6407336; Fax: +972-3-6407339. Email:


Background: To clarify physicians’ actual practice in treating agitation in the nursing home and to elucidate the relationship between background factors, familiarity with interventions, and practice.

Methods: A survey of actual practice for agitation in persons with dementia was administered to 67 physicians aged 31–70+ working in nursing homes in Israel. Questionnaires were administered by personal interview, self-completed, or a combination of the two.

Results: Psychotropic medications are prescribed by 92.5% of physicians for treating agitation, most notably, Haloperidol (39%). Non-pharmacological treatment was also reported to be common, though to a lesser extent, with environmental change being the most prevalent non-pharmacological intervention. Generally, physicians showed low familiarity levels with non-pharmacological interventions, with higher levels noted for physicians with a specialty in geriatrics compared to those who were non-specialized. Physicians who were non-Israeli and younger also reported higher familiarity levels compared to their respective counterparts (i.e. Israeli and older) but this difference did not reach significance.

Conclusion: The findings indicate that, despite current guidelines, psychotropic medications are the treatment of choice among nursing home physicians in Israel. While rates of use of non-pharmacological interventions are substantial, their in-practice application may be hindered by lack of familiarity as well as system barriers. The results have implications for system and education changes.

Research Article
Copyright © International Psychogeriatric Association 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)


American Geriatrics Society, and American Association for Geriatric Psychiatry (2003). Consensus statement on improving the quality of mental health care in U.S. nursing homes: management of depression and behavioral symptoms associated with dementia. Journal of the American Geriatrics Society, 51, 12871298.CrossRefGoogle Scholar
Ames, D. (2005). For debate: should novel antipsychotics ever be used to treat the behavioral and psychological symptoms of dementia (BPSD)? International Psychogeriatrics, 17, 34.CrossRefGoogle Scholar
APA Work Group on Alzheimer's Disease and other Dementias, et al. (2007). American Psychiatric Association practice guideline for the treatment of patients with Alzheimer's disease and other dementias. Second edition. American Journal of Psychiatry, 164 (Suppl. 12), 5–56Google Scholar
Azermai, M., Elseviers, M., Petrovic, M., Van Bortel, L. and Stichele, R. V. (2011). Geriatric drug utilisation of psychotropics in Belgian nursing homes. Human Psychopharmacology: Clinical and Experimental, 26, 1220.CrossRefGoogle ScholarPubMed
Ballard, C. G., Waite, J. and Birks, J. (2008). Atypical antipsychotics for aggression and psychosis in Alzheimer's disease (Review). The Cochrane Library, 4, 1–47.Google Scholar
Ballard, C. al. (2009). Management of agitation and aggression associated with Alzheimer disease. Nature Reviews Neurology, 5, 245255.CrossRefGoogle ScholarPubMed
Chen, Y., Briesacher, B. A., Field, T. S., Tjia, J., Lau, D. T. and Gurwitz, J. H. (2010). Unexplained variation across USA nursing homes in antipsychotic prescribing rates. Archives of Internal Medicine, 170, 8995.CrossRefGoogle ScholarPubMed
Chenoweth, al. (2009). Caring for Aged Dementia Care Resident Study (CADRES) of person-centered care, dementia-care mapping, and usual care in dementia: a cluster-randomized trial. Lancet Neurology, 8, 317325.CrossRefGoogle Scholar
Clarfield, A. M., Brodsky, J. and Leibovitz, A. (2006). Care of the elderly in Israel: old age in a young land. In Pathy, M. S. J., Sinclair, A. J. and Morley, J. E. (eds.). Principles and Practice of Geriatric Medicine, 4th edn (pp. 19471952). Hoboken, NJ: John Wiley & Sons, Ltd.Google Scholar
Clarfield, A. M., Ginsberg, G., Rasooly, I., Levi, S., Gindin, J. and Dwolatzky, T. (2009). For-profit and not-for-profit nursing homes in Israel: do they differ with respect to quality of care? Archives of Gerontology and Geriatrics, 48, 167172.CrossRefGoogle ScholarPubMed
Clarfield, A. M., Paltiel, A., Gindin, Y., Morginstin, B. and Dwolatzky, T. (2000). Country profile: Israel. Journal of the American Geriatrics Society, 48, 980984.CrossRefGoogle ScholarPubMed
Cohen-Mansfield, J. (2000). Theoretical frameworks for behavioral problems in dementia. Alzheimer's Care Today, 1, 821.Google Scholar
Cohen-Mansfield, J. (2004). Nonpharmacologic interventions for inappropriate behaviors in dementia: a review, summary and critique. Focus, 2, 288308.CrossRefGoogle Scholar
Cohen-Mansfield, J. and Billig, N. (1986). Agitated behaviors in the elderly. I. A conceptual review. Journal of the American Geriatrics Society, 34, 711721.CrossRefGoogle ScholarPubMed
Cohen-Mansfield, J. and Jensen, B. (2008a). Assessment and treatment approaches for behavioral disturbances associated with dementia in the nursing home: self-reports of physicians’ practices. Journal of the American Medical Directors Association, 9, 406413.CrossRefGoogle ScholarPubMed
Cohen-Mansfield, J. and Jensen, B. (2008b). Nursing home physicians’ knowledge of and attitudes towards nonpharmacological interventions for treatment of behavioral disturbances associated with dementia. Journal of the American Medical Directors Association, 9, 491498.CrossRefGoogle Scholar
Cohen-Mansfield, al. (2005). Wisdom from the front lines: clinicians’ descriptions of treating agitation in the nursing home, a pilot study. Journal of the American Medical Directors Association, 6, 257264.CrossRefGoogle ScholarPubMed
Cohen-Mansfield, J., Libin, A. and Marx, M. S. (2007). Nonpharmacological treatment of agitation: a controlled trial of systematic individualized intervention. Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 62, 908916.CrossRefGoogle ScholarPubMed
Colenda, C. C., Leist, J. C. and Rapp, S. R. (1996a). Survey of physician practices for community-dwelling agitated dementia patients. International Journal of Geriatric Psychiatry, 11, 635644.3.0.CO;2-Z>CrossRefGoogle Scholar
Colenda, C. C., Rapp, S. R., Leist, J. C. and Poses, R. M. (1996b). Clinical variables influencing treatment decisions for agitated dementia patients: survey of physician judgments. Journal of the American Geriatrics Society, 44, 13751379.CrossRefGoogle ScholarPubMed
Cornegé-Blokland, E., Kleijer, B. C., Hertogh, C. M. P. M. and van Marum, R. J. (2012). Reasons to prescribe antipsychotics for the behavioral symptoms of dementia: a survey in Dutch nursing homes among physicians, nurses, and family caregivers. Journal of the American Medical Directors Association, 13, 80.e8180.e86.CrossRefGoogle ScholarPubMed
Daiello, L. A. (2007). Current issues in dementia pharmacotherapy. American Journal of Managed Care, 13 (Suppl. 8), S198202.Google ScholarPubMed
Douglas, S. J. (2004). Non-pharmacological interventions in dementia. Advances in Psychiatric Treatment, 10, 171177.CrossRefGoogle Scholar
Giron, M. S., Forsell, Y., Bernsten, C., Thorslund, M., Winblad, B. and Fastbom, J. (2001). Psychotropic drug use in elderly people with and without dementia. International Journal of Geriatric Psychiatry, 16, 900906.CrossRefGoogle ScholarPubMed
Huybrechts, K. al. (2012). Differential risk of death in older residents in nursing homes prescribed specific antipsychotic drugs: population based cohort study. BMJ (Clinical Research Ed.), 344, e977.CrossRefGoogle ScholarPubMed
Jin, H., Meyer, J. M. and Jeste, D. V. (2004). Atypical antipsychotics and glucose dysregulation: a systematic review. Schizophrenia Research, 71, 195212.CrossRefGoogle ScholarPubMed
Kales, H. al. (2012). Risk of mortality among individual antipsychotics in patients with dementia. American Journal of Psychiatry, 169, 7179.CrossRefGoogle ScholarPubMed
Lee, P. E., Gill, S. S., Freedman, M., Bronskill, S. E., Hillmer, M. P. and Rochon, P. A. (2004). Atypical antipsychotic drugs in the treatment of behavioural and psychological symptoms of dementia: systematic review. BMJ (Clinical Research Ed.), 329, 75.CrossRefGoogle ScholarPubMed
Livingston, G., Johnston, K., Katona, C., Paton, J. and Lyketsos, C. G. (2005). Systematic review of psychological approaches to the management of neuropsychiatric symptoms of dementia. American Journal of Psychiatry, 162, 19962021.CrossRefGoogle ScholarPubMed
Mashav (2010). The Elderly in Israel: Statistical Abstract 2010. In Brodsky, J., Shnoor, Y. and Be'er, S. (eds.). Available at: Scholar
Olsson, al. (2010). Quality of drug prescribing in elderly people in nursing homes and special care units for dementia: a cross-sectional computerized pharmacy register analysis. Clinical Drug Investigation (Formerly: Drug Investigation), 30, 289300.CrossRefGoogle ScholarPubMed
Salzman, al. (2008). Elderly patients with dementia-related symptoms of severe agitation and aggression: consensus statement on treatment options, clinical trials methodology, and policy. Journal of Clinical Psychiatry, 69, 889898.CrossRefGoogle ScholarPubMed
Schmidt, I. K. and Fastbom, J. (2000). Quality of drug use in Swedish nursing homes: a follow-up study. Clinical Drug Investigation (Formerly: Drug Investigation), 20, 433446.CrossRefGoogle Scholar
Schneider, L. S., Dagerman, K. and Insel, P. S. (2006). Efficacy and adverse effects of atypical antipsychotics for dementia: meta-analysis of randomized, placebo-controlled trials. American Journal of Geriatric Psychiatry, 14, 191210.CrossRefGoogle ScholarPubMed
Selbæk, G., Kirkevold, Ø. and Engedal, K. (2008). The course of psychiatric and behavioral symptoms and the use of psychotropic medication in patients with dementia in Norwegian nursing homes - a 12-month follow-up study. American Journal of Geriatric Psychiatry, 16, 528536, 510.1097/JGP.1090b1013e318167ae318176.CrossRefGoogle ScholarPubMed
Sink, K. M., Holden, K. F. and Yaffe, K. (2005). Pharmacological treatment of neuropsychiatric symptoms of dementia - a review of the evidence. JAMA, 293, 596608.CrossRefGoogle Scholar
Spira, A. P. and Edelstein, B. A. (2006). Behavioral interventions for agitation in older adults with dementia: an evaluative review. International Psychogeriatrics, 18, 195225.CrossRefGoogle Scholar
Taipale, H., Bell, J., Soini, H. and Pitkala, K. (2009). Sedative load and mortality among residents of long-term care facilities: a prospective cohort study. Drugs and Aging, 26, 871881.CrossRefGoogle ScholarPubMed
Verkaik, R., van Weert, J. C. and Francke, A. L. (2005). The effects of psychosocial methods on depressed, aggressive and apathetic behaviors of people with dementia: a systematic review. International Journal of Geriatric Psychiatry, 20, 301314.CrossRefGoogle ScholarPubMed
Vernooij-Dassen, M., Vasse, E., Zuidema, S., Cohen-Mansfield, J. and Moyle, W. (2010). Psychosocial interventions for dementia patients in long-term care. International Psychogeriatrics, 22, 11211128.CrossRefGoogle ScholarPubMed