Older adults with complex medical disorders (dementia, serious mental illness, multiple chronic medical conditions) may have a high prevalence of distress behaviors (eg, physical or verbal aggression, repeated vocalizations, disengagement). For example, among patients with dementia, 75% exhibit at least 1 neuropsychiatric symptom. Across health care settings, these symptoms are often manifestations of patient distress and may be uncomfortable for both patients and their paid caregivers. Exacerbation of these symptoms is likely due to vulnerability to environmental factors such as under- or over-stimulation, or unmet medical, physical, emotional, and social needs. Moreover, these symptoms may be unintentionally reinforced by staff or care routines. Patient distress behaviors can impact patient quality of life, care provision, cost of care, or transition to community-based care settings.
Distress behaviors can cause significant challenges to the ability of health care systems generally, and for clinical providers in particular, to deliver care using traditional, clinician-focused strategies, as these strategies tend to prioritize diagnostic procedures, close monitoring, and delivery of treatments. These challenges can lead to staff burnout and provider distress. In order to better address underlying and unmet patient needs and reduce distress behaviors in a productive and safe work environment, it is imperative that health systems develop evidence-based, effective approaches to support and prepare health care teams around this aspect of high-quality patient care.
One promising approach to promoting safe, person-centered, and positive systemic change for patients at increased risk of distress behaviors are interventions that focus on health care worker (HCW) actions through activities such as skill building, knowledge acquisition, and changes in staff roles and workflow patterns. Despite the integration of individual patient-level nonpharmacologic approaches into recent guidelines for the care of older adults with dementia, approaches that are centered on staff characteristics (eg, optimal staffing, staffing education/training, staff approaches to improved patient care management) have received limited attention. In addition, while patients with serious mental illness and other psychiatric disorders are overrepresented in residential long-term care settings, little is known about the use of these strategies among this high-risk population. Similarly, how to address distress behaviors during periods of stress due to transitions in residential settings is unknown. The goal of this systematic review is to evaluate the effect of health care team-focused interventions intended to reduce patient distress behaviors across key relevant settings.