Demented Nursing Home Patients Research Articles

Story recall and word lists: Differential and combined utilities in predicting cognitive diagnosis

Objectives: Verbal memory assessment metrics are an essential component of cognitive screening tools. We compared the relative utilities of word list and story recall metrics in predicting cognitive functioning in nondemented and demented nursing home patients. We selected memory metrics from the Brief Cognitive Assessment Tool (BCAT) and the Brief Interview for Mental Status (BIMS). The BCAT incorporates both word lists and story recall metrics, while the BIMS only has a word list feature. Method: Two hundred and thirty-nine individuals residing in a Maryland skilled nursing facility were referred for neurocognitive evaluation over a one-year period. These residents met inclusion criteria for retrospective data analysis by completing the BCAT and BIMS and were aged 60 or older. Results: For the entire sample and for demented individuals, all four verbal memory metrics significantly predicted cognitive diagnosis. For nondemented individuals, only the BCAT delayed word list significantly predicted cognitive diagnosis. There appears to be enhanced utility in using both verbal memory metric types, as the inclusion of word list and story recall was a stronger predictor of cognitive diagnosis than any individual verbal memory metric. Conclusion: This study highlights the importance of using cognitive screening tools that contain both story recall and word list metrics. This is particularly true in long-term care settings where the base rate of cognitive impairment is high.

Stopping antipsychotic drug therapy in demented nursing home patients: a randomized, placebo‐controlled study––The Bergen District Nursing Home Study (BEDNURS)

Despite modest efficacy, unpredictable individual utility, and a high rate of adverse effects, behavioural and psychological symptoms of dementia (BPSD) are common determinants for antipsychotic drug therapy in nursing home patients. To explore the impact on BPSD of stopping long-term antipsychotic treatment in nursing home patients with dementia. Fifty-five patients (43 women; mean age 84.1) taking haloperidol, risperidone, or olanzapine for BPSD were randomly assigned to cessation (intervention group, n=27) or continued treatment with antipsychotic drugs (reference group, n=28) for 4 consecutive weeks. The Neuropsychiatric Inventory (NPI) Questionnaire was used to examine changes in behavioural and psychological symptoms. By study completion, 23 of the 27 intervention group patients were still off antipsychotics. Symptom scores (NPI) remained stable or even improved in 42 patients (intervention group, 18 out of 27; reference group, 24 out of 28; p=0.18). As compared to patients with stable or improved symptom scores, patients with behavioural deterioration after antipsychotic cessation used higher daily drug doses at baseline (p=0.42). A large share of elderly nursing home patients on long-term treatment with antipsychotics for BPSD, do well without this treatment. Standardized symptom evaluations and drug cessation attempts should therefore be undertaken at regular intervals.

Starting artificial nutrition and hydration in patients with dementia in the Netherlands: frequencies, patient characteristics and decision-making process

In many patients with dementia, the oral intake of fluids and nutrients becomes insufficient and a decision has to be made whether to start artificial nutrition or hydration (ANH). This study examines the incidence of ANH in nursing-home patients with dementia in The Netherlands, the methods of administration used, patient characteristics, and the characteristics of the ANH decision- making process. In June 2001, a postal questionnaire was sent to all nursing-home physicians (NHPs) (n=1054) in The Netherlands. The response rate was 77%. Of the NHPs, 39% had started ANH during the 1-year study period, mostly by hypodermoclysis. As calculated from the total number of patients in The Netherlands, the incidence density for ANH in demented nursing-home patients was 3.4 per 100 patient-years. The most important considerations in taking this decision were the patient's physical condition, the expected result of rehydration, and the (presumed) wishes of the patient. Decisions to start hydration resembled decisions to start nutrition, but more frequently concerned incompetent patients with an intercurrent infectious disease. Compared with the USA literature, ANH is practised less in The Netherlands. This practice conforms to the prevailing treatment policy endorsed by the Dutch Association of Nursing-Home Physicians. In starting nutrition and/or hydration, an agreement about the (limited) duration of ANH is generally made, and the NHPs generally involve relatives and nurses in the decision-making process. Almost always, all parties involved agreed with decisions taken.

Een cultuurvergelijkend onderzoek naar behandelbesluiten van artsen met betrekking tot demente verpleeghuispatiënten met pneumonie

A cross-cultural study of physician treatment decisions for demented nursing home patients who develop pneumoniaThis qualitative interview study in the Netherlands and North Carolina (US) found that physician treatment decisions are influenced by contextual differences in physician training and healthcare delivery in the US and the Netherlands. Dutch physicians treating nursing home residents with dementia and pneumonia assumed active, primary responsibility for treatment decisions while US physicians were more passive and deferential to family preferences, even in cases where they considered the families’ wishes inappropriate. Dutch physicians knew their patients well and made treatment decisions based on what they perceived was in the best interest of the patient while US physicians reported limited knowledge of their nursing home patients due to a lack of contact time. Efforts to improve care for patients with poor quality of life who lack decision-making capacity must consider the context of societal values, physician training, and the processes by which physicians negotiate patient and family preferences.

A Cross-Cultural Study of Physician Treatment Decisions for Demented Nursing Home Patients Who Develop Pneumonia

To explore factors that influence Dutch and US physician treatment decisions when nursing home patients with dementia become acutely ill with pneumonia.

A Cross-Cultural Study of Physician Treatment Decisions for Demented Nursing Home Patients Who Develop Pneumonia

We wanted to explore factors that influence Dutch and US physician treatment decisions when nursing home patients with dementia become acutely ill with pneumonia. Using a qualitative semistructured interview study design, we collected data from 12 physicians in the Netherlands and 12 physicians in North Carolina who care for nursing home patients. Our main outcome measures were perceptions of influential factors that determine physician treatment decisions regarding care of demented patients who develop pneumonia. Several themes emerged from the study. First, physicians viewed their patient care roles differently. Dutch physicians assumed active, primary responsibility for treatment decisions, whereas US physicians were more passive and deferential to family preferences, even in cases when they considered families' wishes for care as inappropriate. These family wishes were a second theme. US physicians reported a perceived sense of threat from families as influencing the decision to treat more aggressively, whereas Dutch physicians revealed a predisposition to treat based on what they perceived was in the best interest of the patient. The third theme was the process of decision making whereby Dutch physicians based decisions on an intimate knowledge of the patient, and American physicians reported limited knowledge of their nursing home patients as a result of lack of contact time. Physician-perceived care roles regarding treatment decisions are influenced by contextual differences in physician training and health care delivery in the United States and the Netherlands. These results are relevant to the debate about optimal care for patients with poor quality of life who lack decision-making capacity.

The development of a multidisciplinary fall risk evaluation tool for demented nursing home patients in the Netherlands.

BackgroundDemented nursing home patients are at high risk for falls. Falls and associated injuries can have a considerable influence on the autonomy and quality of life of patients. The prevention of falls among demented patients is therefore an important issue. In order to intervene in an efficient way in this group of patients, it is important to systematically evaluate the fall risk profile of each individual patient so that for each patient tailor-made preventive measures can be taken. Therefore, the objective of the present study is to develop a feasible and evidence based multidisciplinary fall risk evaluation tool to be used for tailoring preventive interventions to the needs of individual demented patients.MethodsTo develop this multidisciplinary fall risk evaluation tool we have chosen to combine scientific evidence on the one hand and experts' opinions on the other hand. Firstly, relevant risk factors for falling in elderly persons were gathered from the literature. Secondly, a group of Dutch experts in the field of falls and fall prevention in the elderly were consulted to judge the suitability of these risk factors for use in a multidisciplinary fall risk evaluation tool for demented nursing home patients. Thirdly, in order to generate a compact list of the most relevant risk factors for falling in demented elderly, all risk factors had to fulfill a set of criteria indicating their relevance for this specific target population. Lastly the final list of risk factors resulting from the above mentioned procedure was presented to the expert group. The members were also asked to give their opinion about the practical use of the tool.ResultsThe multidisciplinary fall risk evaluation tool we developed includes the following items: previous falls, use of medication, locomotor functions, and (correct) choice and use of assistive and protective devices. The tool is developed for the multidisciplinary teams of the nursing homes.ConclusionThis evidence and practice based multidisciplinary fall risk evaluation tool targets the preventive interventions aimed to prevent falls and their negative consequences in demented nursing home patients.

A Cross-Cultural Study of Physician Treatment Decisions for Demented Nursing Home Patients Who Develop Pneumonia

A Cross-Cultural Study of Physician Treatment Decisions for Demented Nursing Home Patients Who Develop Pneumonia

Physicians' Experiences with Demented Patients with Advance Euthanasia Directives in the Netherlands

To estimate the incidence of (compliance with) advance euthanasia directives of patients suffering from dementia in the Netherlands and to gain knowledge about the experiences of physicians. Retrospective interview study. Physicians in the Netherlands. Four hundred ten physicians. Physicians were interviewed about their demented patients who had an advance euthanasia directive. Nursing home physicians were interviewed more extensively. Approximately 2,200 demented patients with an advance euthanasia directive die annually after being treated by a physician who knows about this directive. In 76% of such cases, compliance with the directive was discussed, but euthanasia was seldom performed. In two-thirds of the cases of demented nursing home patients with an advance euthanasia directive, the physician was able to identify during the course of the disease a situation for which the patient had intended the directive. One-quarter of the nursing home physicians thought that their most recent patient suffered unbearably to a (very) high degree, and half of them thought that the patient suffered hopelessly to a (very) high degree. In three-quarters of the cases, the relatives did not want the nursing home physician to comply with the directive, but they did want to respect the patient's wishes by forgoing life-prolonging treatment, which occurred in approximately 90% of cases. Most nursing home physicians think that the suffering of patients with dementia can be unbearable and hopeless as a consequence of dementia, but most physicians do not consider dementia to be grounds for euthanasia, unless perhaps the patient has an additional illness.

Are nursing home patients with dementia diagnosis at increased risk for inadequate pain treatment?

Mentally impaired and demented nursing home patients are at increased risk of undertreatment for pain. We wanted to examine pain assessment and complaints and pain treatment of nursing home patients according to mental state, and with special regard to treatment of patients with dementia diagnosis and cognitively impaired patients who did not have a dementia diagnosis. Cross sectional study from three nursing homes in Bergen, Norway including 125 persons (median age 84 years), living permanently in a nursing home. Diagnoses and prescribed and administered analgesic drugs were recorded. An experienced nurse interviewed nurses in charge and patients regarding presence of pain during the last week. Patients who were able to answer whether they had experienced pain during the last week were categorised as communicative. Cognitive function was assessed by means of the Abbreviated Mental Test. Seventeen percent of the patients were cognitively intact, 30% cognitively impaired and 54% had a dementia diagnosis. Forty-seven percent of communicative patients complained of pain, nurses reported pain in 67% patients. Twenty-nine percent of the patients had received scheduled analgesics during the last week, cognitively intact patients 38%, cognitively impaired 30%, demented 25% (p = 0.53). Twenty percent were given analgesics PRN: cognitively intact patients 33%, cognitively impaired 27%, demented 12% (p = 0.05). Logistic regression analyses revealed that patients with dementia diagnosis were less likely to receive PRN medication [Adjusted odds ratio (AOR) 0.22 95% confidence interval (CI) 0.06-0.76] compared to mentally impaired patients. Regarding scheduled medication there was no difference between the groups. Nurses' opinion of pain was a significant factor for receiving analgesic drugs, scheduled AOR 3.95 95% CI 1.48-10.5, PRN 3.80-95% CI 1.28-11.3). A label of dementia may bias the interpretation of pain cues of demented patients, while complaints from cognitively impaired patients may be taken for granted. This may contribute to lower use of PRN medication in demented patients compared to cognitively impaired patients.

Participants in the decision making on artificial nutrition and hydration to demented nursing home patients: A qualitative study

Objectives: To determine the role and influence of participants in the decision making to start or forgo artificial nutrition and hydration (ANH) in demented nursing home patients. Methods: Participant observation by two researchers in two Dutch nursing homes. Results: The most common participants in the ANH decision making are the nursing home physician (NHP), family, and (most frequently attending) nurses. Both the process and outcome depend on the specific orientation of participants to the decision-making process, to starting or forgoing ANH and interactions between participants. The NHP has the greatest influence. Most NHPs try to achieve consensus among all participants, and emotions and feelings of the family play an important role in this respect. Discussion: The NHP seems to be the most obvious person to lead the ANH decision. It is important that participants are aware of the influence of emotions so that they can determine to what extent it is acceptable that personal feelings influence the final decision.

The effects of bright-light therapy on actigraphical measured sleep last for several weeks post-treatment. A study in a nursing home population.

We investigated the time-course of nocturnal actigraphic measures, following the termination of bright-light therapy for sleep disturbances in demented nursing home patients. From an earlier study, 11 nursing home patients (86 +/- 9 years, Mini-Mental Status Examination score 12 +/- 4) with actigraphically measured sleep efficiency < 85%, were recruited to morning bright-light treatment (6000-8000 lux) 2 h per day for 14 days. Actigraphic measures were registered at pretreatment, treatment and at four monthly post-treatment periods. Each actigraphic recording period consisted of seven consecutive days. Sleep improved substantially with treatment; sleep efficiency increased from 73% to 86% and total nocturnal wake time was reduced by nearly 2 h. During the 16 weeks post-treatment period, actigraphic measures gradually returned to pretreatment levels. Sleep efficiency remained significantly higher than the pretreatment level 4 weeks after treatment termination. Sleep onset latency remained significantly reduced up until 12 weeks post-treatment. This study supports previous findings of beneficial effects of bright-light therapy for sleep disturbances in demented nursing home patients. Furthermore, these results are the first to suggest that post-treatment effects of short-term bright-light therapy may last longer than previously assumed.

Truth telling and truthfulness in the care for patients with advanced dementia: an ethnographic study in Dutch nursing homes

The purpose of this study was to investigate and analyze the moral tension that exists in the care for demented nursing home patients, between the principle of respect for autonomy and the value that is attached to respect for the subjective world of the patient. To this end an ethnographical field study was carried out by two researchers in two Dutch nursing homes. Among the central topics that evolved were the different moral problems that nurses experience concerning truth telling and acting truthfully in relation to demented patients. In situations unrelated to the dementia and its diagnosis, the right to be informed is in principle respected, even if the information is sometimes painful. More specific questions of demented patients about their situation are a regular cause of embarrassment for their carers, who rely on various treatment strategies to deal with such questions. These strategies are often successful. However, when they fail, the nurses are faced with a problem they cannot solve, namely the loss of a common shared world and the resulting unmentionable truth about the diagnosis of dementia, as objective basis and legitimization for their approach to the demented patient. We conclude that in the training and professional support given to nurses, more attention should be paid to (awareness of) the moral problems that arise from this loss of a common shared world, so that they can react to the subjective world of demented patients without feeling that they are deceiving them.

Pneumonia: the demented patient's best friend? Discomfort after starting or withholding antibiotic treatment.

To assess suffering in demented nursing home patients with pneumonia treated with antibiotics or without antibiotics. This study should provide the first empirical data on whether pneumonia is a "friend" or an "enemy" of demented patients and promote a debate on appropriate palliative care. Prospective cohort study. Psychogeriatric wards of 61 nursing homes in the Netherlands. Six hundred sixty-two demented patients with pneumonia treated with (77%) or without (23%) antibiotics. Using an observational scale (Discomfort Scale-Dementia of Alzheimer Type), discomfort was assessed at the time of the pneumonia treatment decision and periodically thereafter for 3 months or until death. (Thirty-nine percent of patients treated with antibiotics and 93% of patients treated without antibiotics died within 3 months.) Physicians also offered a retrospective judgment of discomfort 2 weeks before the treatment decision. In addition, pneumonia symptoms were assessed at baseline and on follow-up. Linear regression was performed with discomfort shortly before death as an outcome. A peak in discomfort was observed at baseline. Compared with surviving patients treated with antibiotics, the level of discomfort was generally higher in patients in whom antibiotic treatment was withheld and in nonsurvivors. However, these same patients had more discomfort before the pneumonia. Breathing problems were most prominent. Shortly before death from pneumonia, discomfort increased. Discomfort was higher shortly before death when pneumonia was the final cause of death than with death from other causes. Irrespective of antibiotic treatment, pneumonia causes substantial suffering in demented patients. Adequate symptomatic treatment deserves priority attention.

Classifying the probability of urinary incontinence in psychogeriatric nursing home patients

Urinary incontinence (UI) frequently occurs in psychogeriatric nursing home patients. In general the personnel involved in the care for these patients act on incontinence noted. Patients are not monitored or classified according to likelihood or severity of incontinence. This study was conducted to develop and validate a model for the classification of the likelihood of UI in demented nursing home patients. A multi-center cross-sectional study was conducted using data on clinical and functional status of 692 subjects. Subjects were subdivided in a Derivation set of 532 patients and a Validation set of 160 patients. The data were ascertained with questionnaires completed by physicians and nursing staff. All psychogeriatric wards (25) of four Dutch nursing homes were included. Using univariate logistic regression analysis on the derivation set we identified correlates of UI among 22 clinical and functional patient characteristics. Subsequently, we developed a classification model for prevalent UI, including independent patient characteristics by means of multivariable logistic regression. Next, we stratified patients into groups with varying likelihood's of UI based on the model developed. Subsequently, we transformed the model to an easy applicable classification rule for the identification of patient subgroups with high or low likelihood on UI. Finally, the rule was validated on the validation set. The independent multivariate factors associated with urinary incontinence were impaired ADL and mobility, diminished alertness and fecal impaction. After transforming the regression model to an easy classification rule, the scores ranged from 0 to 7. The area under the curve was 0.88 (95% Confidence Interval (CI): 0.85–0.91) in the derivation set. In the validation set a similar area under the curve was obtained (0.90 (95% CI: 0.85–0.95)). Among subjects with none of the associated factors the rule classified 0.5% as incontinent patients. In case all associated factors were present the proportion classified as incontinent increased to 91%. In conclusion, the developed classification rule provides means to stratifying nursing home patients according to their likelyhood of being incontinent of urine.

Decisions to treat or not to treat pneumonia in demented psychogeriatric nursing home patients: evaluation of a guideline.

We evaluated a new guideline, in the form of a "checklist of considerations," to support end-of-life decision making in the treatment of demented patients with pneumonia. Questionnaires were sent to nursing home physicians (NHPs) in The Netherlands at three times: before implementation of the checklist (concerning 91 individual patients), during use of the checklist (concerning another 107 individual patients), and after data collection (concerning the targeted patient category of demented nursing home patients with pneumonia as a whole). In the last questionnaire, one NHP from each nursing home (n = 55 NHPs) gave his or her general opinion about the checklist. We measured the usefulness of the checklist in supporting decision making and its frequency of actual use. The NHPs accepted the contents of the checklist for use in the targeted patient category. It was used in 46% of the incident cases of pneumonia. The checklist was considered more useful in supporting decision making for the targeted patient category (85% of the NHPs) than for the individual patient (47%). Possible explanations for this discrepancy in "usefulness" include the difference in the nature of the outcome measures and the fact that the checklist was used more frequently for the "easier cases." Information on individual patient level, patient category level, and nursing home and NHP characteristics is used to suggest checklist improvements.

Pneumonia, friend of the elderly.

Must we rescue everyone we can? Should our ability to do something work against us, at times obliging us to act against our better judgment? We can cure even elderly, demented people of pneumonia, but not everyone will consider this a morally compelling argument for doing so. In the decades since we learned to treat pneumonia, the life expectancy in western nations has increased significantly. More and more elderly people will come down with pneumonia in the years to come. How should we think of pneumonia, in the elderly or anyone else? There is good reason to think of pneumonia as a blessing in some cases, specifically in elderly, demented persons. This is not the place to argue for the morality of this perspective. The article by van der Steen and colleagues begins from the reasonable premise that pneumonia may signal a welcome way out of suffering. Their article will do nothing to change the mind of anyone who insists we must always work to cure elderly persons of pneumonia. It will, however, offer useful guidance to families of elderly, demented nursing-home patients and the physicians who treat such patients. The very idea of a checklist rests on the notion that decisions should be made on the basis of persons, who will naturally differ in circumstances, as opposed to principles, which by definition do not vary. The checklist seeks to guide caretakers of incompetent patients to make arduous decisions about both curative and palliative care. The checklist responds to the absence of an advance directive or “living will.” Relatively few Americans have prepared such documents: many do not know about them whereas others avoid thinking about them. Even if we do prepare advance directives, physicians do not always honor them. Presumably any physician who would agree to withhold treatment from an elderly, demented patient would also agree to honor an advance directive requesting this be done. The advance directive would make this decision easier for all concerned. The most important benefit of this checklist from the Netherlands is to help break up a complex question into more manageable segments. Faced with a difficult decision, many of us will respond in the same way as the daughter in case 1—we may feel morally compelled to do everything possible for a demented parent in a nursing home. On further reflection, specifically on the questions brought out by the checklist, we may feel more reluctant than compelled. This is progress. Beyond guiding our deliberation in an enormously trying moment, the checklist serves a broader purpose. It gives us permission to think in concrete terms about the quality of someone else's life. The checklist facilitates the enormously difficult task of deciding for others. It allows us to consider whether pneumonia may be a blessing instead of a burden. This checklist returns us to a familiar debate over the morality of withholding and withdrawing medical treatment. Most primary care physicians and bioethicists in the United States will likely embrace this checklist as a useful and welcome resource.

Bright light therapy for demented nursing home patients with behavioral disturbance

The objective of this study was to examine the effects of morning bright light on behavioral disturbances in dementia using a repeated measures ABA design. We hypothesized that morning bright light in demented patients reduces the agitation rating and directly observed disruptive behavior, but increases observed positive behavior. The study was done in a special care unit of a long term care facility, with 16 demented residents ages 60 to 89, 13 female and three male. Morning bright light (Day-Light Box 10000, produced by DayLight Technologies, Inc, providing 10,000 lux) was administered Monday to Friday during the treatment week. The Global Deterioration Scale rating at baseline, followed by baseline, treatment and post-treatment ratings in the Cohen-Mansfield Agitation Inventory (CMAI) and Environment-Behavior Interaction Code (EBIC) were used as measurements Compared to baseline, the mean total Cohen-Mansfield score decreased more during the phototherapy week than during the post-treatment week (p &lt; 0.05 on one-tailed paired t-test). Regardless of phototherapy, Cohen-Mansfield scores decreased significantly in summer versus fall-spring (p &lt; .005). Although the direct behavioral measures [EBIC] showed no statistically significant change compared to baseline, there was a pattern of greater mean increase in positive behaviors (p = .08) during phototherapy than in the post-treatment week, and a mean decrease of total disruptive behaviors most pronounced in the post-treatment week (p = .05). Bright light therapy has modest efficacy in reducing agitation, with possible concurrent improvement in positive behaviors. Disruptive behaviors may also become less frequent during phototherapy with evidence of even greater delayed optimal effect. Further research should focus on subgroups of patients demonstrating a particularly robust response, enhance power through a larger sample, provide for longer light exposure, and control for seasonal variables.

Use of wrist activity for monitoring sleep/wake in demented nursing-home patients.

Actigraphy is applicable for studying sleep in populations who are unable to tolerate traditional sleep-recording techniques, such as nursing-home patients who are infirm and demented. This study examined whether actigraphy can accurately reflect sleep/wake activity in this population by testing the reliability of a wrist-activity monitor, the Actillume, against traditional sleep measurements and against observations of nursing-home patients. Data from the Actillume are presented as two variables, the sum (total of all activity movements within the prescribed epoch) and the maximum activity (the largest or maximum movement recorded during the prescribed epoch), and by electroencephalogram (EEG). One difficulty in making comparisons was that the EEG records showed diffuse slowing, making it extremely difficult to score sleep/wake activity and making it difficult to use the EEG as a "gold standard". Nevertheless, the correlation for total sleep time from EEG and Actillume was r = 0.91 (p < 0.001) for sum activity and r = 0.81 for maximum activity (p < 0.005). Correlations for percent sleep were r = 0.78 (p < 0.01) for maximum activity and r = 0.61 for sum activity. The comparison of sleep/wake determined by the Actillume vs. observations resulted in a sensitivity of 87% and specificity of 90%. We conclude that the Actillume is the most feasible technique for studying sleep and wake activity in demented nursing-home patients.

A randomized, placebo‐controlled trial of thiothixene in agitated, demented nursing home patients'

AbstractThe therapeutic efficacy of thiothixene in the treatment of behaviorally agitated dementia nursing home patients was studied in a double‐blind, randomized, placebo‐controlled clinical trial. Thirty‐three subjects were randomized for thiothixene (dose range: 0.25–18 mg) or placebo treatment over an 11‐week period, followed by a 6‐week crossover period to assess for return of symptoms in the group crossed over to placebo and further improvement in the group crossed over to thiothixene. Thiothixene was significantly more effective than placebo in the reduction of agitation at the end of 11 weeks of treatment. Symptoms tended to return after discontinuation. There were no significant changes in the Mini‐Mental State Examination (MMSE) or Activities of Daily Living (ADLs) and no significant differences in side‐effects. Two placebo‐treated patients died, and two patients died after being crossed over from thiothixene to placebo. The results suggest the efficacy of low doses of thiothixene for well‐defined agitation in specifically selected demented nursing home patients.