Characterizing Intervention Components and Complexity of Nonpharmacologic Healthcare Interventions to Manage Distress Behaviors in Older Adults.

Distress behaviors are common in residential care settings and contribute to staff burnout and poor quality of life for older adults. While nonpharmacologic interventions reduce distress behaviors, implementation in routine care remains challenging. Our study applies a narrative reanalysis of interventions to 34 studies identified in a prior systematic review to describe the setting, focus, core components, and complexity of interventions identified. Most interventions occurred in post-acute settings, followed by transitions between care settings and inpatient mental health settings. Identified interventions were highly complex and heterogeneous regarding the components assessed and the details reported. Intervention components focused on patients, healthcare workers, environmental, and multiple levels. Common patient-level components included individualized care plans, distress behavior detection, medical management, and symptom monitoring. Common staff-level components included education and healthcare team workflow. Current evidence does not provide sufficient detail to replicate these interventions. We provide a template for standardized intervention testing and reporting implementation.