TIME (English Version)

TIME

Targeted Interdisciplinary Model for Evaluation and treatment of neuropsychiatric symptoms

TIME is a multicomponent intervention to be used by the nursing home staff and physicians, for the assessment and treatment of behavioural and psychological symptoms in dementia or other complex disorders. These symptoms are also called neuropsychiatric symptoms or sometimes challenging behaviour. The intervention is based on principles and structures from cognitive behavioural therapy and from person-centred care. The aim is to customize measures for the individual patient.

The TIME manual is a short and practical aid to carrying out TIME. It gives a step-by-step description of how to implement the intervention model.

Link to a short introduction film about TIME (2 min. 30 sec.): animation TIME

Link to the TIME manual:       TIME Manual 

Link to the educational film about TIME (17 minutes):  TIME Film

Research on TIME:

The TIME study is a three-month cluster randomized trial conducted from January 2016 in 33 Norwegian nursing homes, assigning 229 patients with dementia and moderate to high levels of agitation to receive either the Targeted Interdisciplinary Model for Evaluation and Treatment of Neuropsychiatric Symptoms (TIME) or a brief education-only intervention.  We also performed a systematic process evaluation  during the study and for one year, as outlined in the trial protocol.

Link to the TIME study protocol published in BMC Psychiatry:  Study Protocol for the TIME-trial

Link to the TIME-trial, a cluster randomized controlled trial in nursing homes, showing results of effectiveness of the intervention with TIME in nursing homes. This paper was published in the American Journal of Geriatric Psychiatry, in January 2018.  In this trial agitation was measured by the singel-item agitation in the Neuropsychiatric Inventory – Nursing Home Version (NPI-NH). A significant between-group difference in reduction of agitation at both eight weeks (1.1; 95% confidence interval, 0.1 to 2.1; P=0.03) and 12 weeks (1.6; 95% confidence interval, 0.6 to 2.7; P=0.002) in favour of the TIME intervention was found. Symptoms of delusions at eight weeks, and depression, disinhibition, and quality of life at 12 weeks, showed significant between-group differences in favour of the TIME intervention.

The TIME trial was funded by the Innlandet Hospital Trust

The staff’s coping and learning experiences with TIME

The staff’s coping and learning experiences were explored in a qualitative study using interviews of five focus groups from the intervention nursing homes, three to six months after the randomized controlled trial. The study findings were published in Aging & Mental Health in april 2018, Lichtwarck B. et al. Aging & Mental Health 2018. The conclusion in this study was that TIME shifts the way of learning for the staff from a traditional to a more innovative and reflection-based learning through a process of learning how to learn at work. The staff’s experienced increased coping in their approach to complex problems. The results emphasise the importance of a structured and biopsychosocial approach to NPS in clinical practice.

The process evaluation of the intervention with TIME in nursing homes

We have performed a thorough process evaluation of the intervention with TIME during the RCT in 33 nursing homes. This has been conducted using mixed methods with a quasi-experimental design. The results were published in 2019,  see Lichtwarck, B.et al BMC Health Services Research 2019. A high degree of reach, adoption, implementation and maintenance contributed to the effectiveness of TIME at resident level. One other causal assumption of the effectiveness of TIME is the development in the staff during the case conferences of a new, shared and situated knowledge about each individual resident, not reflected by measurements in general knowledge and attitudes.

Other research project from a psychiatric hospital ward using TIME

TIME has recently also been evaluated with qualitative methods in a research project in an psychogeriatric hospital ward in Norway for patients with other conditions than dementia. In this project we wanted to gain knowledge about how the staff in a geriatric psychiatry ward experience TIME as a model for problem solving in their approach to patients without dementia. Main findings: Through the use of TIME, the staff experiences increased coping, shared understanding and joint commitment to treatment for the individual patient. TIME appeared to be a suitable model for interdisciplinary problem solving and for the development of cognitive milieu therapy in a geriatric psychiatry ward for staff that work with patients without dementia. Link to english abstract to the article: Shared Understanding and Commitment,  Myhre J. Tidskriftet Aldring og Helse 2018

The TIME project has been supported by:

Innlandet Hospital Trust, Norway; The Center for Age-related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad Norway; The Norwegian Medical Association fund for quality and patient safety; The Municipality of Rana, Norway; and the National Centre of Rural Medicine (NCRM) The artic University of Norway,Tromsø (UiT).

Contact information:

Bjørn Lichtwarck, MD/researcher,   bjorn.lichtwarck@sykehuset-innlandet.no

Anette Væringstad, M.Sc.,Nurse Specialist in Psychiatry, anette.vaeringstad@sykehuset-innlandet.no

Both at The Research Centre for Age-related Functional Decline and Disease, Innlandet Hospital Trust.