Objectives

Challenging behavior and pain are common in nursing home residents with dementia. STA OP! with family is a multidisciplinary stepwise method that involves family in addressing challenging behavior and pain. This study examines the impact of STA OP! with family on residents, family, and nursing staff.

Methods

Pre-post-test study with multilevel analyses of impact of the method at 3 and 6 months following implementation. Challenging behavior was assessed with the Neuropsychiatric Inventory Questionnaire Nursing Home version as primary outcome. Secondary outcomes included observed pain, quality of life, medication use, and family caregivers’ experience of involvement in the method and caregiver burden. In addition, we assessed emotional burden of challenging behavior on nursing staff.

Results

Ten wards in a Dutch nursing home implemented STA OP! with family. 77 residents and their family caregivers were included. Challenging behavior decreased 3 months (standardized coefficient -0.2; 95%CI -0.3 to -0.04) and 6 months after implementation (-0.2; 95%CI -0.3 to -0.03). Observed pain in residents (3 months: -0.01 95%CI -0.2 to 0.2; 6 months: -0.2; 95%CI -0.3 to -0.004) and emotional burden on nursing staff also decreased (3 months: -0.3; 95%CI -0.4 to -0.1; 6 months: -0.3; 95%CI -0.4 to -0.1). No change was seen in residents’ quality of life and medication use, or in family caregivers’ involvement, burden, and positive caregiving experiences.

Conclusions

STA OP! with family improved challenging behavior and some of the secondary resident and nursing staff outcomes. Further research is needed to optimize family involvement in the method.

Trial registration

The study protocol was registered at OSF on May 18, 2022: https://osf.io/5ghnx.

© 2026 The Author(s). International Journal of Geriatric Psychiatry published by John Wiley & Sons Ltd.