Centre for Elderly and Nursing Home Medicine (SEFAS)

Main content

Nursing home patients have complex mental health problems, disabilities and social needs, compounded by widespread prescription of psychotropic drugs. To preserve their dignity and quality of life is an important goal. This can only be achieved within NHs that offers highly competent conditions of treatment and care.

COSMOS (COmmunication, Systematic pain assessment and treatment, Medication review, Organization of activities, and Safety) is a practical intervention aimed to improve the quality of life in nursing home patients. The intervention combines the most effective research results to improve staff competence, and patients’ mental health, safety, quality of life and to reduce psychotropic drug use and costs. A total of 545 patients from 67 nursing home units from the eastern and western part of Norway were included.

The nursing home staff was educated in the five focus areas:

  • Communication with advance care planning (ACP)
  • Systematic pain assessment and treatment
  • Medication reviews
  • Organization of activities
  • Safety

The intervention involved a thorough implementation process and was carried out in all units. The intervention lasted for four months, with follow up after nine months. The protocol for the study is published (Husebo et al. 2015) and more articles are coming in 2017.


The COSMOS intervention combines most effective research results to improve staff competence, and patients’ mental health, safety, QoL, and to reduce psychotropic drug use and costs. The efficacy testing of COSMOS includes systematic literature review, a pilot study, a 9-month RCT, and a dissemination plan. Data collection took place at baseline, months 4, and 9.

The intervention entails provision of staff training, study guidelines and manuals. 67 NH long-term-care (LTC) wards in Kvam, Sund, Øygarden, Askøy, Bærum, Bergen and Sarpsborg, in total 545 patients, ≥65 years are included.

Outcome measures

Quality of life, psychiatric behavior like depression and agitation, use of medications, pain, advance care planning, activities of daily living, hospital admission and mortality. 


  1. Detering, KM. et al. 2010 The impact of advance care planning on end of life care in elderly patients: RCT. BMJ.
  2. Husebo, BS. et al. 2011 Efficacy of treating pain to reduce BPSD in NH patients: RCT trial. BMJ.
  3. Helse direktoratet. 2012 Veileder om medikamentgjennomgang (IS-1998).
  4. Testad, I et al. 2014 The value of personalized psychosocial interventions to address behavioral and psychological symptoms in people with dementia living in care home settings: a systematic review. Int Psychogeriatr