top of page

The Effect of a Multicomponent Intervention on Quality of Life in Residents of Nursing Homes: A Randomized Controlled Trial (COSMOS)

Contact Information


Bettina S Husebø

Multicomponent intervention; activity; advance care planning; dementia; implementation; medication review; neuropsychiatric symptoms; nursing home; pain assessment; pain treatment; quality of life.


Objectives To investigate if the multicomponent intervention of the COSMOS trial, combining communication, systematic pain management, medication review, and activities, improved quality of life (QoL) in nursing home patients with complex needs. Design Multicenter, cluster-randomized, single-blinded, controlled trial. Setting Thirty-three nursing homes with 67 units (clusters) from 8 Norwegian municipalities. Participants Seven hundred twenty-three patients with and without dementia (≥65 years) were cluster randomized to usual care or intervention in which health care staff received standardized education and on-site training for 4 months with follow-up at month 9. Measurements Primary outcome was change in QoL as measured by QUALIDEM (QoL dementia scale); QUALID (QoL late-stage dementia scale), and EQ-VAS (European QoL–visual analog scale) from baseline to month 4. Secondary outcomes were activities of daily living (ADL), total medication, staff distress, and clinical global impressions of change (CGIC). Results During the active intervention, all 3 QoL measures worsened, 2 significantly (QUALID P = .04; QUALIDEM P = .002). However, follow-up analysis from month 4 to 9 showed an intervention effect for EQ-VAS ( P = .003) and QUALIDEM total score ( P = .01; care relationship P = .02; positive affect P = .04, social relations P = .01). The secondary outcomes of ADL function, reduction of medication (including psychotropics) and staff distress, improved significantly from baseline to month 4. Intervention effects were also demonstrated for CGIC at month 4 ( P = .023) and 9 ( P = .009), mainly because of deterioration in the control group. Conclusion and implications Temporarily, the QoL decreased in the intervention group, leading to our hypothesis that health care staff may be overwhelmed by the work-intensive COSMOS intervention period. However, the decrease reversed significantly during follow-up, indicating a potential learning effect. Further, the intervention group improved in ADL function and received less medication, and staff reported less distress and judged COSMOS as able to bring about clinically relevant change. This suggests that nonpharmacologic multicomponent interventions require long follow-up to ensure uptake and beneficial effects.


Husebø, B. S., Ballard, C., Aarsland, D., Selbaek, G., Slettebo, D. D., Gulla, C., Aasmul, I., Habiger, T., Elvegaard, T., Testad, I., & Flo, E. (2019). The Effect of a Multicomponent Intervention on Quality of Life in Residents of Nursing Homes: A Randomized Controlled Trial (COSMOS). Journal of the American Medical Directors Association, 20(3), 330–339.





Conent Area

Bettina S Husebø

EWB-Related Construct

(4) quality of life
(2)Life Satisfaction
(3) Positive Affect

Study Design

Species or Study Population

(5) RCT

Sex (%Female)


Age (Mean, SD)

86.7, 7.5

Younger Controls?


Longitudinal Data?


Sample Size



multicomponent intervention

Ethnicity (%white)

not stated (Norway)

Inclusion Criteria

Resident in long time care ward in nursing home
65 Years and older (Older Adult )

Exclusion Criteria

Dying patients with reduced consciousness at baseline
Active Schizophrenia

EWB Measures

QUALIDEM (QoL dementia scale);
QUALID (QoL late-stage dementia scale),
EQ-VAS (European QoL-visual analog scale)

Non-EWB Behavioral

Neuropsychiatric Inventory - Nursing Home version (NPI-NH)
Mobilization Observation Behavior Intensity Dementia-2 (MOBID-2 Pain Scale)
Mini mental state Examination
Functional Assessment Staging (FAST)
Activities of daily living (ADL)
clinical global impression of change (CGIC)

Physiological Measures


Brain IMaging Modality

Brain IMaging Paradigm


Brain Region/Circuit


Biological Measures


Other Neural Measures

Data Availability?


Data Avalability Details


Diagnostic Measures

bottom of page