The identified facilitating factors can guide Dementia Care Mapping implementation strategy development.

DCM exhibited no statistically significant effect in terms of QoL and challenging behavior of PwD in NHs. To increase the likelihood of a positive effect for PwD, it is necessary to ensure successful implementation of the intervention.

BackgroundThe main objective of care for people with dementia is the maintenance and promotion of quality of life (Qol). Most of the residents in nursing homes have challenging behaviors that strongly affect their Qol. Person-centered care (PCC) is an approach that aims to achieve the best possible Qol and to reduce challenging behaviors. Dementia Care Mapping (DCM) is a method of implementing PCC that has been used in Germany for several years. However, there are no data on the effectiveness of DCM or the challenges of implementation of DCM in German nursing homes.Methods/designIn this quasi-experimental non-randomized cluster-controlled study, the effects of DCM will be compared to 2 comparison groups. 9 nursing homes will take part: 3 will implement DCM, 3 will implement a comparison intervention using an alternative Qol assessment, and 3 have already implemented DCM. The main effect outcomes are Qol, challenging behaviors, staff attitudes toward dementia, job satisfaction and burnout of caregivers. These outcomes will be measured on 3 data points. Different quantitative and qualitative data sources will be collected through the course of the study to investigate the degree of implementation as well as facilitators of and barriers to the implementation process.DiscussionThis study will provide new information about the effectiveness of DCM and the implementation process of DCM in German nursing homes. The study results will provide important information to guide the national discussion about the improvement of dementia-specific Qol, quality of care in nursing homes and allocation of resources. In addition, the study results will provide information for decision-making and implementation of complex psychosocial interventions such as DCM. The findings will also be important for the design of a subsequent randomized controlled trial (e.g. appropriateness of outcomes and measurements, inclusion criteria for participating nursing homes) and the development of a successful implementation strategy.Trial registrationCurrent Controlled Trials ISRCTN43916381.

In Germany hourly care for people with dementia and relief for family caregivers are often delivered through social care groups. The existing literature describes these groups from the perspective of professionals or family caregivers, with little involvement of people with dementia. This qualitative study is the first step in exploring the experiences of people with dementia in social care groups. Five persons suffering from dementia in one group were interviewed and additionally observed with DCM in three group sessions. The interview transcripts were coded open and axial according to Grounded Theory. The DCM data was analysed descriptive. The main phenomena in the interviews are 'familiar community' and 'personal meaning'. The DCM results show that people with lower cognitive function are excluded from most activities, whereas more staff attention causes better well-being. To create a 'familiar community' in a social care group, staff skills and knowledge are required.

Need driven dementia care at home requires the use of needs assessments like CarenapD. The CarenapD Manual states that the person with dementia (PwD) and caregivers (CA) should be included in the assessment process. In a pre-post study CarenapD has been applied in PwD (n = 55) and CA (n = 49) by professional staff (n = 15), CA were much more involved than PwD. Needs in PwD in T0 and T1 showed frequently functional needs(50 %), no need were frequently found in dementia-specific needs (42 %) and frequently unmet need was present in social needs (35 %). Burden-related needs in CA were reduced from T0 to T1 in daily difficulties (-14 %), support (-20 %) and breaks from caring (-9 %).This secondary analysis compares the need results of PwD and CA to discuss the unequal involvement of clients. In this secondary analysis needs data of PwD and CA is included. Need in PwD at T0 and T1 showed frequently met functional need (50 %), frequently no need in dementia specific needs (42 %) and high unmet need in social needs (35 %). Burden in CA could be reduced from T0 to T1 in Daily Difficulties (-14 %), Support (-20 %) and Breaks from Caring (9 %). Compared to the literature it is remarkable that a high rate in no need was found in dementia specific needs. Needs of CA show congruent results, it seems to have come to relief of burden in CA. Lack of knowledge and shame in CA as well as the continuous presence of both clients within the assessment process may have caused that dementia-specific needs were not enough addressed. PwD and CA should be actively involved in the assessment process and should contribute their individual point of view, as stated in the CarenapD Manual.

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