A Cluster-Randomised Trial of Staff Education to Improve the Quality of Life of People with Dementia Living in Residential Care: The DIRECT Study

Abstract

BackgroundThe Dementia In Residential care: EduCation intervention Trial (DIRECT) was conducted to determine if delivery of education designed to meet the perceived need of GPs and care staff improves the quality of life of participants with dementia living in residential care.Methodology/Principal FindingsThis cluster-randomised controlled trial was conducted in 39 residential aged care facilities in the metropolitan area of Perth, Western Australia. 351 care facility residents aged 65 years and older with Mini-Mental State Examination ≤24, their GPs and facility staff participated. Flexible education designed to meet the perceived needs of learners was delivered to GPs and care facility staff in intervention groups. The primary outcome of the study was self-rated quality of life of participants with dementia, measured using the QOL-Alzheimer's Disease Scale (QOL-AD) at 4 weeks and 6 months after the conclusion of the intervention. Analysis accounted for the effect of clustering by using multi-level regression analysis. Education of GPs or care facility staff did not affect the primary outcome at either 4 weeks or 6 months. In a post hoc analysis excluding facilities in which fewer than 50% of staff attended an education session, self-rated QOL-AD scores were 6.14 points (adjusted 95%CI 1.14, 11.15) higher at four-week follow-up among residents in facilities randomly assigned to the education intervention.ConclusionThe education intervention directed at care facilities or GPs did not improve the quality of life ratings of participants with dementia as a group. This may be explained by the poor adherence to the intervention programme, as participants with dementia living in facilities where staff participated at least minimally seemed to benefit.Trial RegistrationANZCTR.org.au ACTRN12607000417482

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“…34 Considering the limited nature of the educational intervention, and the lack of follow-up and reinforcement, the results obtained in this study are promising. Previous studies with a more robust design 35 and longer NH staff educational interventions (6 months) failed to show any impact on the quality of life of dementia patients. Moreover, in other studies, the educational intervention supported the implementation of videos for relatives 30 or of the Gold Standard Framework in Care Homes 12e14 with the implementation of organizational tools, support from facilitators, helpline and conference calls, 12 the support of specialist care nurses, 14 the identification of key champions, 13 whereas in the present study, besides the educational intervention, no other forms of support were provided, with the exception of the possibility (although it was never used) to contact experts for support.…”

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Organisational Culture in Residential Aged Care Facilities: A Cross-Sectional Observational Study

“…Costs, staff shortages, staff turnover and communication problems are cited as barriers to sustainable improvements in the care of people living in residential care facilities [2]. Although educational interventions in residential care may be evaluated positively by participants [3], we found evidence that impact on residents may be restricted by limited staff participation [4]. Focusing on sustainable culture change may offer an alternative method of quality improvement in residential care settings.…”