Effectiveness of Dementia Care Mapping™ to reduce agitation in care home residents with dementia: an open-cohort cluster randomised controlled trial

Abstract

Objectives: Agitation is common and problematic in care home residents with dementia. This study investigated the (cost)effectiveness of Dementia Care Mapping TM (DCM) for reducing agitation in this population. Method: Pragmatic, cluster randomised controlled trial with cost-effectiveness analysis in 50 care homes, follow-up at 6 and 16 months and stratified randomisation to intervention (n ¼ 31) and control (n ¼ 19). Residents with dementia were recruited at baseline (n ¼ 726) and 16 months (n ¼ 261). Clusters were not blinded to allocation. Three DCM cycles were scheduled, delivered by two trained staff per home. Cycle one was supported by an external DCM expert. Agitation (Cohen-Mansfield Agitation Inventory (CMAI)) at 16 months was the primary outcome. Results: DCM was not superior to control on any outcomes (cross-sectional sample n ¼ 675: 287 control, 388 intervention). The adjusted mean CMAI score difference was-2.11 points (95% CI-4.66 to 0.44, p ¼ 0.104, adjusted ICC control ¼ 0, intervention 0.001). Sensitivity analyses supported the primary analysis. Incremental cost per unit improvement in CMAI and QALYs (intervention vs control) on closed-cohort baseline recruited sample (n ¼ 726, 418 intervention, 308 control) was £289 and £60,627 respectively. Loss to follow-up at 16 months in the original cohort was 312/ 726 (43Á0%) mainly (87Á2%) due to deaths. Intervention dose was low with only a quarter of homes completing more than one DCM cycle. Conclusion: No benefits of DCM were evidenced. Low intervention dose indicates standard care homes may be insufficiently resourced to implement DCM. Alternative models of implementation, or other approaches to reducing agitation should be considered.

Effectiveness of Resilience Interventions on Psychosocial Outcomes for Persons With Neurocognitive Disorders: A Systematic Review and Meta-Analysis

“…In terms of social behavior, one study indicated significant differences in favor of resilience interventions compared with controls ( 38 ). Meanwhile, no significant differences were found in neuropsychiatric symptoms ( 39 – 41 , 43 , 44 ), adjustment ( 26 ), stress ( 29 ), and anxiety ( 29 ) in favor of resilience interventions compared with controls. Besides, the results of other outcomes' assessments were inconsistent.…”

“…In terms of well-being, one study showed no significance in favor of resilience interventions compared with controls ( 26 ), while the other study showed statistical significance ( 27 ). About the effects on agitation, one showed no significance in favor of resilience interventions compared with controls ( 41 ), while one showed statistical significance ( 45 ).…”

“…Participants in most studies ( n = 10) were persons with dementia ( 26 , 28 , 29 , 38 , 41 – 44 , 46 , 47 ), one as persons with MCI ( 39 ), one as persons with MCI and early dementia ( 27 ), one as persons with dementia or cognitive impairment ( 45 ), and one was Alzheimer's ( 40 ). The number of participants ranged from 19 to 726, and seven studies had more than 100 participants.…”

“…We identified six resilience approaches based on content descriptions, including integrated approaches ( n = 5), exercise regimen or activity programs ( n = 4), psychological interventional technique ( n = 2), a psychiatric intervention ( n = 1), disease/case management ( n = 1), and cognitive stimulation therapy ( n = 1). Among five studies with integrated approaches, one was individualized person-centered care provided by standard procedures to diminish turmoil in care home residents with dementia ( 41 ), one was multimodal non-drug therapy on dementia's symptom and care need ( 38 ), one was multidimensional home-based care coordination provided by an interdisciplinary team to maximize independence for persons with MCI living home ( 39 ), one was a staff-led intervention that comprises four mandatory modules and one optional module to facilitate the adaptation of seniors with dementia after placement into residential care ( 26 ), and one was a psychosocial intervention including multifaceted and semi-tailored counseling, education, and support ( 40 ).…”

A biopsychosocial interpretation of the Neuropsychiatric Inventory – Nursing Home assessment: reconceptualising psychiatric symptom attributions

“…Participants ( n = 725) were recruited from 50 care homes (mean 15 residents per care home) as part of a randomised controlled trial, 17 we present baseline data only. Permanent residents with a formal diagnosis of dementia or a score ≥4 on the Functional Assessment Staging Test of Alzheimer's disease 18 were recruited.…”