Caring for Aged Dementia Care Resident Study (CADRES) of person-centred care, dementia-care mapping, and usual care in dementia: a cluster-randomised trial
Chenoweth L, King MT, Jeon YH, Brodaty H, Stein-Parbury J, Norman R, et al.;
Commented by , 24 Apr 2009
Aim of the study
To investigate the effectiveness of person-centred care and dementia-care mapping compared to each other and with conventional dementia care and examine whether either intervention can decrease the need-driven dementia-compromised behaviors, improve quality of life (QOL), reduce the use of psychotropic drugs, restraints and rates of accidents or injuries.
Method
Cluster randomized controlled trial where 15 urban residential sites were randomly assigned to person-centred care, dementia-care mapping or usual care. The primary outcome was agitation measured with the Cohen-Mansfield agitation inventory (CMAI).
Secondary outcomes included other behavioral symptoms using the NPI-NH, global deterioration rating scale, QOL using the QUALID, falls, costs of treatment. Outcomes measures were assessed before treatment, at the end of 4 months of intervention, and 4 months later. Hierarchical linear models were used to test treatment and time effects.
Results
289 residents with dementia and age over 60 participated. 236 (82%) remained in the study to completion. CMAI scores at follow-up were lower than usual care in sites providing dementia-care mapping and person-centred care. Compared to usual care there were less falls associated with mapping but more falls associated with person-centred care. There were no differences for the other outcomes.
Professor Gauthier's comments
Agitation as measured by the CMAI was lower in both person-centred care and dementia-care mapping compared to usual care, supporting the need for individually tailored behavioral interventions. The CMAI proved to be more sensitive than the NPI to detect improvement in behaviors.
This study is important in many ways; the cluster design is being used more and more for non-pharmacological research involving schools and residences providing care. Agitation is a very common and distressing symptom in later stages of dementia: any improvement is welcome, considering the limited efficacy of psychotropic drugs.
The accompanying editorial by Clive Ballard and Dag Aarsland (ref. 1) highlights the need for longer duration of treatment periods, and possibly an additive benefit of other treatments such as physical exercise.
The Australian Health Minister's advisory Council provided funding for this study, and such state funding is essential for non-pharmacological studies in dementia. Hopefully the Sarkozy Alzheimer Plan in France and similar programs in Europe and elsewhere will provide funding for similar studies.
References
1. Ballard C, Aarsland D. Person-centred care and care mapping in dementia. Lancet Neurology 2009, 8, 302-303