Claire A Surr1, Ivana Holloway2, Rebecca E A Walwyn2, Alys W Griffiths1, David Meads3, Adam Martin3, Rachael Kelley1, Clive Ballard4, Jane Fossey5, Natasha Burnley1, Lynn Chenoweth6, Byron Creese4, Murna Downs7, Lucy Garrod5, Elizabeth H Graham8, Amanda Lilley-Kelly2, Joanne McDermid9, Vicki McLellan2, Holly Millard5, Devon Perfect5, Louise Robinson10, Olivia Robinson1, Emily Shoesmith1, Najma Siddiqi11,12, Graham Stokes13, Daphne Wallace7, Amanda J Farrin2. 1. Centre for Dementia Research, School of Health and Community Studies, Leeds Beckett University, Leeds, UK. 2. Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK. 3. Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK. 4. Medical School, University of Exeter, Exeter, UK. 5. Psychological Services, Oxford Health NHS Foundation Trust, Oxford, UK. 6. Centre for Healthy Brain Ageing, University of New South Wales, Sydney, Australia. 7. Centre for Applied Dementia Studies, University of Bradford, Bradford, UK. 8. Academic Unit of Elderly Care and Rehabilitation, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK. 9. Liaison Psychiatry Services, Wolfson Centre for Age Related Diseases, Kings College London, London, UK. 10. Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK. 11. Department of Health Sciences, Hull York Medical School, University of York, York, UK. 12. Bradford District Care NHS Foundation Trust, Bradford, UK. 13. Memory Care, HC-One, Darlington, UK.
Abstract
OBJECTIVES: Agitation is common and problematic in care home residents with dementia. This study investigated the (cost)effectiveness of Dementia Care Mapping™ (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 = 31) and control (n = 19). Residents with dementia were recruited at baseline (n = 726) and 16 months (n = 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 = 675: 287 control, 388 intervention). The adjusted mean CMAI score difference was -2.11 points (95% CI -4.66 to 0.44, p = 0.104, adjusted ICC control = 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 = 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 (43·0%) mainly (87·2%) 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.
RCT Entities:
OBJECTIVES: Agitation is common and problematic in care home residents with dementia. This study investigated the (cost)effectiveness of Dementia Care Mapping™ (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 = 31) and control (n = 19). Residents with dementia were recruited at baseline (n = 726) and 16 months (n = 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 = 675: 287 control, 388 intervention). The adjusted mean CMAI score difference was -2.11 points (95% CI -4.66 to 0.44, p = 0.104, adjusted ICC control = 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 = 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 (43·0%) mainly (87·2%) 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.
Entities:
Keywords:
Alzheimer’s disease; Current Controlled Trials ISRCTN82288852; health economic evaluation; institutional care/residential care; intervention; long-term care; person-centred care; practice development; psychosocial interventions
Authors: Claudia Carrarini; Mirella Russo; Fedele Dono; Filomena Barbone; Marianna G Rispoli; Laura Ferri; Martina Di Pietro; Anna Digiovanni; Paola Ajdinaj; Rino Speranza; Alberto Granzotto; Valerio Frazzini; Astrid Thomas; Andrea Pilotto; Alessandro Padovani; Marco Onofrj; Stefano L Sensi; Laura Bonanni Journal: Front Neurol Date: 2021-04-16 Impact factor: 4.003