TY - JOUR
T1 - Effectiveness of Dementia Care Mapping™ to reduce agitation in care home residents with dementia
T2 - an open-cohort cluster randomised controlled trial
AU - Surr, Claire A.
AU - Holloway, Ivana
AU - Walwyn, Rebecca E.A.
AU - Griffiths, Alys W.
AU - Meads, David
AU - Martin, Adam
AU - Kelley, Rachael
AU - Ballard, Clive
AU - Fossey, Jane
AU - Burnley, Natasha
AU - Chenoweth, Lynn
AU - Creese, Byron
AU - Downs, Murna
AU - Garrod, Lucy
AU - Graham, Elizabeth H.
AU - Lilley-Kelly, Amanda
AU - McDermid, Joanne
AU - McLellan, Vicki
AU - Millard, Holly
AU - Perfect, Devon
AU - Robinson, Louise
AU - Robinson, Olivia
AU - Shoesmith, Emily
AU - Siddiqi, Najma
AU - Stokes, Graham
AU - Wallace, Daphne
AU - Farrin, Amanda J.
N1 - Funding Information:
CB reports grants and personal fees from Acadia pharmaceutical company, grants and personal fees from Lundbeck, personal fees from Roche, personal fees from Otusaka, personal fees from Novartis, personal fees from Eli Lilly, personal fees from Pfizer, outside the submitted work.
Funding Information:
This work was supported by the National Institute for Health Research Health Technology Assessment programme (project number 11/15/13). The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the HTA, NIHR, NHS or the Department of Health and Social Care. We would like to thank all the care homes, individuals with dementia, their family members and care home staff for taking part in this study and giving freely of their time and members of the Independent Trial Steering Committee and Data Monitoring Committee who provided oversight and gave expert advice throughout the trial. We would like to thank the following people who have contributed to the successful completion of this trial. Chris Albertyn, Marie Crabbe, Cara Gates, Stephanie Jones, Baber Malik, Harriet Maunsell, Kirsty Nash, Sahdia Parveen, Luisa Rabanal, Bina Sharma, Emily Standell, Miguel Vasconcelos Da Silva and other researchers who collected the data; Madeline Goodwin, Alison Fergusson, Laura Stubbs and others who undertook data management; Benjamin Thorpe who assisted with statistical programming; Sharon Jones, Lisa Heller, Juniper West, Judith Farmer, Maria Scurfield and others who supported DCM? intervention implementation activities; Jan Leeks and Lindsey Collins who delivered Dementia Awareness training; Jane Ward and other members of the Lay Advisory Group and Susan Fortescue who sat on the Trial Management Group and Lay Advisory Group; Ian Wheeler who provided administrative support for the trial and Matt Murray from the Alzheimer?s Society who provided oversight for the Lay Advisory Group. GS would like to acknowledge Bupa UK, who were his employing organisation during the majority of the study period. Fossey receives support from the NIHR Oxford Health Biomedical Research Centre; a partnership between Oxford Health NHS Foundation Trust and the University of Oxford.
Funding Information:
We would like to thank all the care homes, individuals with dementia, their family members and care home staff for taking part in this study and giving freely of their time and members of the Independent Trial Steering Committee and Data Monitoring Committee who provided oversight and gave expert advice throughout the trial. We would like to thank the following people who have contributed to the successful completion of this trial. Chris Albertyn, Marie Crabbe, Cara Gates, Stephanie Jones, Baber Malik, Harriet Maunsell, Kirsty Nash, Sahdia Parveen, Luisa Rabanal, Bina Sharma, Emily Standell, Miguel Vasconcelos Da Silva and other researchers who collected the data; Madeline Goodwin, Alison Fergusson, Laura Stubbs and others who undertook data management; Benjamin Thorpe who assisted with statistical programming; Sharon Jones, Lisa Heller, Juniper West, Judith Farmer, Maria Scurfield and others who supported DCM™ intervention implementation activities; Jan Leeks and Lindsey Collins who delivered Dementia Awareness training; Jane Ward and other members of the Lay Advisory Group and Susan Fortescue who sat on the Trial Management Group and Lay Advisory Group; Ian Wheeler who provided administrative support for the trial and Matt Murray from the Alzheimer’s Society who provided oversight for the Lay Advisory Group. GS would like to acknowledge Bupa UK, who were his employing organisation during the majority of the study period. Fossey receives support from the NIHR Oxford Health Biomedical Research Centre; a partnership between Oxford Health NHS Foundation Trust and the University of Oxford.
Publisher Copyright:
© 2020 Leeds Beckett University. Published by Informa UK Limited, trading as Taylor & Francis Group.
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021
Y1 - 2021
N2 - 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.
AB - 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.
KW - Alzheimer’s disease
KW - Current Controlled Trials ISRCTN82288852
KW - health economic evaluation
KW - institutional care/residential care
KW - intervention
KW - long-term care
KW - person-centred care
KW - practice development
KW - psychosocial interventions
UR - http://www.scopus.com/inward/record.url?scp=85083586756&partnerID=8YFLogxK
U2 - 10.1080/13607863.2020.1745144
DO - 10.1080/13607863.2020.1745144
M3 - Article
C2 - 32279541
AN - SCOPUS:85083586756
SN - 1360-7863
VL - 25
SP - 1410
EP - 1423
JO - Aging and Mental Health
JF - Aging and Mental Health
IS - 8
ER -