[Aging Brain Care Program from Indianapolis: Transferability to the German healthcare system]

[The "Lübeck Worlds of Movement Model"-results of the effects evaluation]

BACKGROUND

There are few standardized and evaluated intervention programs for elderly people in need of care that consider motor, cognitive and social aspects. Therefore, the "Lübeck Worlds of Movement Model" was developed by the Lübeck Geriatrics Research Group as a multidimensional standardized intervention program for continuous use in the nursing home.

OBJECTIVES

The model was evaluated for its effects over the course of one year in the areas of self-care competence (primary endpoint), mobility, coordination, flexibility, strength, endurance, and cognition. The results are presented in this article.

MATERIALS AND METHODS

The sample recruitment took place in 6 nursing homes in Kiel (control group) and 10 in Lübeck (intervention group). Care-dependent senior citizens from the neighborhood were also allowed to participate. Inclusion criteria were the ability to walk at least 6 m independently and the cognitive and sensory capacities to follow the group training. The evaluation study had 255 subjects. To verify the effects of the intervention, various tests were performed at baseline and after 3, 6, 9, and 12 months: Barthel Index, Timed Up and Go, 4‑meter walk test, Romberg stand, one-leg stand, 20-Cents Test, 8‑Point Reach Test, hand force, 5‑Chair-Rise Test, 2‑Minute Step Test, and Six-Item Screener.

RESULTS

Comparison of the control group with the subjects who had participated in at least half of the training sessions (per-protocol analysis) showed the highest effect size in the multivariate analysis of variance after one year for the Barthel index, followed by the Timed Up and Go, cumulated over all times for the Romberg stand and 5‑Chair-Rise Test. The maximum effect measured over the entire assessment occurred after 6 months (partial eta square ηp² = 0.332).

CONCLUSIONS

The model developed preventive effects on all investigated dimensions over the course of a year, but with differences in intensity and time of maximum effect. The motivation for long-term participation was high.

Effectiveness and Safety of Dementia Care Management in Primary Care: A Randomized Clinical Trial

IMPORTANCE

Dementia care management (DCM) can increase the quality of care for people with dementia. Methodologically rigorous clinical trials on DCM are lacking.

OBJECTIVE

To test the effectiveness and safety of DCM in the treatment and care of people with dementia living at home and caregiver burden (when available).

DESIGN, SETTING, AND PARTICIPANTS

This pragmatic, general practitioner-based, cluster-randomized intervention trial compared the intervention with care as usual at baseline and at 12-month follow-up. Simple 1:1 randomization of general practices in Germany was used. Analyses were intent to treat and per protocol. In total, 6838 patients were screened for dementia (eligibility: 70 years and older and living at home) from January 1, 2012, to March 31, 2016. Overall, 1167 (17.1%) were diagnosed as having dementia, and 634 (9.3%) provided written informed consent to participate.

INTERVENTIONS

Dementia care management was provided for 6 months at the homes of patients with dementia. Dementia care management is a model of collaborative care, defined as a complex intervention aiming to provide optimal treatment and care for patients with dementia and support caregivers using a computer-assisted assessment determining a personalized array of intervention modules and subsequent success monitoring. Dementia care management was targeted at the individual patient level and was conducted by 6 study nurses with dementia care-specific qualifications.

MAIN OUTCOMES AND MEASURES

Quality of life, caregiver burden, behavioral and psychological symptoms of dementia, pharmacotherapy with antidementia drugs, and use of potentially inappropriate medication.

RESULTS

The mean age of 634 patients was 80 years. A total of 407 patients received the intended treatment and were available for primary outcome measurement. Of these patients, 248 (60.9%) were women, and 204 (50.1%) lived alone. Dementia care management significantly decreased behavioral and psychological symptoms of dementia (b = -7.45; 95% CI, -11.08 to -3.81; P < .001) and caregiver burden (b = -0.50; 95% CI, -1.09 to 0.08; P = .045) compared with care as usual. Patients with dementia receiving DCM had an increased chance of receiving antidementia drug treatment (DCM, 114 of 291 [39.2%] vs care as usual, 31 of 116 [26.7%]) after 12 months (odds ratio, 1.97; 95% CI, 0.99 to 3.94; P = .03). Dementia care management significantly increased quality of life (b = 0.08; 95% CI, 0 to 0.17; P = .03) for patients not living alone but did not increase quality of life overall. There was no effect on potentially inappropriate medication (odds ratio, 1.86; 95% CI, 0.62 to 3.62; P = .97).

CONCLUSIONS AND RELEVANCE

Dementia care management provided by specifically trained nurses is an effective collaborative care model that improves relevant patient- and caregiver-related outcomes in dementia. Implementing DCM in different health care systems should become an active area of research.

TRIAL REGISTRATION

clinicaltrials.gov Identifier: NCT01401582.