1
|
Surr CA, Holloway I, Walwyn REA, Griffiths AW, Meads D, Martin A, Kelley R, Ballard C, Fossey J, Burnley N, Chenoweth L, Creese B, Downs M, Garrod L, Graham EH, Lilley-Kelly A, McDermid J, McLellan V, Millard H, Perfect D, Robinson L, Robinson O, Shoesmith E, Siddiqi N, Stokes G, Wallace D, Farrin AJ. Effectiveness of Dementia Care Mapping™ to reduce agitation in care home residents with dementia: an open-cohort cluster randomised controlled trial. Aging Ment Health 2021; 25:1410-1423. [PMID: 32279541 DOI: 10.1080/13607863.2020.1745144] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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.
Collapse
Affiliation(s)
- Claire A Surr
- Centre for Dementia Research, School of Health and Community Studies, Leeds Beckett University, Leeds, UK
| | - Ivana Holloway
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Rebecca E A Walwyn
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Alys W Griffiths
- Centre for Dementia Research, School of Health and Community Studies, Leeds Beckett University, Leeds, UK
| | - David Meads
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Adam Martin
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Rachael Kelley
- Centre for Dementia Research, School of Health and Community Studies, Leeds Beckett University, Leeds, UK
| | | | - Jane Fossey
- Psychological Services, Oxford Health NHS Foundation Trust, Oxford, UK
| | - Natasha Burnley
- Centre for Dementia Research, School of Health and Community Studies, Leeds Beckett University, Leeds, UK
| | - Lynn Chenoweth
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, Australia
| | - Byron Creese
- Medical School, University of Exeter, Exeter, UK
| | - Murna Downs
- Centre for Applied Dementia Studies, University of Bradford, Bradford, UK
| | - Lucy Garrod
- Psychological Services, Oxford Health NHS Foundation Trust, Oxford, UK
| | - Elizabeth H Graham
- Academic Unit of Elderly Care and Rehabilitation, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Amanda Lilley-Kelly
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Joanne McDermid
- Liaison Psychiatry Services, Wolfson Centre for Age Related Diseases, Kings College London, London, UK
| | - Vicki McLellan
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Holly Millard
- Psychological Services, Oxford Health NHS Foundation Trust, Oxford, UK
| | - Devon Perfect
- Psychological Services, Oxford Health NHS Foundation Trust, Oxford, UK
| | - Louise Robinson
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Olivia Robinson
- Centre for Dementia Research, School of Health and Community Studies, Leeds Beckett University, Leeds, UK
| | - Emily Shoesmith
- Centre for Dementia Research, School of Health and Community Studies, Leeds Beckett University, Leeds, UK
| | - Najma Siddiqi
- Department of Health Sciences, Hull York Medical School, University of York, York, UK.,Bradford District Care NHS Foundation Trust, Bradford, UK
| | | | - Daphne Wallace
- Centre for Applied Dementia Studies, University of Bradford, Bradford, UK
| | - Amanda J Farrin
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| |
Collapse
|