NEW YORK -- March 11, 2009 -- Both person-centred care and dementia-care mapping reduce agitation in people with dementia in residential care. In addition, person-centred approaches can be taught quickly and should be introduced as standard practice in residential care homes, according to a study released early online and appearing in the April issue of The Lancet Neurology.
Two individually tailored behavioural interventions already used widely in clinical practice, person-centred care and dementia-care mapping, have been shown to improve outcomes for people with dementia, but the evidence is mainly descriptive and observational.
To provide further evidence, Lynn Chenoweth, University of Technology Sydney, Sydney, Australia, and colleagues conducted the Caring for Aged Dementia Care Resident Study (CADRES) to examine the effectiveness of these interventions and whether they could improve quality of life, decrease need-driven dementia-compromised behaviours, or reduce the use of psychotropic drugs and rates of accidents and injuries.
The study included 15 residential care sites in Sydney involving 289 residents with dementia aged 60 years or older. Patients were randomly assigned to person-centred care, dementia-care mapping, or usual care,
Carers received training and support in the relevant intervention or continued usual care. The Cohen-Mansfield agitation inventory (CMAI) was used to measure 29 behaviours of agitation including biting, scratching, and hiding things. Patients were assessed before the intervention, after 4 months of the intervention, and then at 4 months' follow-up.
Findings showed that both interventions reduced agitation compared with usual care at the end of the 4-month treatment, and these benefits were continued beyond the intervention period, with a further decrease recorded at 4-month follow-up.
However, no other improvement in quality of life or significant reduction in neuropsychotic symptoms such as depression or hallucinations was recorded in either group. The authors also noted that neither intervention was associated with a lower intake of psychotropic drugs, although dementia-care mapping was associated with fewer falls.
In addition, the cost of person-centred care was considerably lower than for dementia-care mapping. Dementia-care mapping also required expert training and is labour intensive, which makes it impractical for most residential care homes, said the authors.
"Consideration should be given to the introduction of person-centred approaches as standard practice in residential facilities … not just to reduce distress in residents, but to enable staff to identify and meet residents' unmet psychosocial needs," they said.
In an accompanying comment, Clive Ballard and Dag Aarsland from King's College London, London, United Kingdom, said that: "CADRES is an extremely important trial that might greatly affect clinical practice." They call for more research to develop approaches that can improve overall quality of life and other neuropsychiatric symptoms, and reduce inappropriate prescribing of psychotropic drugs for residents of care homes.
SOURCE: The Lancet Neurology
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