Dementia in residential care: education intervention trial (DIRECT); protocol for a randomised controlled trial

Christopher D Beer,Barbara Horner,Frank Schaper,Penelope Flett,Nick Bretland,Osvaldo P Almeida,Nicola T Lautenschlager,Leon Flicker,Samuel Scherer

doi:10.1186/1745-6215-11-63

Abstract

BackgroundThere is scope to improve the quality of life (QOL) of people with dementia living in residential care facilities (RCF). The DIRECT study will determine if delivery of education to General Practitioners (GPs) and care staff improves the quality of life of residential care recipients with cognitive impairment.Methods/DesignA prospective randomised controlled trial conduced in residential aged care facilities in the metropolitan area of Perth, Western Australia. Participants are care facility residents, aged 65 years and older and with mini-mental state examination scores less than 25. GPs and care facility staff have been independently randomised to intervention or control groups. An education programme, designed to meet the perceived needs of learners, will be delivered to GPs and care staff in the intervention groups. The primary outcome of the study will be quality of life of the people with dementia, measured using the QOL-Alzheimer's Disease Scale (QOL-AD) and Alzheimer Disease Related QOL Scale (ADRQL), 4 weeks and 6 months after the conclusion of the education intervention.ResultsRecruitment of 351 people with dementia, cared for by staff in 39 residential facilities and 55 GPs, was undertaken between May 2007 and July 2008. Collection of baseline data is complete. Education has been delivered to GPs and Care staff between September 2008 and July 2009. Follow- up data collection is underway.DiscussionThe study results will have tangible implications for proprietors, managers and staff from the residential care sector and policy makers. The results have potential to directly benefit the quality of life of both patients and carers.Trial registrationThese trial methods have been prospectively registered (ACTRN12607000417482).

Highlights

There is scope to improve the quality of life (QOL) of people with dementia living in residential care facilities (RCF)
Little is known about the subjective experience of people with dementia living in residential care
Cross sectional data suggest that staff training and specialisation are associated with improvements in the quality of life of people with dementia living in residential care [15]

Summary

Introduction

There is scope to improve the quality of life (QOL) of people with dementia living in residential care facilities (RCF). Many Australians with dementia, nearly half, live in residential care [1]. A large proportion of RCF residents have dementia, the majority with moderate-severe dementia [2,3,4]. Only a small proportion of beds are dementia-specific, and these have usually been designed to deal with specific behavioural and psychological challenges associated with dementia, such as frequent wandering [1]. Little is known about the subjective experience of people with dementia living in residential care. Many of the common challenges encountered in caring for people with dementia can be ameliorated. There are data confirming that high quality care is associated with a lower incidence of depression [10]

Results

Discussion

Conclusion