Effects of dementia-care mapping on residents and staff of care homes: a pragmatic cluster-randomised controlled trial.

Geertje Van De Ven,Irena Draskovic,Rogier Donders,Raymond T C M Koopmans,Myrra J F J Vernooij-Dassen,Sytse U Zuidema,Eddy M M Adang,Jerson Laks

doi:10.1371/journal.pone.0067325

Abstract

BackgroundThe effectiveness of dementia-care mapping (DCM) for institutionalised people with dementia has been demonstrated in an explanatory cluster-randomised controlled trial (cRCT) with two DCM researchers carrying out the DCM intervention. In order to be able to inform daily practice, we studied DCM effectiveness in a pragmatic cRCT involving a wide range of care homes with trained nursing staff carrying out the intervention.MethodsDementia special care units were randomly assigned to DCM or usual care. Nurses from the intervention care homes received DCM training and conducted the 4-months DCM-intervention twice during the study. The primary outcome was agitation, measured with the Cohen-Mansfield agitation inventory (CMAI). The secondary outcomes included residents’ neuropsychiatric symptoms (NPSs) and quality of life, and staff stress and job satisfaction. The nursing staff made all measurements at baseline and two follow-ups at 4-month intervals. We used linear mixed-effect models to test treatment and time effects.Results34 units from 11 care homes, including 434 residents and 382 nursing staff members, were randomly assigned. Ten nurses from the intervention units completed the basic and advanced DCM training. Intention-to-treat analysis showed no statistically significant effect on the CMAI (mean difference between groups 2·4, 95% CI −2·7 to 7·6; p = 0·34). More NPSs were reported in the intervention group than in usual care (p = 0·02). Intervention staff reported fewer negative and more positive emotional reactions during work (p = 0·02). There were no other significant effects.ConclusionsOur pragmatic findings did not confirm the effect on the primary outcome of agitation in the explanatory study. Perhaps the variability of the extent of implementation of DCM may explain the lack of effect.Trial RegistrationDutch Trials Registry NTR2314.

Highlights

The prevalence of neuropsychiatric symptoms (NPSs) such as anxiety, apathy, and hallucinations among institutionalised people with dementia is about 80% [1]
Dementia-care mapping (DCM) is a person-centred, multicomponent intervention developed by the Dementia Research Group at Bradford University in the UK and is based on Kitwood’s social-psychological theory of personhood in dementia [5]
Care for people with dementia in the Netherlands is generally provided in dementia special-care units, where residents generally live in small groups of 5 to 12 people

Summary

Introduction

The prevalence of neuropsychiatric symptoms (NPSs) such as anxiety, apathy, and hallucinations among institutionalised people with dementia is about 80% [1]. A strong relationship has been found between high staff turnover and poor resident outcomes such as quality of life. Dementia-care mapping (DCM) is a person-centred, multicomponent intervention developed by the Dementia Research Group at Bradford University in the UK and is based on Kitwood’s social-psychological theory of personhood in dementia [5]. This theory states that much of the ill-being that people with dementia experience is due to negative environmental influences, including staff attitudes and care practices. In order to be able to inform daily practice, we studied DCM effectiveness in a pragmatic cRCT involving a wide range of care homes with trained nursing staff carrying out the intervention

Methods

Results

Conclusion