Abstract
Objectives The DESCANT (Dementia Early Stage Cognitive Aids New Trial) intervention provided a personalised care package designed to improve the cognitive abilities, function and well-being of people with early-stage dementia and their carers, by providing a range of memory aids, together with appropriate training and support. This sub-study aimed to assess implementation and identify contextual factors potentially associated with participant outcomes. Method A mixed-methods approach was adopted alongside the pragmatic randomised trial. Data were obtained from intervention records and interviews with five dementia support practitioners across seven National Health Service Trusts in England and Wales. A reporting framework was constructed from available literature and data assessed by descriptive statistics and thematic analysis. Results Participation and engagement was high with 126 out of 128 participants completing the intervention with packages tailored to individual participants. Misplacing items and poor orientation to date and time were common areas of need. Memory aids frequently supplied included orientation clocks (91%), whiteboards (60%), calendars (43%) and notebooks (32%), plus bespoke items. Intervention duration and timing were broadly consistent with expectations. Variation reflected participants’ needs, circumstances and preferences. Qualitative findings suggested a potentially positive impact on the well-being of people with dementia and their carers. Issues associated with successful roll-out of the intervention are explored in the discussion. Conclusion Successful implementation increased confidence in future findings of the randomised trial. Depending on these, DESCANT may prove a scalable intervention with potential to improve the function and quality of life of people with dementia and their carers.
Highlights
Worldwide it was estimated there were over 50 million people living with dementia in 2020, estimated to reach 152 million in 2050 (Alzheimer’s Disease International, 2020)
Participation and engagement was high with 126 out of 128 participants completing the intervention with packages tailored to individual participants
Intervention duration and timing were broadly consistent with expectations
Summary
Worldwide it was estimated there were over 50 million people living with dementia in 2020, estimated to reach 152 million in 2050 (Alzheimer’s Disease International, 2020). There are estimated to be around 300 memory clinics in the UK (Moore, Goodison & Sampson, 2019). They focus on diagnosis but are increasingly involved in post-diagnostic treatment and coordination of care both in the UK and internationally (Voigt-Radloff et al, 2011). Diagnosis is important and needs to be followed by appropriate post-diagnostic support (de Vugt and Verhey, 2013). Examples of the latter include peer groups, cognitive behaviour therapy, and financial and legal advice (Hailey et al, 2016). The availability of evidence-based interventions post-diagnosis has not kept up with the demand for such support (Wright et al, 2019)
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