Abstract
BackgroundThe growing number of people with dementia, and the increasing cost of care, provides a major incentive to develop and test methods of supporting them in the community for longer. Most attention has been given to pharmacological interventions, but there is increasing recognition that psychosocial interventions may be equally effective, even preferable where medication has negative side-effects. Reminiscence groups, run by professionals and volunteers, which use photographs, recordings and other objects to trigger personal memories are probably the most popular therapeutic approach to working with people with dementia, but there is little evidence for their effectiveness and cost-effectiveness. The recent inclusion of family carers in groups with people with dementia, notably in our own pilot studies, has generated informal evidence that this joint approach improves relationships between people with dementia and their carers, and benefits both.Design and methodsThis multi-centre, pragmatic randomised controlled trial (RCT) to assess the effectiveness and cost-effectiveness of joint reminiscence groups for people with dementia and their family care-givers has two parallel arms – an intervention group and a control group who receive care as usual. The intervention consists of joint reminiscence groups held weekly for twelve consecutive weeks, followed by monthly maintenance sessions for a further seven months.The primary outcome measures are the quality of life of people with dementia, as assessed by QoL-AD, and their care-givers' mental health as assessed by the GHQ-28. Secondary outcomes include: the autobiographical memories of people with dementia; the quality of the relationship between them and their care-givers; and the levels of depression and anxiety felt by them and their care-giver. Using a 5% significance level, comparison of 200 pairs attending joint reminiscence groups with 200 pairs receiving usual treatment will yield 80% power to detect a standardised difference of 0.38 in the QoL-AD rated by the person with dementia and 0.28 in the GHQ-28 or carer-rated QoL-AD. The trial will include a cost-effectiveness analysis from a public sector perspective.DiscussionOur Cochrane review (2005) on reminiscence therapy for people with dementia did not identify any rigorous trials or economic analyses in this field.Trial RegistrationISRCTN42430123
Highlights
The growing number of people with dementia, and the increasing cost of care, provides a major incentive to develop and test methods of supporting them in the community for longer
The review concluded that 'in view of the limitations of the studies reviewed, there is an urgent need for more quality research in the field'. This dearth of evidence is reflected in the National Institute for Health and Clinical Excellence and Social Care Institute for Excellence (NICE-SCIE) Guideline on the management and treatment of dementia [3], which found insufficient evidence to recommend that reminiscence should be routinely offered to people with dementia, its potential impact on mood of the person with dementia was highlighted
The objective of this paper is to describe the study protocol of this pragmatic randomised controlled trial (RCT) among people with mild to moderate dementia and their family caregivers
Summary
The growing number of people with dementia, and the increasing cost of care, provides a major incentive to develop and test methods of supporting them in the community for longer. The review concluded that 'in view of the limitations of the studies reviewed, there is an urgent need for more quality research in the field' This dearth of evidence is reflected in the National Institute for Health and Clinical Excellence and Social Care Institute for Excellence (NICE-SCIE) Guideline on the management and treatment of dementia [3], which found insufficient evidence to recommend that reminiscence should be routinely offered to people with dementia, its potential impact on mood of the person with dementia was highlighted. A number of systematic reviews of psychosocial interventions are available [e.g. [1,5,6], as well as a number of Cochrane reviews of specific approaches [e.g. [7,8]
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