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. These are the conclusions of an Article to be published Online First and in the April edition of The Lancet Neurology.
People with dementia have complex needs that can be difficult to meet and can lead to need-driven dementia compromised behaviours such as agitation, sleep disturbance, screaming, crying, and pacing. The traditional approach of nursing in residential care focuses on daily living and leaves many people with dementia spending long hours alone, which is known to exacerbate these behaviours. With the prevalence of dementia likely to quadruple worldwide by 2041, the challenge is to introduce interventions that can maintain standards of care and quality of life for people with dementia, with only limited funds and staff.
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, Professor Lynn Chenoweth from the University of Technology Sydney, Australia, and colleagues did the Caring for Aged Dementia Care Resident Study (CADRES). In this study, 15 residential care sites in Sydney involving 289 residents with dementia aged 60 years or older were randomly assigned to person-centred care, dementia-care mapping, or usual care, 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 psychotropic drugs and rates of accidents and injuries.
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 four 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, at $2 250 per site, the cost of person-centred care was considerably lower than for dementia-care mapping at $10 034 per site. Dementia-care mapping also requires expert training and is labour intensive, which makes it impractical for most residential care homes, say the authors.
They conclude: "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."
In an accompanying Comment, Clive Ballard and Dag Aarsland from King's College London, UK, say 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.
Professor Lynn Chenoweth, University of Technology Sydney, New South Wales, Australia. T) +61 2 9369 0288 or +61 2 9369 0304
E) lynnette.chenoweth@uts.edu.au
Professor Clive Ballard, King's College London, London, UK.
E) clive.ballard@kcl.ac.uk
Dr Dag Aarsland, King's College London, London, UK.
E) daarsland@gmail.com
Notes to editors:
*Person-centred care puts the person with dementia at the centre of the care-planning process ensuring they receive appropriate care which meets their needs as individuals. Dementia-care mapping is an assessment tool designed to improve person-centred care. Detailed observations and scoring of the factors associated with wellbeing in people with dementia (e.g. enjoyment of eating, touching and interacting) are used to help the planning implementation and assessment of person-centred care.
Journal
The Lancet Neurology