Caring for Aged Dementia Care Resident Study (CADRES) of person-centred care, dementia-care mapping, and usual care in dementia: a cluster-randomised trial Effect of enhanced psychosocial care on antipsychotic use in nursing home residents with severe dementia: cluster randomised trial Cluster Randomized Controlled Trial of An Aged Care Specific Leadership and Management Program to Improve Work Environment, Staff Turnover, and Care Quality. Efficacy of nonpharmacologic interventions for agitation in advanced dementia: a randomized, placebo-controlled trial. PerCEN: a cluster randomized controlled trial of person-centered residential care and environment for people with dementia. The Enriched Opportunities Programme for people with dementia: A cluster-randomised controlled trial in 10 extra care housing schemes Preserving Identity and Planning for Advance Care (PIPAC): preliminary outcomes from a patient-centered intervention for individuals with mild dementia Dementia care mapping: effects on residents' quality of life and challenging behavior in German nursing homes. A quasi-experimental trial. A randomized crossover trial to study the effect of personalized, one-to-one interaction using Montessori-based activities on agitation, affect, and engagement in nursing home residents with Dementia. Effect of individualized social activities on quality of life among older adults with mild to moderate cognitive impairment in a geriatric psychiatry facility Non-pharmacological management of behavioural symptoms in nursing homes. Testing a tool for assessing the risk of bias for nonrandomized studies showed moderate reliability and promising validity. Coming to grips with challenging behavior: a cluster randomized controlled trial on the effects of a multidisciplinary care program for challenging behavior in dementia. Teaching and maintaining behavior management skills in the nursing home. Effects of Dementia-Care Mapping on Residents and Staff of Care Homes: A Pragmatic Cluster-Randomised Controlled Trial
BACKGROUND Evidence for improved outcomes for people with dementia through provision of person-centred care and dementia-care mapping is largely observational . We aim ed to do a large , r and omised comparison of person-centred care , dementia-care mapping , and usual care . METHODS In a cluster r and omised controlled trial , urban residential sites were r and omly assigned to person-centred care , dementia-care mapping , or usual care . Carers received training and support in either intervention or continued usual care . Treatment allocation was masked to assessors . The primary outcome was agitation measured with the Cohen-Mansfield agitation inventory ( CMAI ) . Secondary outcomes included psychiatric symptoms including hallucinations , neuropsychological status , quality of life , falls , and cost of treatment . Outcome measures were assessed before and directly after 4 months of intervention , and at 4 months of follow-up . Hierarchical linear models were used to test treatment and time effects . Analysis was by intention to treat . This trial is registered with the Australia and New Zeal and Clinical Trials Registry , number ACTRN12608000084381 . FINDINGS 15 care sites with 289 residents were r and omly assigned . Pairwise contrasts revealed that at follow-up , and relative to usual care , CMAI score was lower in sites providing mapping ( mean difference 10.9 , 95 % CI 0.7 - 21.1 ; p=0.04 ) and person-centred care ( 13.6 , 3.3 - 23.9 ; p=0.01 ) . Compared with usual care , fewer falls were recorded in sites that used mapping ( 0.24 , 0.08 - 0.40 ; p=0.02 ) but there were more falls with person-centred care ( 0.15 , 0.02 - 0.28 ; p=0.03 ) . There were no other significant effects . INTERPRETATION Person-centred care and dementia-care mapping both seem to reduce agitation in people with dementia in residential care Abstract Objective To evaluate the effectiveness of a training and support intervention for nursing home staff in reducing the proportion of residents with dementia who are prescribed neuroleptics . Design Cluster r and omised controlled trial with blinded assessment of outcome . Setting 12 specialist nursing homes for people with dementia in London , Newcastle , and Oxford . Participants Residents of the 12 nursing homes ; numbers varied during the study period . Intervention Training and support intervention delivered to nursing home staff over 10 months , focusing on alternatives to drugs for the management of agitated behaviour in dementia . Main outcome measures Proportion of residents in each home who were prescribed neuroleptics and mean levels of agitated and disruptive behaviour ( Cohen-Mansfield agitation inventory ) in each home at 12 months . Results At 12 months the proportion of residents taking neuroleptics in the intervention homes ( 23.0 % ) was significantly lower than that in the control homes ( 42.1 % ) : average reduction in neuroleptic use 19.1 % ( 95 % confidence interval 0.5 % to 37.7 % ) . No significant differences were found in the levels of agitated or disruptive behaviour between intervention and control homes . Conclusions Promotion of person centred care and good practice in the management of patients with dementia with behavioural symptoms provides an effective alternative to neuroleptics OBJECTIVE To evaluate the effectiveness of a leadership and management program in aged care . DESIGN Double-blind cluster r and omized controlled trial . SETTING Twelve residential and community-aged care sites in Australia . PARTICIPANTS All care staff employed for 6 months or longer at the aged care sites were invited to participate in the surveys at 3 time points : baseline ( time 1 ) , 9 months from baseline ( time 2 ) , and 9 months after completion of time 2 ( time 3 ) from 2011 to 2013 . At each time point , at least 500 care staff completed a survey . At baseline ( N = 503 ) the largest age group was 45 to 54 years ( 37 % ) , and the majority of care staff were born in Australia ( 70 % ) , spoke English ( 94 % ) , and had at least completed secondary education ( 57 % ) . INTERVENTION A 12-month Clinical Leadership in Aged Care ( CLiAC ) program for middle managers , which aim ed to further develop their leadership and management skills in creating positive workplace relationships and in enabling person-centered , evidence -based care . MAIN OUTCOME MEASURES The primary outcomes were care staff ratings of the work environment , care quality and safety , and staff turnover rates . Secondary outcomes were care staff 's intention to leave their employer and profession , workplace stress , job satisfaction , and cost-effectiveness of implementing the program . Absenteeism was excluded due to difficulty in obtaining reliable data . Managers ' self-rated knowledge and skills in leadership and management are not included in this article , which focuses on care staff perceptions only . RESULTS At 6 months after its completion , the CLiAC program was effective in improving care staff 's perception of management support [ mean difference 0.61 , 95 % confidence interval ( CI ) 0.04 - 1.18 ; P = .04 ] . Compared with the control sites , care staff at the intervention sites perceived their managers ' leadership styles as more transformational ( mean difference 0.30 , 95 % CI 0.09 - 0.51 ; P = .005 ) , transactional ( mean difference 0.22 , 95 % CI 0.05 - 0.39 ; P = .01 ) , and less passive avoidant ( mean difference 0.30 , 95 % CI 0.07 - 0.52 ; P = .01 ) ; and were rated higher on the overall leadership outcomes ( mean difference 0.35 , 95 % CI 0.13 - 0.56 ; P = .001 ) as well as individual manager outcomes : extra effort ( P = .004 ) , effectiveness ( P = .001 ) , and satisfaction ( P = .01 ) . There was no evidence that CLiAC was effective in reducing staff turnover , or improving patient care quality and safety . CONCLUSIONS While the CLiAC leadership program had direct impact on the primary process outcomes ( management support , leadership actions , behaviors , and effects ) , this was insufficient to change the systems required to support care service quality and client safety . Nevertheless , the findings send a strong message that leadership and management skills in aged care managers can be nurtured and used to change leadership behaviors at a reasonable cost BACKGROUND A r and omized , placebo-controlled clinical trial was undertaken to determine the efficacy of nonpharmacologic individualized interventions ( individualized to address unmet needs such as boredom or pain ) in decreasing agitation in persons with dementia . METHOD Agitated nursing home residents with advanced dementia ( from 9 nursing homes in 5 locations in Maryl and , United States ) were r and omized into an  intervention group ( n = 89 ) and a  placebo control group ( n = 36 ) . On the basis of data from baseline assessment , a systematic methodology for individualizing nonpharmacologic interventions , Treatment Routes for Exploring Agitation ( TREA ) , was used with the intervention group : an unmet need was hypothesized , a corresponding treatment category was identified , and specifics of the treatment were chosen to fit the person 's need , past identity , preferences , and abilities . ( Unmet needs were hypothesized based on physician evaluations , structured staff interviews , relative question naires , direct observations of agitation with the Agitation Behavior Mapping Instrument [ the primary outcome measure ] and affect with Lawton 's Modified Behavior Stream [ the secondary outcome measure ] , and resident assessment s. ) TREA interventions were implemented for 2 weeks , and observations of agitation and affect were recorded . The study was conducted from June 2006 until December 2011 . RESULTS Relative to a control group , TREA interventions for unmet needs produced statistically significant declines in total ( P < .001 ) , physical nonaggressive ( P < .001 ) , and verbal agitation ( P = .004 ) and significant increases in pleasure ( P < .001 ) and interest ( P < .05 ) . CONCLUSIONS This is the first large r and omized controlled trial to demonstrate the efficacy of TREA and one of only a few such trials of nonpharmacologic interventions for agitation in persons with dementia . The translation of these findings into practice is sorely needed and would require structural changes dedicating staff time to observing each agitated resident , determining unmet needs , obtaining appropriate intervention material s , conducting the individualized nonpharmacologic interventions , and evaluating results . TRIAL REGISTRATION Clinical Trials.gov identifier : NCT00820859 BACKGROUND There is good evidence of the positive effects of person-centered care ( PCC ) on agitation in dementia . We hypothesized that a person-centered environment ( PCE ) would achieve similar outcomes by focusing on positive environmental stimuli , and that there would be enhanced outcomes by combining PCC and PCE . METHODS 38 Australian residential aged care homes with scope for improvement in both PCC and PCE were stratified , then r and omized to one of four intervention groups : ( 1 ) PCC ; ( 2 ) PCE ; ( 3 ) PCC + PCE ; ( 4 ) no intervention .  People with dementia , over 60 years of age and consented were eligible . Co- outcomes assessed pre and four months post-intervention and at 8 months follow-up were resident agitation , emotional responses in care , quality of life and depression , and care interaction quality . RESULTS From 38 homes r and omized , 601 people with dementia were recruited . At follow-up the mean change for quality of life and agitation was significantly different for PCE ( p = 0.02 , p = 0.05 , respectively ) and PCC ( p = 0.0003 , p = 0.002 respectively ) , compared with the non-intervention group ( p = 0.48 , p = 0.93 respectively ) . Quality of life improved non-significantly for PCC+PCE ( p = 0.08 ) , but not for agitation ( p = 0.37 ) . Improvements in care interaction quality ( p = 0.006 ) and in emotional responses to care ( p = 0.01 ) in PCC+PCE were not observed in the other groups . Depression scores did not change in any of the groups . Intervention compliance for PCC was 59 % , for PCE 54 % and for PCC+PCE 66 % . CONCLUSION The hypothesis that PCC+PCE would improve quality of life and agitation even further was not supported , even though there were improvements in the quality of care interactions and resident emotional responses to care for some of this group . The Australian New Zeal and Clinical Trials Registry Number is ACTRN 12608000095369 Objectives : The Enriched Opportunities Programme ( EOP ) is a multi-level intervention focussing on improved quality of life for people with dementia . This study compared the experience of people living with dementia and other mental health problems in extra care housing schemes that utilised EOP with schemes that employed an active control intervention . Method : Ten extra care housing schemes were cluster r and omised to receive either the EOP intervention or an active control intervention for an 18-month period . Residents with dementia or other significant mental health problems ( 20–30 per scheme ) were assessed on a number of outcome measures at baseline , six months , one year and 18 months . The primary outcome measure was quality of life . Self-reported depression was an important secondary outcome . Results : The EOP-participating residents rated their quality of life more positively over time ( 4.0 ( SE 0.6 ) units ; 14 % p < 0.001 ) than the active control ( 1.3 ( SE 0.6 ) units ; 4 % p = 0.003 ) . There was also a significant group – time interaction for depressive symptoms ( p = 0.003 ) . The EOP-participating residents reported a reduction of 25 % at both six and 12 months and a 37 % reduction at 18 months ( all p 's < 0.001 ) . EOP residents were less likely than residents in the active control sites to move to a care home or to be admitted to a hospital inpatient bed . They were more likely to be seen by a range of community health professionals . Conclusion : The EOP had a positive impact on the quality of life of people with dementia in well-staffed extra care housing schemes Objectives : The purpose of this pilot study was to conduct limited-efficacy testing of the newly developed Preserving Identity and Planning for Advance Care ( PIPAC ) intervention on self-reported and proxy-reported emotional and health-related outcomes of individuals in the early stages of dementia . Method : A two-group comparison design was implemented . Blocked r and omization was used to assign individuals with mild dementia and a family contact to either ( 1 ) the four-session , multi-component intervention group focused on reminiscence and future planning or ( 2 ) the minimal support phone contact comparison group . Of the 19 enrolled dyads , 18completed post-treatment assessment s ( i.e. 10 intervention and 8 comparison group ) . Individuals with dementia were M= 82.8 ( SD = 6.46 ) years old ; 31.6 % were men and 68.4 % were women . Participants were predominantly white/Caucasian ( n = 18 , 94.7 % ) with one black/African-American ( 5.3 % ) . Results : Analyses of covariance controlling for baseline differences revealed clinical ly meaningful differences ( with medium to large effect sizes ) between groups at post-treatment for depressive symptoms , quality of life , health-related quality of life indicators , and decisional conflict . Individuals in the intervention group were also observed to exhibit higher levels of coping . Feasibility data collected from participants and interventionists were encouraging . Conclusion : Emotion-focused , patient-centered interventions like PIPAC hold promise for advancing treatment options in the early and mild stages of dementia . A full-scale , r and omized clinical trial of this intervention is warranted to determine both short-term and long-term impacts on clinical outcomes including improved depressive symptomatology , quality of life , and health-related factors that impact daily functioning in social environments BACKGROUND Person-centered care ( PCC ) is a widely recognized concept in dementia research and care . Dementia Care Mapping ( DCM ) is a method for implementing PCC . Prior studies have yielded heterogeneous results regarding the effectiveness of DCM for people with dementia ( PwD ) . We aim ed to investigate the effectiveness of DCM with regard to quality of life ( QoL ) and challenging behavior in PwD in nursing homes ( NHs ) . METHODS Leben-QD II is an 18-month , three-armed , pragmatic quasi-experimental trial . The sample of PwD was divided into three groups with three living units per group : ( A ) DCM applied since 2009 , ( B ) DCM newly introduced during the study , and ( C ) a control intervention based on a regular and st and ardized QoL rating . The primary outcome was QoL measured with the Quality of Life-Alzheimer 's Disease ( QoL-AD ) proxy , and the secondary outcomes were QoL ( measured with QUALIDEM ) and challenging behavior ( measured with the Neuropsychiatric Inventory Nursing Home version , NPI-NH ) . RESULTS There were no significant differences either between the DCM intervention groups and the control group or between the two DCM intervention groups regarding changes in the primary or secondary outcomes . At baseline , the estimated least square means of the QoL-AD proxy for groups A , B , and C were 32.54 ( confidence interval , hereafter CI : 29.36 - 35.72 ) , 33.62 ( CI : 30.55 - 36.68 ) , and 30.50 ( CI : 27.47 - 33.52 ) , respectively . The DCM groups A ( 31.32 ; CI : 28.15 - 34.48 ) and B ( 27.60 ; CI : 24.51 - 30.69 ) exhibited a reduction in QoL values , whereas group C exhibited an increase ( 32.54 ; CI : 29.44 - 35.64 ) after T2 . CONCLUSIONS DCM exhibited no statistically significant effect in terms of QoL and challenging behavior  of PwD in NHs . To increase the likelihood of a positive effect for PwD , it is necessary to ensure successful implementation of the intervention BACKGROUND Increasingly more attention has been paid to non-pharmacological interventions as treatment of agitated behaviors  that accompany dementia . The aim of the current study is to test if personalized one-to-one interaction activities based on Montessori principles will improve agitation , affect , and engagement more than a relevant control condition . METHODS We conducted a r and omized crossover trial in nine residential facilities in metropolitan Melbourne , Australia ( n = 44 ) .  Personalized one-to-one activities that were delivered using Montessori principles were compared with a non-personalized activity to control for the non-specific benefits of one-to-one interaction . Participants were observed 30 minutes before , during , and after the sessions . The presence or absence of a selected physically non-aggressive behavior was noted in every minute , together with the predominant type of affect and engagement . RESULTS Behavior counts fell considerably during both the Montessori and control sessions relative to beforeh and . During Montessori activities , the amount of time spend actively engaged was double compared to during the control condition and participants displayed more positive affect and interest as well . Participants with no fluency in English ( all from non-English speaking background s ) showed a significantly larger reduction in agitation during the Montessori than control sessions . CONCLUSION Our results show that even non-personalized social contact can assist in settling agitated residents . Tailoring activities to residents ' needs and capabilities elicit more positive interactions and are especially suitable for people who have lost fluency in the language spoken predominantly in their residential facility . Future studies could explore implementation by family members and volunteers to avoid dem and s on facilities ' re sources . TRIAL REGISTRATION Australian New Zeal and Clinical Trials Registry - ACTRN12609000564257 Objectives : The study examined the effect of an individualized social activities intervention ( ISAI ) on quality of life among older adults with mild to moderate cognitive impairment in a geriatric psychiatry facility . Method : This r and omized control trial consisted of 52 older adults ( M = 70.63 , SD = 5.62 ) with mild to moderate cognitive impairment in a geriatric inpatient psychiatry facility . A 2 ( group condition ) × 2 ( time of measurement ) design was used to compare the control ( treatment-as-usual ) and intervention ( treatment-as-usual plus ISAI ) conditions at pre- and post-treatment . ISAI consisted of 30- to 60-minute sessions for up to 15 consecutive days . The Dementia Quality of Life instrument and Neurobehavioral Rating Scale – Revised were used to examine quality of life and behavioral and psychological symptoms of dementia at pre- and post-treatment . Results : Intent-to-treat analyses indicated a significant time × group condition interaction on quality of life , with this effect remaining when only completer data were included . There was no evidence of a significant treatment effect on behavioral and psychological symptoms of dementia . Conclusion : Findings suggest that individualized social activities are a promising treatment for cognitively impaired geriatric in patients BACKGROUND Behavioural and psychological symptoms of dementia ( BPSD ) are often reported in institutions for the elderly . OBJECTIVE To evaluate the effectiveness of a staff education intervention to manage BPSD in older people with a diagnosis of dementia . METHODS The trial was conducted in 16 nursing homes ; 306 patients with a diagnosis of dementia and presenting BPSD were selected . Nursing homes were r and omly allocated to an intervention group or a control group . An 8-week staff education and training programme was conducted in the nursing homes in the intervention group . The main outcome measures were the Cohen-Mansfield Agitation Inventory ( CMAI ) and an Observation Scale ( OS ) score . Assessment s were done at baseline ( W0 ) , at the end of the ' intervention ' period ( W8 ) and 12 weeks after ( W20 ) . RESULTS There was a significant decrease in the global CMAI score between baseline and W8 ( -7.8 ; p > 0.01 ) and between baseline and W20 ( -6.5 ; p > 0.01 ) in the intervention group but not in the control group . Results of mixed linear models showed that the CMAI global score , the CMAI physically non-aggressive behaviours subscale score and verbally non-aggressive behaviours subscale score significantly decreased in the intervention group ( p < 0.001 ) although there was no significant evolution in the control group . Direct assessment with the OS produced the same pattern of results , with a significant decrease only in the intervention group . CONCLUSION The intervention reduced BPSD in severely demented nursing home residents and this effect was still present 3 months after the end of the programme OBJECTIVES To develop and vali date a new risk-of-bias tool for nonr and omized studies ( NRSs ) . STUDY DESIGN AND SETTING We developed the Risk of Bias Assessment Tool for Nonr and omized Studies ( RoBANS ) . A validation process with 39 NRSs examined the reliability ( interrater agreement ) , validity ( the degree of correlation between the overall assessment s of RoBANS and Method ological Index for Nonr and omized Studies [ MINORS ] , obtained by plotting the overall risk of bias relative to effect size and funding source ) , face validity with eight experts , and completion time for the RoBANS approach . RESULTS RoBANS contains six domains : the selection of participants , confounding variables , the measurement of exposure , the blinding of the outcome assessment s , incomplete outcome data , and selective outcome reporting . The interrater agreement of the RoBANS tool except the measurement of exposure and selective outcome reporting domains ranged from fair to substantial . There was a moderate correlation between the overall risks of bias determined using RoBANS and MINORS . The observed differences in effect sizes and funding sources among the assessed studies were not correlated with the overall risk of bias in these studies . The mean time required to complete RoBANS was approximately 10 min . The external experts who were interviewed evaluated RoBANS as a " fair " assessment tool . CONCLUSIONS RoBANS shows moderate reliability , promising feasibility , and validity . The further refinement of this tool and larger validation studies are required OBJECTIVES The Grip on Challenging Behavior care program was developed using the current guidelines and models on managing challenging behavior in dementia in nursing homes . It was hypothesized that the use of the care program would lead to a decrease in challenging behavior and in the prescription of psychoactive drugs without increase in use of restraints . DESIGN A r and omized controlled trial was undertaken using a stepped-wedge design to implement the care program and to evaluate the effects . An assessment of challenging behavior and psychoactive medication was undertaken every 4 months on all participating units followed by the introduction of the care program in a group of 3 to 4 units . A total of 6 time assessment s took place over 20 months . SETTING Seventeen dementia special care units of different nursing homes . PARTICIPANTS A total of 659 residents of dementia special care units . All residents with dementia on the unit were included . Units were assigned by r and om allocation software to 1 of 5 groups with different starting points for the implementation of the care program . INTERVENTION A care program consisting of various assessment procedures and tools , which ensure a multidisciplinary approach and which structure the process of managing challenging behavior in dementia . MEASUREMENTS Challenging behavior was measured using the Cohen-Mansfield Agitation Inventory ( CMAI ) and the Neuropsychiatric Inventory . Research assistants ( blinded for intervention status of the unit ) interviewed nurses on the units about challenging behavior . Data on psychoactive drugs and restraints were retrieved from resident charts . RESULTS A total of 2292 assessment s took place involving 659 residents ( 1126 control measurements , 1166 intervention measurements ) . The group of residents who remained in the intervention condition compared with the group in the control condition differed significantly in the CMAI change scores between successive assessment s [ -2.4 CMAI points , 95 % confidence interval ( CI ) -4.3 to -0.6 ] . No significant effects were found for the control-to-intervention group compared with the group who remained in the control group ( 0.0 CMAI points , 95 % CI -2.3 to 2.4 ) . Significant effects were found on 5 of the 12 Neuropsychiatric Inventory items and on the use of antipsychotics ( odds ratio 0.54 , 95 % CI 0.37- 0.80 ) and antidepressants ( odds ratio 0.65 , 95 % CI 0.44 - 0.94 ) . No effect on use of restraints was observed . CONCLUSIONS The Grip on Challenging behavior program was able to diminish some forms of challenging behavior and the use of psychoactive drugs PURPOSE To examine the efficacy of a comprehensive behavior management skills training program for improving certified nursing assistants ' ( CNA ) skill performance in the nursing home , to assess the effectiveness of a staff motivational system for maintaining newly acquired behavior management skills for a 6-month period , and to evaluate any result ing effects on resident agitation . DESIGN AND METHODS This study used a r and omized clinical trial of 88 residents with behavior disturbances and 106 CNAs who cared for them in two urban nursing homes . After CNAs received 4 weeks of behavior management training , supervisory nursing staff implemented formal staff management ( FSM ) , design ed to maintain training effects over time . The supervisory staff used conventional staff management ( CSM , usual supervisory routine ) on control units . We completed behavioral observations and paper- and -pen assessment s at baseline and repeated them during a 4-week post-intervention phase and at 3- and 6-month follow-ups . RESULTS During the immediate post-training phase , both the FSM and CSM groups improved five out of seven communication skills and the ability to delay physical assistance during care routines . Although CNAs showed a reduction in the use of ineffective behavior management strategies , they did not increase their use of effective behavioral strategies . Follow-up assessment s suggested that the FSM system was more effective than CSM for maintaining and even improving communication skills over time . Resident agitation was reduced during care interactions and maintained at follow-up . IMPLICATION S The behavior management skills training program improved CNAs ' ability to interact with behaviorally disturbed nursing home residents and produced sustained reductions in agitation . The FSM system was more effective for maintaining communication skills 6 months after training Background The effectiveness of dementia-care mapping ( DCM ) for institutionalised people with dementia has been demonstrated in an explanatory cluster-r and omised controlled trial ( c RCT ) with two DCM research ers carrying out the DCM intervention . In order to be able to inform daily practice , we studied DCM effectiveness in a pragmatic c RCT involving a wide range of care homes with trained nursing staff carrying out the intervention . Methods Dementia special care units were r and omly 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 . Results 34 units from 11 care homes , including 434 residents and 382 nursing staff members , were r and omly 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 . Conclusions Our 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 Registration Dutch Trials Registry NTR2314
Background Person-centered care is a holistic and integrative approach design ed to maintain well-being and quality of life for people with dementia , and it includes the elements of care , the individual , the carers , and the family .
Aim A systematic literature review and meta- analysis were undertaken to investigate the effectiveness of person-centered care for people with dementia .