Apathy in nursing home residents with dementia: results from a cluster-randomized controlled trial. Improving decision-making for feeding options in advanced dementia: a randomized, controlled trial. Early-stage memory loss support groups: outcomes from a randomized controlled clinical trial. PerCEN: a cluster randomized controlled trial of person-centered residential care and environment for people with dementia. A multidimensional home-based care coordination intervention for elders with memory disorders: the maximizing independence at home (MIND) pilot randomized trial. The Enriched Opportunities Programme for people with dementia: A cluster-randomised controlled trial in 10 extra care housing schemes A randomized controlled trial for an individualized positive psychosocial intervention for the affective and behavioral symptoms of dementia in nursing home residents. Dementia care in the general practice setting: a cluster randomized trial on the effectiveness and cost impact of three management strategies. Effects of multimodal nondrug therapy on dementia symptoms and need for care in nursing home residents with degenerative dementia: a randomized-controlled study with 6-month follow-up. The Effect of a Disease Management Intervention on Quality and Outcomes of Dementia Care Efficacy of musical interventions in dementia: evidence from a randomized controlled trial. Effectiveness of an individualized functional training program on affective disturbances and functional skills in mild and moderate dementia--a randomized control trial. A randomized clinical trial of theory-based activities for the behavioral symptoms of dementia in nursing home residents. AwareCare: a pilot randomized controlled trial of an awareness-based staff training intervention to improve quality of life for residents with severe dementia in long-term care settings. Effectiveness of dementia follow-up care by memory clinics or general practitioners: randomised controlled trial The impact of reminiscence on the quality of life of residents with dementia in long-stay care. A controlled clinical trial on the effects of motor intervention on balance and cognition in institutionalized elderly patients with dementia CORDIAL: Cognitive Rehabilitation and Cognitive-behavioral Treatment for Early Dementia in Alzheimer Disease A Multicenter, Randomized, Controlled Trial Systematic implementation of an advance directive program in nursing homes: a randomized controlled trial. The Efficacy of Nonpharmacological Treatment for Dementia-related Apathy Palliative assessment and advance care planning in severe dementia: An exploratory randomized controlled trial of a complex intervention A home-based training program improves caregivers' skills and dementia patients' aggressive behaviors: a randomized controlled trial. Using silver yoga exercises to promote physical and mental health of elders with dementia in long-term care facilities. The Effects of a Multimodal Intervention on Outcomes of Persons With Early-Stage Dementia
PURPOSE Here we evaluate an interdisciplinary occupational and sport therapy intervention for dementia patients suffering from apathy . SUBJECTS AND METHODS A prospect i ve , controlled , rater-blinded , clinical trial with two follow-ups was conducted as part of a larger cluster-r and omized trial in 18 nursing homes in Berlin . n=117 dementia patients with apathy , defined as a score of 40 or more on the apathy evaluation scale ( AES ) or presence of apathy on the Neuropsychiatric Inventory ( NPI )  , were r and omly assigned to intervention or control group . The intervention included 10 months of brief activities , provided once a week . The primary outcome measure was the total score on the AES scale measured directly after the intervention period and again after 12 months . RESULTS We found significant group differences with respect to apathy during the 10 month intervention period ( F2,82=7.79 , P<0.01 ) , which reflected an increase in apathy in the control group , but not in the intervention group . Within one year after the intervention was ceased , the treatment group worsened and no longer differed significantly from the control group ( P=0.55 ) . CONCLUSIONS Our intervention was effective for the therapy of apathy in dementia , when applied , but not one year after cessation of therapy OBJECTIVES To test whether a decision aid improves quality of decision-making about feeding options in advanced dementia . DESIGN Cluster r and omized controlled trial . SETTING Twenty-four nursing homes in North Carolina . PARTICIPANTS Residents with advanced dementia and feeding problems and their surrogates . INTERVENTION Intervention surrogates received an audio or print decision aid on feeding options in advanced dementia . Controls received usual care . MEASUREMENTS Primary outcome was the Decisional Conflict Scale ( range : 1 - 5 ) measured at 3 months ; other main outcomes were surrogate knowledge , frequency of communication with providers , and feeding treatment use . RESULTS Two hundred fifty-six residents and surrogate decision-makers were recruited . Residents ' average age was 85 ; 67 % were Caucasian , and 79 % were women . Surrogates ' average age was 59 ; 67 % were Caucasian , and 70 % were residents ' children . The intervention improved knowledge scores ( 16.8 vs 15.1 , P < .001 ) . After 3 months , intervention surrogates had lower Decisional Conflict Scale scores than controls ( 1.65 vs 1.90 , P < .001 ) and more often discussed feeding options with a healthcare provider ( 46 % vs 33 % , P = .04 ) . Residents in the intervention group were more likely to receive a dysphagia diet ( 89 % vs 76 % , P = .04 ) and showed a trend toward greater staff eating assistance ( 20 % vs 10 % , P = .08 ) . Tube feeding was rare in both groups even after 9 months ( 1 intervention vs 3 control , P = .34 ) . CONCLUSION A decision aid about feeding options in advanced dementia reduced decisional conflict for surrogates and increased their knowledge and communication about feeding options with providers OBJECTIVES This article describes results of a r and omized controlled trial comparing a time-limited  early-stage memory loss ( ESML )  support group program conducted by a local Alzheimer 's Association chapter to a wait-list ( WL ) control condition . METHODS One hundred and forty-two dyads were r and omized in blocks to ESML ( n = 96 ) or WL ( n = 46 ) . Mean age of participants was 74.9 years , and mean Mini-Mental State Examination was 23.4 . The primary outcome was participant 's quality of life ; secondary outcomes included mood , family communication , and perceived stress . RESULTS On the intent-to-treat ( ITT ) pre-post analysis , significant differences were seen in participant quality of life ( p < .001 ) , depression ( p < .01 ) , and family communication ( p < .05 ) . Within the care partner groups , there was no significant difference between ESML and WL in the ITT analysis . A post hoc exploratory examination of changes that were associated with improved quality of life in ESML participants revealed significant reductions of depressive symptoms and behavior problems ( p < .05 ) , improved family communication ( p < .05 ) , self-efficacy ( p < .01 ) , Medical Outcomes Study short form ( SF-36 ) role-emotional ( p < .05 ) , SF-36 social functioning ( p < .05 ) , and SF-36 mental health components ( p < .01 ) in improvers . DISCUSSION These results support the efficacy of ESML support groups for individuals with dementia 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 To assess whether a dementia care coordination intervention delays time to transition from home and reduces unmet needs in elders with memory disorders . DESIGN 18-month r and omized controlled trial of 303 community-living elders . SETTING 28 postal code areas of Baltimore , MD . PARTICIPANTS Age 70 + years , with a cognitive disorder , community-living , English-speaking , and having a study partner available . INTERVENTION 18-month care coordination intervention to systematic ally identify and address dementia-related care needs through individualized care planning ; referral and linkage to services ; provision of dementia education and skill-building strategies ; and care monitoring by an interdisciplinary team . MEASUREMENTS Primary outcomes were time to transfer from home and total percent of unmet care needs at 18 months . RESULTS Intervention participants had a significant delay in time to all-cause transition from home and the adjusted hazard of leaving the home was decreased by 37 % ( Hazard ratio : 0.63 , 95 % Confidence Interval : 0.42 - 0.94 ) compared with control participants . Although there was no significant group difference in reduction of total percent of unmet needs from baseline to 18 months , the intervention group had significant reductions in the proportion of unmet needs in safety and legal/advance care domains relative to controls . Intervention participants had a significant improvement in self-reported quality of life ( QOL ) relative to control participants . No group differences were found in proxy-rated QOL , neuropsychiatric symptoms , or depression . CONCLUSIONS A home-based dementia care coordination intervention delivered by non- clinical community workers trained and overseen by geriatric clinicians led to delays in transition from home , reduced unmet needs , and improved self-reported QOL 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 This r and omized controlled study tested the effectiveness of individualized activities , led by certified nursing assistants ( CNAs ) , to increase positive and reduce negative affect and behavior among nursing home residents with dementia . METHOD Nursing home residents with mild to advanced dementia ( N = 180 ) were r and omly assigned to usual care ( UC , n = 93 ) or 1 of 2 experimental conditions . Residents in the attention control group ( AC , N = 43 ) participated in st and ardized one-to-one activities with their CNAs . Individualized Positive Psychosocial Intervention ( IPPI ) participants ( n = 44 ) received a CNA-led activity matched to their interests and ability . Outcomes were residents ' positive and negative affect and verbal and nonverbal behavior . RESULTS The IPPI and AC groups experienced similar benefits -more pleasure , alertness , engagement , positive touch , and positive verbal behavior-compared with UC . The AC group displayed more anger , uncooperativeness , and very negative verbal behavior than UC or IPPI . DISCUSSION This study demonstrates the value of individualized activities for nursing home residents with dementia . In a stringent test , residents were happier and less angry during a customized intervention compared with a st and ardized intervention . Even brief individualized CNA-led activities bring pleasure to nursing home residents and constitute an effective strategy to enhance positive affect and engagement in persons with dementia OBJECTIVE To compare a complex nondrug intervention including actively approaching counseling and caregiver support groups with differing intensity against usual care with respect to time to institutionalization in patients with dementia . METHODS Within this three-armed cluster-r and omized controlled trial , 390 community-dwelling patients aged 65 years or older with physician-diagnosed mild to moderate dementia and their caregivers were enrolled via 129 general practitioners in Middle Franconia , Germany . The intervention included general practitioners ' training in dementia care and their recommendation of support groups and actively approaching caregiver counseling . Primary study end point was time to institutionalization over 2 years . In addition , long-term intervention effects were assessed over a time horizon of 4 years . Secondary end points included cognitive functioning , ( instrumental ) activities of daily living , burden of caregiving , and health-related quality of life after 2 years . Frailty models with strict intention-to-treat approach and mixed linear models were applied to account for cluster r and omization . Health care costs were assessed from the societal perspective . RESULTS After 2 ( 4 ) years , 12 % ( 24 % ) of the patients were institutionalized and another 21 % ( 35 % ) died before institutionalization . No significant differences between study groups were observed with respect to time to institutionalization after 2 and 4 years ( P 0.25 and 0.71 , respectively ) . Secondary end points deteriorated , but differences were not significant between study groups . Almost 80 % of the health care costs were due to informal care . Total annual costs amounted to more than € 47,000 per patient and did not differ between study arms . CONCLUSION The intervention showed no effects on time to institutionalization and secondary outcomes OBJECTIVES To determine the efficacy of multimodal , nondrug therapy on symptoms of dementia and need for care in institutionalized individuals with degenerative dementia . DESIGN R and omized , controlled , longitudinal trial . Data were analyzed using multiple linear regression . SETTING Five German nursing homes . PARTICIPANTS One hundred thirty-nine nursing home residents with primary degenerative dementia ( Mini-Mental State Examination score < 24 ) . INTERVENTION The 6-month intervention comprised three components : motor stimulation , activities of daily living , and cognitive stimulation ( MAKS ) . Groups of 10 patients led by two therapists participated in the st and ardized intervention for 2 hours , 6 days a week . The intervention was described in detail in an intervention manual . Adherence to the manual was high . Controls received treatment as usual . MEASUREMENTS Overall geriatric symptoms were recorded using the Nurses ' Observation Scale for Geriatric Patients , functional independence using the Barthel Index , and care time using the Re source Utilization in Dementia-Formal Care . RESULTS Of 646 individuals screened , 146 were eligible , and 130 were included in the intention-to-treat analysis . At 6 months , results of the per- protocol analysis ( n = 119 ) showed improvement in overall dementia symptoms in the MAKS group and no change in the control group ( adjusted mean difference ( AMD ) = -6.8 , 95 % confidence interval ( CI ) = -10.3 to -3.3 ; P < .001 , Cohen d = 0.66 ) . This effect was greatest on the social behavior ( AMD = -1.9 , 95 % CI = -2.9 to -0.8 ; P < .001 ; Cohen d = 0.54 ) and instrumental activity of daily living ( IADL ) ( AMD = -1.4 , 95 % CI = -2.5 to -0.30 ; P = .01 ; Cohen d = 0.43 ) subscales . No effect was seen on functional independence or total care time . CONCLUSION This 6-month nondrug multimodal intervention improved dementia symptoms in nursing home residents , especially in social behavior and IADL capabilities Context Dementia is an incurable chronic disease , but assistance to caregivers can reduce the severity of patients ' symptoms and delay institutionalization . Because this assistance requires provision of multiple health care and social services , patients and caregivers might benefit from a coordinated system of care . Contribution The investigators r and omly assigned patients with dementia and their caregivers to usual care or to a coordinated system of care . In the coordinated system , care managers regularly assessed patient and caregiver pairs and coordinated guideline -recommended provision of services by health care providers and community agencies using computerized information systems . The study found that pairs cared for in the coordinated system received higher- quality health care and more needed assistance than those who received usual care . Caution s The study focused on a relatively homogeneous population of white , well-educated , otherwise healthy , noninstitutionalized patients with health insurance . The findings might not apply to other population s. Implication s The quality of care for patients with dementia and their caregivers can be improved with a model of care in which services provided by the health system and community agencies are coordinated by a care manager . The Editors Dementia has enormous health and financial consequences for affected individuals , their family caregivers , and society ( 15 ) . Although most dementia is currently neither preventable nor reversible , existing practice guidelines reflect evidence from r and omized , controlled trials that caregiver assistance and support can delay institutionalization ( 68 ) , and nonpharmacologic management of problem behaviors and depression can reduce symptom severity and improve patient health ( 9 , 10 ) . Yet , adherence to published dementia care guidelines ( 1114 ) is poor ( 15 ) , including inappropriate use of psychoactive medications for initial management of agitation ( 16 ) ; low referral rates to community agencies ( 17 , 18 ) ; and underdetection of elder abuse , for which cognitive impairment is a risk factor ( 19 ) , and of depression ( 20 ) , a common comorbid condition ( 21 ) . There are few controlled trials of improvement interventions for dementia care . An opinion leader intervention improved neurologists ' reported adherence to dementia care guidelines ( 18 ) , and a recent trial using advanced practice nurses within primary care improved care quality ( 22 ) ; other trials reported limited impacts ( 23 , 24 ) . All studies were conducted primarily within or outside of health care delivery systems ; to date , trials of comprehensive , guideline -based dementia care interventions that incorporate all chronic care model components , including substantive collaboration between health systems and community agencies ( 25 , 26 ) , have not been reported . Yet , this would seem to be a well-suited approach because of the multifaceted nature of dementia care management and the need for coordinated efforts across health care delivery systems and community agencies to provide recommended medical , behavioral , and social services and support . To address gaps in care quality for persons with dementia , we design ed and tested a guideline -based , comprehensive dementia care management intervention in a clinic-level , cluster r and omized , controlled trial ( 27 ) . Intervention components were based on the chronic care model and emphasized linkages with community re sources and multiagency coordination ( 25 , 26 , 28 ) . Key components included dementia care managers , formal procedures for communication within and between organizations and agencies , Internet-based care management , collaborative care planning with caregivers , caregiver self-management support , ongoing follow-up , and provider education . We hypothesized that patient and caregiver dyads in intervention clinics would receive care in higher accordance with guidelines ; receive more community re sources and services ; have fewer unmet caregiving assistance needs ; and have better patient and caregiver health and caregiving quality , social support , and perceived care quality than dyads receiving usual care . Methods The institutional review boards of the University of California , Los Angeles , and all participating health care organizations approved the study procedures . All enrolled patient and caregiver dyads provided written informed consent . Three health care organizations ( Kaiser Permanente San Diego , Scripps Clinic , University of California , San Diego , Healthcare ) and 3 community agencies ( Alzheimer 's AssociationSan Diego Chapter , Southern Caregiver Re source Center , Meals on WheelsGreater San Diego ) providing services for persons with dementia and their informal caregivers in the San Diego metropolitan area participated . Private group practice , academic group practice , and health maintenance organization practice types were represented by the 3 health care organizations . Study Participants The study included 18 clinics from the participating health care organizations ( 4 to 8 per organization ) ( Table 1 ) . The inclusion criterion was that these be primary care clinics . Table 1 . Characteristics of Participating Health Care Organizations * Patients with dementia who were age 65 years or older and receiving Medicare were identified by querying health care organization administrative data bases for occurrence during the previous year of a dementia diagnosis code ( 29 ) at an outpatient visit or hospitalization or a cholinesterase inhibitor prescription . Patient lists were grouped by primary provider and were circulated to those providers for confirmation of dementia diagnosis and identification of additional potential participants from his or her practice ( generating < 5 % of the sample ) . Patients had to have an informal caregiver ( age 18 years ) . Patients were recruited by mail with English- and Spanish- language letters from their physician and an opt-out postcard , followed by up to 3 mailings of a patient consent or assent form ( depending on the physician 's design ation of the patient 's ability to provide consent ) , a caregiver consent form ( containing a proxy consent for the patient if he or she was judged unable to provide consent ) , and a baseline caregiver survey . R and omization was conducted at the clinic level , based on the clinic-focused design of the care management intervention . Within each health care organization , we paired clinics by patient volume ; within each pair , we r and omly assigned 1 clinic to the intervention and the other clinic to usual care using a computerized r and om-number generator operated by a study statistician . Participants were unaware of clinic r and omization status at enrollment and at completion of the baseline survey and were not reminded of r and omization status at follow-up . Intervention A steering committee that included a physician from each health care organization , a leader from each community agency , a community caregiver , and investigators used a formal method ( 30 ) to identify 23 existing dementia guideline recommendations as care goals ( 11 , 12 , 14 ) . They also design ed a structured assessment , algorithms linking specific care management actions to assessment results , and interorganization care coordination and referral protocol s. A key intervention element was health care organization and community agencybased dementia care managers ( primarily social workers ) who received formal training and used an Internet-based care management software system for care planning and coordination ( 25 , 26 , 28 ) . Every enrolled patient and caregiver dyad in the intervention group was assigned 1 health care organization care manager , who contacted them to schedule a structured home assessment . Assessment responses were entered into the software system , generating a preliminary problem list and guides to care-plan actions . The care manager collaborated with the caregiver to prioritize problem areas ; teach problem-solving skills ; initiate care plan actions ; and send an assessment summary , a problem list , and selected recommendations to the patient 's primary care physician and other design ated providers . A menu of potential care plan actions ( for example , referral for respite care services ) was documented in a comprehensive care management manual . The care management protocol included ongoing follow-up , usually by telephone , with frequency based on need and a formal in-home re assessment every 6 months to assess the need for major care-plan revisions . The software system had a feature to enable efficient tracking of multiple cases and tasks . Referrals to a particular community agency were guided by flagged problem areas . With patient and caregiver consent , referrals were communicated through the software system to that agency , whose design ated care manager subsequently received system access to the assessment , problem list , and care plan . Each dyad could have 1 or more community agency care managers . Care managers from the health care organizations and community agencies received the same formal education and training program , which was conducted jointly , and met monthly to refine care coordination procedures . Care management began within a month after enrollment of the first dyads and was active throughout the study follow-up unless a case was closed , for example , because a patient moved out of the study area and no longer was enrolled in the health care organization . At each intervention clinic , more than 90 minutes of st and ardized , interactive seminars ( in up to 5 sessions ) on relevant care issues , including  evaluation of acute behavioral changes , depression management  , and determination of decision-making capacity  ( 31 ) , were offered to primary care providers . Selected intervention tools and documents with more detailed descriptions can be accessed at www.adc.ucla.edu/access/access.swf . Patients , caregivers , and providers in the usual care group were not offered study interventions . Outcome Measures Primary Outcome The study 's primary outcome was Although musical interventions have recently gained popularity as a non-pharmacological treatment in dementia , there is still insufficient evidence of their effectiveness . To investigate this issue , a single-center r and omized controlled trial was conducted with forty-eight patients with Alzheimer 's disease or mixed dementia to compare the effects of music versus cooking interventions in the emotional , cognitive , and behavioral domain , as well as on professional caregiver distress . Each intervention lasted four weeks ( two one-hour sessions a week ) . Multi-component evaluations ( with blind assessors ) were conducted before , during , and after the interventions to assess their short and long-term effects ( up to four weeks post interventions ) . Analyses revealed that both music and cooking interventions led to positive changes in the patients ' emotional state and decreased the severity of their behavioral disorders , as well as reduced caregiver distress . However , no benefit on the cognitive status of the patients was seen . While results did not demonstrate a specific benefit of music on any of the considered measures , the present study suggests the efficacy of two pleasant non-pharmacological treatments in patients with moderate to severe dementia . Our findings highlight the potential of such interventions in improving the well-being of patients living in residential care  , as well as reducing caregiver distress OBJECTIVES We reported the findings of a r and omized controlled trial ( RCT ) to examine the effects of an individualized functional enhancement program ( FEP ) on functional skills and mood symptoms in mild and moderate dementia . SUBJECTS & METHODS 74 Chinese older persons with dementia were recruited into a skills training program by occupational therapists ( OT ) . Thirty seven subjects were trained with an individualized selection of daily activities ( FEP Intervention , I ) ; 37 were trained with general occupational therapy ( Control , C ) . The FEP comprised of twice weekly group sessions of skills training and problem solving using cognitive behavioral approach . RESULTS At 1 month after completion of program , both I and C subjects showed an improvement in process skills of the assessment of motor and process skills (AMPS)(paired t-tests , p < 0.05 ) . At 4 months post-program , the I group showed a further reduction of cornell scale for depression in dementia ( CSDD ) scores ( paired t-test , p = 0.02 ) ; Apathy improved at 1 month post-training ( p = 0.04 ) , but deteriorated at 4 months ( p = 0.01 ) . Group differences in changes of mood and functional scores were not significant ( ANVOCA , p > 0.05 ) . CONCLUSIONS The findings suggested a potential benefit for individualized occupational therapy . It should be tailor made with individual needs and continued for sustained effectiveness OBJECTIVES To test the main and interactive effects of activities derived from the Need-Driven Dementia-Compromised Behavior model for responding to behavioral symptoms in nursing home residents . DESIGN R and omized double-blind clinical trial . SETTING Nine community-based nursing homes . PARTICIPANTS One hundred twenty-eight cognitively impaired residents r and omly assigned to activities adjusted to functional level ( FL ) ( n=32 ) , personality style of interest ( PSI ) ( n=33 ) ,  functional level and personality style of interest ( FL+PSI ) ( n=31 ) , or active control ( AC ) ( n=32 ) . INTERVENTION Three weeks of activities provided twice daily . MEASUREMENTS Agitation , passivity , engagement , affect , and mood assessed from video recordings and real-time observations during baseline , intervention , r and om times outside of intervention , and 1 week after intervention . RESULTS All treatments improved outcomes during intervention except mood , which worsened under AC . During intervention the PSI group demonstrated greater engagement , alertness , and attention than the other groups ; the FL+PSI group demonstrated greater pleasure . During r and om times , engagement returned to baseline levels except in the FL group in which it decreased . There was also less agitation and passivity in groups with a component adjusted to PSI . One week after the intervention , mood , anxiety , and passivity improved over baseline ; significantly less pleasure was displayed after withdrawal of treatment . CONCLUSION The hypothesis that activities adjusted to FL+PSI would improve behavioral outcomes to a greater extent than partially adjusted or nonadjusted activities was partially supported . PSI is a critical component of individualized activity prescription BACKGROUND The extent to which care home residents with severe dementia show awareness is influenced by the extent to which the environment provides opportunities for engagement and by the way in which care staff interact with them . We aim ed to establish whether training care staff to observe and identify signs of awareness in residents with severe dementia result ed in improved quality of life for residents . METHODS In this pilot cluster r and omized trial , care staff in four homes ( n = 32 ) received training and supervision and carried out structured observations of residents using the AwareCare measure  ( n = 32 ) over an eight-week period , while staff in four control homes ( n = 33 ) had no training with regard to their residents ( n = 33 ) and no contact with the research team . The primary outcome was resident quality of life . Secondary outcomes were resident well-being , behavior and cognition , staff attitudes and well-being , and care practice s in the home . RESULTS Following intervention , residents in the intervention group had significantly better quality of life as rated by family members than those in the control group , but care staff ratings of quality of life did not differ . There were no other significant between-group differences . Staff participating in the intervention identified benefits in terms of their underst and ing of residents ' needs . CONCLUSIONS Staff were able to use the observational measure effectively and relatives of residents in the intervention homes perceived an improvement in their quality of life Objective To examine the effectiveness of  post-diagnosis dementia treatment and coordination of care by memory clinics compared with general practitioners . Design Multicentre r and omised controlled trial . Setting Nine memory clinics and 159 general practitioners in the Netherl and s. Participants 175 patients with a new diagnosis of mild to moderate dementia living in the community and their informal caregivers . Interventions Usual care provided by memory clinic or general practitioner . Main outcome measures Caregiver rated quality of life of the patient measured with the quality of life in Alzheimer ’s disease instrument and self perceived burden of the informal caregiver measured with the sense of competence question naire ( intention to treat analysis ) . Results The quality of life of the patients in the memory clinic group was 0.5 ( 95 % confidence interval −0.7 to 1.6 ) points higher than in the general practitioner group . Caregivers ’ burden was 2.4 ( −5.8 to 1.0 ) points lower in the memory clinic group than in the general practitioner group . Conclusion No evidence was found that memory clinics were more effective than general practitioners with regard to post-diagnosis treatment and coordination care for patients with dementia . Without further evidence on the effectiveness of these modalities , other arguments , such as cost minimisation , patients ’ preferences , or regional health service planning , can determine which type of dementia care is offered . Trial registration Clinical trials NCT00554047 BACKGROUND There is increasing recognition of the potential use of reminiscence in maintaining or improving the quality of life  of people with dementia . Despite being used widely in dementia care , evidence on the effectiveness of reminiscence remains uncertain . AIMS This study aims to evaluate the effectiveness of a structured education-based reminiscence programme-the Dementia Education Programme Incorporating Reminiscence for Staff-for  people with dementia residing in long-stay care setting s in Irel and . METHODS Dementia Education Programme Incorporating Reminiscence for Staff is a two-group , single-blind , cluster r and omised trial conducted in long-stay residential care setting s in Irel and . The primary outcome was the self-rated quality of life of residents as measured by the Quality of Life-Alzheimer 's Disease instrument . RESULTS Using an intention-to-treat analysis , we found that the estimated effect of the intervention on the quality of life of residents was a non-significant 3.54 ( p = 0.1 ; 95 % confidence interval -0.83 , 7.90 ) , expressed as the difference in mean improvement between the intervention and control groups . However , the per- protocol analysis yielded a significant effect for the intervention on the quality of life of residents of 5.22 ( p = 0.04 ; 95 % confidence interval 0.11 , 10.34 ) . CONCLUSIONS Reminiscence may , in certain circumstances , be an effective care option for people with dementia in long-stay setting s with potential to impact positively on the quality of life of residents Purpose : To analyse the effects of two interventions on the cognition and balance of institutionalized elderly people with mixed dementia . Methods : Fifty-four participants were allocated into three groups . Group 1 was assisted by an interdisciplinary programme comprising physiotherapy , occupational therapy and physical education . A physiotherapist alone carried out the intervention in group 2 . Group 3 was considered as control . Assessors were blinded to guarantee the absence of bias . Cognitive functions were analysed with the  Mini-Mental State Examination and the Brief Cognitive Screening Battery . Balance was assessed with the Berg Balance Scale and the Timed Get-Up- and -Go Test . Multiple analysis of variance ( MANOVA ) was used to test possible main effects of the interventions . Results : The results showed benefits on the balance of subjects in both groups 1 ( F=3.9 , P<0.05 ) and 2 ( F=3.1 , P<0.05 ) , compared with group 3 . MANOVA did not indicate benefits on the cognitive functions between groups 1 and 3 ( F=1.1 , P>0.05 ) and groups 2 and 3 ( F=1.6 , P>0.05 ) . However , univariate analysis indicated some benefits of the interdisciplinary intervention on two specific domains measured by the Brief Cognitive Screening Battery ( F=26.5 , P<0.05 ; F=4.4 , P<0.05 ) . Conclusion : Six months of multidisciplinary or physiotherapeutic intervention were able to improve a person 's balance . Although global cognition did not improve through treatment , when the intervention was carried out on a multidisciplinary basis we observed an attenuation in the decline of global cognition on two specific cognitive domains . Exercises applied in different context s may have positive outcomes for people with dementia Cognitive rehabilitation ( CR ) is a promising treatment approach for older adults with dementia because it aims at supporting the management of day-to-day problems . There is insufficient evidence regarding whether CR provides clinical ly meaningful benefits . In this study , we evaluated the feasibility , acceptance , efficacy , and usefulness of a CR intervention in a multicenter , r and omized , controlled trial on 201 patients with mild dementia in Alzheimer disease and their carers . The intervention comprised 12 individual weekly sessions and combined 4 established strategies adopted from neurorehabilitation and psychotherapy .  Activities of daily living were chosen as the primary outcome . The results show that the feasibility , treatment adherence , and carer commitment were excellent . However , no effect of the intervention was demonstrable on everyday functioning . There were improvements favoring the intervention on quality of life and treatment satisfaction and a significant antidepressant effect in female participants . The lack of impact on everyday activities may be due to method ological limitations including insufficient personalization , short treatment duration , poor transfer into the real-life setting , and low sensitivity of assessment instruments . The findings of this study may be helpful for design ing further studies that are needed to determine the potential of CR in older adults with dementia CONTEXT Although advance directives are commonly used in the community , little is known about the effects of their systematic implementation . OBJECTIVES To examine the effect of systematic ally implementing an advance directive in nursing homes on patient and family satisfaction with involvement in decision making and on health care costs . DESIGN R and omized controlled trial conducted June 1 , 1994 , to August 31 , 1998 . SETTING AND PARTICIPANTS A total of 1292 residents in 6 Ontario nursing homes with more than 100 residents each . INTERVENTION The Let Me Decide advance directive program included educating staff in local hospitals and nursing homes , residents , and families about advance directives and offering competent residents or next-of-kin of mentally incompetent residents an advance directive that provided a range of health care choices for life-threatening illness , cardiac arrest , and nutrition . The 6 nursing homes were pair-matched on key characteristics , and 1 home per pair was r and omized to take part in the program . Control nursing homes continued with prior policies concerning advance directives . MAIN OUTCOME MEASURES Residents ' and families ' satisfaction with health care and health care services utilization over 18 months , compared between intervention and control nursing homes . RESULTS Of 527 participating residents in intervention nursing homes , 49 % of competent residents and 78 % of families of incompetent residents completed advance directives .  Satisfaction was not significantly different in intervention and control nursing homes . The mean difference ( scale , 1 - 7 ) between intervention and control homes was -0.16 ( 95 % confidence interval [ CI ] , -0.41 to 0.10 ) for competent residents and 0.07 ( 95 % CI , -0.08 to 0.23 ) for families of incompetent residents . Intervention nursing homes reported fewer hospitalizations per resident ( mean , 0.27 vs 0.48 ; P = .001 ) and less re source use ( average total cost per patient , Can $ 3490 vs Can $ 5239 ; P = .01 ) than control nursing homes . Proportion of deaths in intervention ( 24 % ) and control ( 28 % ) nursing homes were similar ( P = .20 ) . CONCLUSION Our data suggest that systematic implementation of a program to increase use of advance directives reduces health care services utilization without affecting satisfaction or mortality Objective To determine the usefulness of a formal , structured , nonpharmacological treatment for  apathetic dementia patients .  Patients and Methods A controlled , cross-over , r and omized , simple-blind , multicentre clinical trial . A total of 146 institutionalized or day care dementia patients with a stage 1 or 2 Clinical Dementia Rating , with no significant motor or sensory problems , or with rapidly evolving dementia and in a clinical ly stable state were recruited . A  cognitive mini examination , and functional , depression , and potential toxicity scales , Neuropsychiatric Inventory Question naire ( NPI-Q ) , and Dementia Apathy Interview and Rating ( DAIR ) scales  were applied at baseline . Patients were r and omized to initial intervention ( music and art therapy and psychomotor activity ) or initial control ( free activities in the day room ) and changed over at 4 weeks . NPI-Q and DAIR scales were administered at the end of weeks 4 and 8 . Results A significant difference between intervention and control periods , as measured using the DAIR scale , was observed , with a difference of 0.21 ( 95 % confidence interval : 0.07 - 0.34 , P<0.005 ) . The difference was very important in the patients with moderated apathy . However , differences were not so important in the patients with severe apathy  and there were no differences at all in the non-apathetic patients . No significant differences were found with the NPI-Q scale , although there was a clear improvement trend in the “ apathy ” question on this scale . This effect seems to extend beyond the therapeutic intervention period . Conclusions A structured , nonpharmacological , short-term occupational therapy intervention is more useful than activities of the patients ' own choice for improving apathy in patients with mild or moderate dementia Patients with advanced dementia often receive poor end-of-life care . We aim ed to design and pilot a palliative care and advance care plan ( ACP ) intervention . Patients had undergone emergency hospital admission and had severe dementia . The intervention consisted of a palliative care patient assessment which informed an ACP discussion with the carer , who was offered the opportunity to write an ACP for the person with dementia . Carer – patient dyads were r and omized to ‘ usual care ’ or the intervention . Carer-related outcome measures included the Kessler Distress Scale , Decision Satisfaction Inventory , Client Satisfaction Question naire and the Euroqol-5D , measured at baseline , six weeks , six months and three months after bereavement . The Satisfaction with End of Life Care in Dementia Scale was completed if the patient died . The 32 patient participants were physically frail and in the advanced stages of dementia : 62 % had pressure damage to the skin , all needed feeding assistance and 95 % were in pain .  Nearly 50 % died during the six-month follow-up period . Carers were difficult to recruit during acute admission ; 33 patients and carers entered the study ( 22 intervention arm ; 11 control arm ) . Only seven carers made ACPs . The care planning discussion was well received , but few carers wrote an ACP , despite intensive support from an experienced nurse specialist . Advance care planning is , in theory , a necessary intervention for people with severe dementia ; the reluctance of carers to write plans needs to be explored further OBJECTIVE To investigate the effects of an individualized , home-based caregiver-training program for caregivers of elderly patients with dementia and behavioral problems . METHODS Using a r and omized clinical trial in the neurologic clinics of two hospitals and a community care management center in northern Taiwan , we tested an individualized home-based caregiver-training program for managing behavioral problems , with referrals to community services and telephone consultation . Participants were patients with dementia and their caregivers ( N = 129 ) : 63 in the intervention group and 66 in the control group . The control group received only written instructions and social telephone follow-ups . Behavioral problems of elderly dementia patients were assessed by the Chinese version of the Cohen-Mansfield Agitation Inventory , community form . Family caregivers ' outcomes were measured by the Agitation Management Self-efficacy Scale and the Preparedness and Competence Scales . These instruments were administered before the program and 2 weeks , 3 months , and 6 months afterward . RESULTS Family caregivers who received the individualized home-based training program had better preparedness ( t = 2.72 , df = 127 , p < 0.01 ) , competence ( t = 4.77 , df = 126 , p < 0.001 ) , and overall self-efficacy ( t = 3.81 , df = 127 , p < 0.001 ) at 3 months than those in the control group . Moreover , the growth rate by treatment interaction effect was significant for caregiver competence ( t = 2.25 , df = 127 , p < 0.05 ) and overall self-efficacy for managing behavioral problems ( t = 2.16 , df = 127 , p < 0.05 ) . The probability of physically aggressive behavior for patients in the intervention group decreased from 0.27 to 0.12 . CONCLUSION Our individualized home-based caregiver-training program improved caregivers ' preparedness , competence , and self-efficacy for managing problematic behaviors and decreased physical aggressiveness of elderly patients with dementia BACKGROUND This study aim ed to test the effects of yoga exercises on the physical and mental health of elderly people with dementia living in long-term care facilities . METHODS A quasi-experimental , pretest-post-test design was used . A convenience sample of 68 residents in long-term care facilities in southern Taiwan , aged 60 years and above with mild to moderate dementia , was selected . An experimental group of 33 elders participated in a 12-week yoga training program of three 55-minute sessions a week ; a control group of 35 elders maintained their usual daily activities . Data were collected before and after completing the 12-week study . Measurements included body composition , cardiopulmonary functions , body flexibility , muscle strength and endurance , balance , joints motion , depression , and problem behaviors . RESULTS The yoga-trained participants had better physical and mental health than those who did not participate , including lowered blood pressure , reduced respiration rate , strengthened cardiopulmonary fitness , enhanced body flexibility , improved muscle strength and endurance , improved balance , and increased joints motion ( all p values < 0.05 ) . In addition , the depression state ( p < 0.001 ) and problem behaviors ( p < 0.001 ) of these demented elders were significantly reduced . CONCLUSION Yoga exercise has positive benefits for both the physical and mental health of elders with dementia living in long-term care facilities . It is recommended that yoga be included as one of the routine activities in these long-term care facilities Theories supporting the existence of a use-dependent neuroplasticity in the older brain were used to guide this pilot study . A repeated- measures r and omized design was used to test the effectiveness of a multimodal ( Taiji exercises , cognitive-behavioral therapies , support group ) intervention on cognitive functioning , physical functioning , and behavioral outcomes in persons with dementia . The treatment group ( n = 24 persons with dementia ) participated in a 40-week intervention , with outcomes assessed at 20 and 40 weeks to assess optimal treatment length . Control group subjects ( n = 19 persons with dementia ) received attention-control educational programs . At 20 weeks , differences between groups were found for mental ability and self-esteem , with gains in balance being evident . Also , stability in depression and physical health were evident at 20 and 40 weeks for treatment group subjects . Continued improvement in outcomes was not observed at 40 weeks . However , findings support further testing of the intervention along with potential for achieving positive outcomes in early-stage dementia
An influential review in 2010 concluded that non-pharmacological multi-component interventions have positive effects on cognitive functioning , activities of daily living , behaviour and mood of people with dementia .
Our aim here is to provide an up-to- date overview of research into psychosocial interventions and their impact on psychosocial outcomes .