Systematic care for caregivers of patients with dementia: a multicenter, cluster-randomized, controlled trial
SourceAmerican Journal of Geriatric Psychiatry, 19, 6, (2011), pp. 521-531
Article / Letter to editor
Display more detailsDisplay less details
Primary and Community Care
Epidemiology, Biostatistics & HTA
American Journal of Geriatric Psychiatry
SubjectNCEBP 11: Alzheimer Centre; NCEBP 2: Evaluation of complex medical interventions; NCEBP 4: Quality of hospital and integrated care; NCEBP 6: Quality of nursing and allied health care; NCEBP 7: Effective primary care and public health; ONCOL 3: Translational research; NCEBP 6: Quality of nursing and allied health care
OBJECTIVE: To evaluate the effectiveness of the Systematic Care Program for Dementia (SCPD) on patient institutionalization and to determine the predictors of institutionalization. DESIGN: Single-blind, multicenter, cluster-randomized, controlled trial. SETTING: Six community mental health services (CMHSs) across the Netherlands. PARTICIPANTS: A total of 295 patient-caregiver dyads referred to a CMHS with suspected patient dementia. INTERVENTION: Training of health professionals in the SCPD and its subsequent use. The SCPD consists of a systematic assessment of caregiver problems and alerts health professionals in flexible, connecting, proactive interventions to them. The intensity of the SCPD depends on the judgment of the health professional, based on individual caregiver needs. PRIMARY OUTCOME: Institutionalization in long-term care facilities at 12 months of follow-up. RESULTS: No main intervention effect on institutionalization was found. However, a better sense of competence in the control group reduced the chance of institutionalization but not in the intervention group. The caregiver's sense of competence and depressive symptoms and the patient's behavioral problems and severity of dementia were the strongest predictors of institutionalization. The intensity of the program was low, even for dyads exposed to the SCPD. CONCLUSIONS: Although no main effect was found, the results suggest that the SCPD might prevent a deterioration of the sense of competence in the intervention group. The intensity of a program is crucial and should be prescribed on the basis of evidence rather than left to the discretion of health professionals. Future controlled trials in daily clinical practice should use a process analysis to control for compliance.
Upload full text
Use your RU credentials (u/z-number and password) to log in with SURFconext to upload a file for processing by the repository team.