Caring for Aged Dementia Care Resident Study (CADRES) of person-centred care, dementia-care mapping, and usual care in dementia: a cluster-randomised trial
Caring for Aged Dementia Care Resident Study (CADRES) of person-centred care, dementia-care mapping, and usual care in dementia: a cluster-randomised trial
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DOI：
10.1016/s1474-4422(09)70045-6
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发表时间：
2009-04-01
期刊：
影响因子：
48
通讯作者：
Luscombe, Georgina
中科院分区：
文献类型：
--
作者：
Chenoweth, Lynn;King, Madeleine T.;Luscombe, Georgina
背景通过提供以人为中心的护理和痴呆症护理图谱，改善痴呆症患者预后的证据在很大程度上是观察性的。我们的目标是对以人为中心的护理、痴呆症护理地图和常规护理进行大规模、随机的比较。方法在整群随机对照试验中，城市居民点被随机分配到以人为中心的护理、痴呆护理地图或常规护理。照顾者接受了干预或继续常规护理方面的培训和支持。治疗分配对评价员是保密的。主要结果是用科恩-曼斯菲尔德激动量表(CMAI)测量激越程度。次要结果包括精神症状，包括幻觉、神经心理状态、生活质量、跌倒和治疗费用。在干预前、干预后4个月和随访4个月时对结果进行评估。用多层线性模型检验治疗效果和时间效应，按意向处理进行分析。这项试验在澳大利亚和新西兰临床试验注册登记，编号为ACTRN12608000084381。结果随机分配了15个护理地点，289名居民。两两对比显示，在随访时，相对于常规护理，CMAI评分在提供地图(平均差异10.9，95%可信区间0.7-21.1；p=0.04)和以人为中心的护理(13.6，3.3-23.9；p=0.01)方面较低。与常规护理相比，使用地图的网站记录的跌倒较少(0.24，0.08-0-40；p=0.02)，但以人为中心的护理的跌倒更多(0.15，0.02-0.28；p=0.03)。没有其他显著的影响。解释以人为中心的护理和痴呆症护理映射似乎都能减少住院护理中痴呆症患者的焦虑。
Background Evidence for improved outcomes for people with dementia through provision of person-centred care and dementia-care mapping is largely observational. We aimed to do a large, randomised comparison of person-centred care, dementia-care mapping, and usual care.Methods In a cluster randomised controlled trial, urban residential sites were randomly 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 Zealand Clinical Trials Registry, number ACTRN12608000084381.Findings 15 care sites with 289 residents were randomly 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.