PerCEN: a cluster randomized controlled trial of person-centered residential care and environment for people with dementia
PerCEN: a cluster randomized controlled trial of person-centered residential care and environment for people with dementia
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DOI：
10.1017/s1041610214000398
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发表时间：
2014-07-01
影响因子：
7
通讯作者：
Brodaty, Henry
中科院分区：
文献类型：
--
作者：
Chenoweth, Lynn;Forbes, Ian;Brodaty, Henry
背景：有充分的证据表明，以人为本的护理（PCC）对痴呆患者的躁动有积极的影响。我们假设以人为本的环境（PCE）通过关注积极的环境刺激可以达到类似的结果，并且将PCC和PCE结合起来可以提高结果。方法：对38家在PCC和PCE方面都有改善空间的澳大利亚住宅养老院进行分层，然后随机分为四个干预组：(1)PCC；(2)个人消费支出;(3) PCC + PCE;(4)无干预。年龄超过60岁且同意的痴呆症患者符合条件。干预前和干预后4个月以及随访8个月时评估的共同结果包括住院患者的躁动、护理中的情绪反应、生活质量和抑郁，以及护理互动质量。结果：从38个家庭中随机招募了601名痴呆症患者。随访时，PCE组（p = 0.02, p = 0.05）和PCC组（p = 0.0003, p = 0.002）与非干预组（p = 0.48, p = 0.93）相比，生活质量和躁动的平均变化有显著差异。PCC+PCE组的生活质量无显著改善（p = 0.08），但躁动无显著改善（p = 0.37）。PCC+PCE组在护理互动质量（p = 0.006）和护理情绪反应（p = 0.01）方面的改善在其他组中未观察到。抑郁评分在任何一组中都没有变化。PCC组干预依从性为59%，PCE组为54%，PCC+PCE组为66%。结论：PCC+PCE会进一步改善生活质量和躁动的假设不被支持，尽管在护理互动的质量和住院医生对护理的情绪反应方面有改善。澳大利亚新西兰临床试验注册编号为ACTRN 12608000095369。
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 randomized 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 fourmonths 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 randomized, 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 Zealand Clinical Trials Registry Number is ACTRN 12608000095369.