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 randomized 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 systematically 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.
Key Words
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Article info
Publication history
Published online: January 06, 2014
Accepted:
December 31,
2013
Received in revised form:
December 12,
2013
Received:
August 20,
2013
Identification
Copyright
© 2014 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.
