Caring for Aged Dementia Care Resident Study (CADRES) of person-centred care, dementia-care mapping, and usual care in dementia: a cluster-randomised trial
Abstract
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.
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Citalopram has some efficacy but has cardiac side-effects and reduces cognition.
“citalopram has some efficacy but has cardiac side-effects and reduces cognition. 12”
From Non-pharmacological interventions for agitation in dementia: systematic review of randomised controlled trials (2014) · cites this paper as [12]
Of the 37 studies with incomplete outcome data, 12 clearly adopted an intention-to-treat approach to statistical analysis.
“Of the 37 studies with incomplete data, 12 clearly adopted an intention to treat (ITT) approach to statistical analysis (Alamo 2002; Briel 2006; Chenoweth 2009; Glasgow 2004; Joos 1996; Kennedy 2004; Margalit 2005; McLean 2004; Meland 1997; Smith 2006; Sorlie 2007; Wilkinson 2008), raising the possibility of bias in the remaining 25 studies.”
From Interventions for providers to promote a patient-centred approach in clinical consultations (2012) · cites this paper as Chenoweth 2009
Twelve studies explicitly reported concealed and secure allocation.
“Twelve studies explicitly reported concealed and secure allocation (Bieber 2008; Briel 2006; Chenoweth 2009; Dijkstra 2006; Kinmonth 1998; Loh 2007; Longo 2006; Smith 2006; Sorlie 2007; Stewart 2007; Wilkinson 2008; Wolf 2008).”
From Interventions for providers to promote a patient-centred approach in clinical consultations (2012) · cites this paper as Chenoweth 2009
The potential for a unit of analysis error for some outcomes was acknowledged in only 19 of the studies that randomized providers or practices.
“The potential for a unit of analysis error for some outcomes was acknowledged in only 19 of the studies that randomized providers or practices.”
From Interventions for providers to promote a patient-centred approach in clinical consultations (2012) · cites this paper as Chenoweth 2009
Only five out of the 22 cluster-randomized studies had the ICC reported.
“Notably, only five (Chenoweth 2009; Kennedy 2004; Kinmonth 1998; Krones 2008; Loh 2007) out of the 22 studies had the ICC reported.”
From Interventions for providers to promote a patient-centred approach in clinical consultations (2012) · cites this paper as Chenoweth 2009
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- Authors
- Chenoweth, L., King, M. T., Jeon, Y.-H., Brodaty, H., Stein-Parbury, J., Norman, R., Haas, M., & Luscombe, G.
- Affiliations
- University of Technology Sydney (AU)
- The University of Sydney (AU)
- UNSW Sydney (AU)
- Corresponding author
- Chenoweth, Lynn
- ORCID
- Venue
- The Lancet Neurology
- Publisher
- Elsevier BV
- Published
- 2009-04
- Volume
- 8
- Issue
- 4
- Pages
- 317-325
- ISSN
- 1474-4422 (ISSN-L)
- OpenAlex
- W2129114099
- Cited by
- 528
- References
- 24
- Citations by year
- 2026: 5 · 2025: 15 · 2024: 15 · 2023: 24 · 2022: 18 · 2021: 32 · 2020: 44 · 2019: 37 · 2018: 35 · 2017: 45 · 2016: 37 · 2015: 43 · 2014: 53 · 2013: 37 · 2012: 35
- FWCI
- 53.43
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Lancet Neurology (publishedVersion)
- PubMed (publishedVersion)
- eSpace (Curtin University) (submittedVersion)
- ANU Open Research (Australian National University) (submittedVersion)
- UTS ePRESS (University of Technology Sydney) (submittedVersion)
- Topics
- Health Sciences › Health Professions › General Health Professions › Geriatric Care and Nursing Homes
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Keywords
- dementia, person-centred care, Dementia Care Mapping, residential care, nursing homes, agitation, Cohen-Mansfield Agitation Inventory, falls, carer training, usual care, quality of life, psychiatric symptoms
- MeSH terms
- Accidental Falls, Aged, 80 and over, Analysis of Variance, Australia, Benzodiazepines, Dementia, Female, Humans, Male, Psychiatric Status Rating Scales, Psychomotor Agitation, Quality of Life, Antipsychotic Agents, Linear Models, Treatment Outcome, Patient-Centered Care
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