Skip to main content Accessibility help
×
Home

PerCEN: a cluster randomized controlled trial of person-centered residential care and environment for people with dementia

  • Lynn Chenoweth (a1) (a2), Ian Forbes (a3), Richard Fleming (a4), Madeleine T. King (a5), Jane Stein-Parbury (a6), Georgina Luscombe (a7), Patricia Kenny (a8), Yun-Hee Jeon (a9), Marion Haas (a8) and Henry Brodaty (a10)...

Abstract

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 four months 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.

Copyright

Corresponding author

Correspondence should be addressed to: Lynn Chenoweth, Professor of Aged Care and Extended Practice Nursing, Faculty of Health, University of Technology, Sydney, Australia. Professor of Nursing, Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, Australia. Phone: +61 2 9514 5710. Email: Lynnette.Chenoweth@uts.edu.au.

References

Hide All
Alexopoulos, G., Abrams, R., Young, R. and Shamian, C. (1998). Cornell scale for depression in dementia. Biological Psychology, 23, 271284.
Australian Institute of Health and Welfare. (2012) Dementia in Australia. Cat. No. AGE 70. 2012, Canberra: AIHW.
Beer, C. et al. (2010). Factors associated with self and informant ratings of the quality of life of people with dementia living in care facilities: a cross sectional study. Plos One, 5, e15621–e15621.
Bicket, M. et al. (2010). The physical environment influences neuropsychiatric symptoms and other outcomes in assisted living residents. International Journal of Geriatric Psychiatry, 25, 10441054.
Briller, S., Proffitt, M., Perez, K., Calkins, M. and Marsden, J. (2001). Maximizing cognitive and functional abilities. In Nay, R. and Garratt, S. (eds.), Creating Successful Dementia Care Settings, Vol. 2. Sydney: Health Professions Press.
Brooker, D. (2004). What is person-centred care in dementia? Reviews in Clinical Gerontology, 13, 215222.
Brooker, D., Woolley, R. and Lee, D. (2007). Enriching opportunities for people living with dementia in nursing homes: an evaluation of a multi-level activity-based model of care. Aging and Mental Health, 11, 361370.
Brooker, D., Argyle, E., Scally, A. J. and Clancy, D. (2011). The Enriched Opportunities Programme for people with dementia: a cluster-randomised controlled trial in 10 extra care housing schemes. Aging and Mental Health. Published on-line. doi:10.1080/13607863.2011.583628 http://dx.doi.org/10.1080/13607863.2011.583628
Burke, C., Chenoweth, L. and Stein-Parbury, J. (2012). Person-Centred Environment and Care Tool (PCECAT). PhD thesis. Australia: University of Technology Sydney.
Chenoweth, L. et al. (2009). Caring for Aged Dementia Care Residents study (CADRES): a cluster-randomised trial of Person-Centred Care in dementia. Lancet Neurology, 8, 317325.
Chenoweth, L. et al. (2011) Person-Centred Dementia Care and Environment (PerCEN): Study protocol of a cluster randomised controlled group trial of client and care outcomes in the residential dementia care setting (ANZCTR 12608000095369). Worldviews on Evidence-Based Nursing, 8, 153165.
Cohen-Mansfield, J. (1999). Measurement of inappropriate behaviour associated with dementia. Journal of Gerontologic Nursing, 25, 4251.
Cohen-Mansfield, J., Libin, A. and Marx, M. (2007). Non-pharmacological treatment of agitation: a controlled trial of systematic individualised intervention. The Journals of Gerontology, Series A: Biological Sciences and Medical Sciences, 62, 908916.
Davis, S., Byers, S., Nay, R. and Koch, S. (2009). Guiding design of dementia friendly environments in residential care settings. Dementia, 8, 185. Published on-line doi:10.1177/1471301209103250.
Day, K., Carreon, D. and Stump, C. (2000). The therapeutic design of environments for people with dementia: a review of the empirical research. The Gerontologist, 40, 397416.
Dean, R., Proudfoot, R., and Lindesay, J. (1993). Quality of Interactions Schedule (QUIS). International Journal of Geriatric Psychiatry, 8, 819826.
Desborough, J. et al. (2011). Multi-professional clinical medication reviews in care homes for the elderly: study protocol for a randomised controlled trial with cost effectiveness analysis. Trials, 12, 218. doi: 10.1186/1745-6215-12-218.
Edvardsson, D., Winblad, B. and Sandman, P. (2008). Person-centred care of people with severe Alzheimer's disease: current status and ways forward. The Lancet Neurology, 7, 362367.
Fleming, R. (2005). Emotional Responses in Care Assessment (ERiC). Sydney, Australia: The Hammond Care Group.
Fleming, R. (2011). An environmental audit tool suitable for use in homelike facilities for people with dementia. Australasian Journal on Ageing 30, 108112.
Fleming, R. and Purandare, N. (2010). Long-term care for people with dementia: environmental design guidelines. International Psychogeriatrics, 22, 10841096.
Hounsome, N., Orrell, M. and Edwards, R.T. (2011). EQ-5D as a quality of life measure in people with dementia and their carers. Evidence and key issues. Values in Health, 14, 390399.
Jeon, Y-H., Luscombe, G., Chenoweth, L., Stein-Parbury, J., Brodaty, H. and Haas, M. (2012). Staff Outcomes from the Caring for Aged Dementia Care REsident Study (CADRES): a cluster randomised trial. International Journal of Nursing Studies, 49, 508518. http://dx.doi.org/10.1016/j.ijnurstu.2011.10.020
Kitwood, T. and Bredin, K. (1992). Towards a theory of dementia care: personhood and well-being. Ageing and Society, 12, 269287.
Murray, D.M. (1998). Design and Analysis of Group-Randomised Trials. Oxford: Oxford University Press.
Ott, B. and Fogel, B. (1992). Measurement of depression in dementia: self vs clinician rating. International Journal of Geriatric Psychiatry, 7, 899904.
Reisberg, B., Ferris, S.H., de Leon, M.J. and Crook, T. (1982). The global deterioration scale for assessment of primary degenerative dementia. American Journal of Psychiatry, 139, 11361139.
SAS Institute Inc. (2011). SAS/STAT® 9.3 User's Guide. Cary, NC: SAS Institute Inc.
Smith, S. C. et al. (2005). Measurement of health-related quality of life for people with dementia: development of a new instrument (DEMQOL) and an evaluation of current methodology. Health Technology Assessment, 9, 10, 193.
Stein-Parbury, J., Chenoweth, L., Jeon, Y-H., Brodaty, H., Haas, M. and Norman, R. (2012). Implementing Person-Centred Care in residential dementia care. Clinical Gerontologist, 35, 404424.
Surr, C. (2006). Preservation of self in people with dementia living in residential care: a socio-biographical approach. Social Science and Medicine, 62, 17201730.

Keywords

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed