Table 5 Quantitative studies. Characteristics of the Randomised Controlled Trials reviewed
Author, year, country | Aim | Research design | Instruments | Sample and size (+characteristics) | Type and description of intervention | Analysis method | Outcomes |
|---|---|---|---|---|---|---|---|
Van den Dungen et al., 2016 [15] The Netherlands, United Kingdom Supplementary papers: Perry et al., 2008 [16] Van den Dungen et al., 2012 [17] | To assess the effect of a two-component intervention of case finding and subsequent care on diagnostic yield of case finding and its impact on the mental health of patients and relatives. | Cluster randomised controlled trial with process evaluation | Cambridge Cognition Examination (CAMCOG) Quality of Life-Alzheimer’s Disease (QoL-AD) Mental Health part of SF-36 (MH5) Short form health survey (SF36) MDS Euro-Qol (EQ5D) 12-item General Health Questionnaire (GHQ12) Short sense of Competence Questionnaire (SSCQ) Neuropsychiatric Inventory (NPI) 12-item Social Support List (SSL12) 15-item Katz questionnaire (Katz15) Mini Mental State Examination (MMSE) | 162 participants ≥ 65 years in 15 primary care practices in whom Family Practitioners (n=29) suspect cognitive impairment, but without a dementia diagnosis 2 PNs over 7 intervention practices | Intervention 1: Family practitioners (FP) attended 5 hours of dementia education. Education content based on the EASYcare dementia training program described in Perry et al., [18] Intervention 2. In addition to above, case finding of MCI and dementia and collaborative care by a dementia trained PN (a Registered Nurse) and the FP. Nurse assessment and care planning was based on the outcomes of the Residential Assessment Instrument (RAI). | Generalised Estimating Equations (GEE) analysis Odds Ratio, 95% confidence interval | Training FPs resulted in a non-significant increase in the number of new MCI diagnosis. There were no differences in mental health (QOL measure) between the group receiving collaborative care and the control group. FPs and PNs found care management to be a positive experience, although the nurses it to be time consuming. Further study of collaboration between FP and PNs is recommended. |
Thyrian, J.R.et al., 2017 [19] Germany. Supplementary papers: Dreier et al., 2016 [20] Thyrian et al., 2013 [21]. | To test the effectiveness and safety of Dementia Care management (DCM) in the treatment and care of people with dementia living at home and caregiver burden (when available) | Cluster-randomised intervention trial | Quality of Life (QoL-AD score) Neuropsychiatric symptoms (NPI score) Caregiver burden (BIZA-D score) Anti-dementia drug treatment Potentially inappropriate medication prescription | 634 people diagnosed as having dementia 407 received the intervention | DCM Is a model of collaborative care aimed at providing optimal care for patients with dementia and support care-givers. DCM uses a computer-assisted assessment determining a personalised array of intervention modules and monitoring. DCM was provided by a dementia trained RN for 6 months in the home according to a systematic, detailed protocol. The nurses completed an intensive training program described in Drier et al., [21]. | Descriptive statistics  - Means, SD  - Proportions Primary analysis  - Generalised regression models Secondary analysis  - Stratification of the models by patient’s living situation | A significant decrease in patient’s behavioural and psychological symptoms of dementia and caregiver burden was reported. There was a significant increase in quality of life for patients not living alone, but no improvement in quality of life overall. No significant effect on patient’s cognitive status, daily living activities, or institutionalisation was found. |
Callahan et al., 2006 [18] United States Supporting papers Austrom et al., 2005 [22] Austrom et al., 2006 [23] Austrom et al., 2004 [24] Boustani et al., 2005 [25] | To test the effectiveness of a collaborative care model to improve the quality of care for patients with Alzheimer’s disease. | Randomised Controlled Trial | Total patient Neuropsychiatric Inventory (NPI) Total caregiver Neuropsychiatric Inventory (NPI) Cornell Scale for Depression in Dementia (CSDD) Telephone Interview for Cognitive Status Patient Health Questionnaire-Alzheimer Disease Cooperative Study Group ADLS Caregiver Patient Health Questionnaire-9 | 153 predominantly ethnic older adults with Alzheimer Disease and their care-givers 84 people received the intervention of collaborative care management The settings were large primary care practices, community-based health centres and a Veteran Affairs Medical Centre. | 12 months of care management using current Alzheimer’s Disease treatment guidelines Delivered by a FP and an advanced PN (geriatric nurse practitioner) acting as the care manager Care-givers and patients were seen by the nurse fortnightly and then monthly for period of 1 year There were 4 intervention components 1. A behavioural intervention protocol (described in Austrom et al., [24], Boustani et al.,[25] 2. Weekly Care manager support meetings 3. A web-based longitudinal tracking system 4. voluntary group care-giver sessions for care-givers with a group exercise group for patients | 2-tailed α level of 0.05 2-sample t tests Χ2 tests Mixed-effects regression Kaplan-Meier estimation Wilcoxon test | Patients experienced significant improvements in total NPI scores which continued beyond the 12 month intervention The intervention had no significant impact on patient depression scores, cognition or function. There were significant improvements in caregiver stress at 12 months but not at 18 months. There was no difference in cumulative hospitalisation rates , mean hospital days or rates of nursing home placement |