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

Published online by Cambridge University Press:  26 March 2014

Lynn Chenoweth ,
Ian Forbes ,
Richard Fleming ,
Madeleine T. King ,
Jane Stein-Parbury ,
Georgina Luscombe ,
Patricia Kenny ,
Yun-Hee Jeon ,
Marion Haas  and
Henry Brodaty
Lynn Chenoweth*
Affiliation:
Aged and Extended Care Nursing, Faculty of Health, University of Technology, Sydney, NSW, Australia Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
Ian Forbes
Affiliation:
Faculty of Design, Architecture and Building, University of Technology Sydney, Sydney, NSW, Australia
Richard Fleming
Affiliation:
Dementia Training Study Centre, University of Wollongong, Wollongong, Australia
Madeleine T. King
Affiliation:
Director Quality of Life Research Centre, University of Sydney, Sydney, NSW, Australia
Jane Stein-Parbury
Affiliation:
Faculty of Health, University of Technology, Sydney, NSW, Australia
Georgina Luscombe
Affiliation:
Sydney Medical School, University of Sydney, Sydney, NSW, Australia
Patricia Kenny
Affiliation:
Centre for Health Economics Research and Evaluation, University of Technology, Sydney, NSW, Australia
Yun-Hee Jeon
Affiliation:
Faculty of Nursing and Midwifery, University of Sydney, Sydney, NSW, Australia
Marion Haas
Affiliation:
Centre for Health Economics Research and Evaluation, University of Technology, Sydney, NSW, Australia
Henry Brodaty
Affiliation:
School of Psychiatry, University of New South Wales, Sydney, Australia
*
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.
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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.

Keywords

aged caredementiaresidential facilitiesrandomized controlled trial (RCT)
Type
Research Article
Information
International Psychogeriatrics , Volume 26 , Issue 7 , July 2014 , pp. 1147 - 1160
Copyright
Copyright © International Psychogeriatric Association 2014 

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