Coaching for Dementia Care

(DCPR_CC3 Trial)

Overseen By Lorna Prophater, MS

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Alzheimer's Disease and Related Disorders Association, Inc

Disqualifiers: Under 18, No leadership endorsement

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 9

449 Participants Needed

Trial Summary

What is the purpose of this trial?

The goal of this clinical trial is to compare staff outcomes in long-term care communities who participate in the intervention versus those who do not. The main questions it aims to answer are: 1. Is employee satisfaction impacted by the intervention and 2. Is dementia care confidence impacted by the intervention. Participants will include monthly coaching visits for the intervention group and completion of surveys pre, immediately post and three-months post. Researchers will compare the intervention group to the control group to see if the intervention impacted the outcomes.

Will I have to stop taking my current medications?

The trial information does not specify whether participants need to stop taking their current medications.

What data supports the effectiveness of the treatment Person-Centered Dementia Care Practice Coaching Intervention?

Research shows that person-centered care, which focuses on the individual needs and preferences of people with dementia, can improve patient outcomes by reducing emotional distress and enhancing quality of life. Although implementing this approach can be challenging, it is considered a preferred model of care in various settings. ^{1 2 3 4 5}

Is coaching for dementia care safe for humans?

The research does not provide specific safety data for coaching interventions like Person-Centered Dementia Care, but it highlights the need for safe healthcare delivery for patients with dementia, who often experience more adverse events during hospital stays. ^{2 6 7 8 9}

How is the Patient-Centered Dementia Care Practice Coaching Intervention different from other dementia treatments?

This treatment is unique because it focuses on person-centered care, which emphasizes the individual's abilities, meaningful engagement, and respect for their dignity and choices, rather than just addressing medical symptoms. It aims to improve the psychosocial experience of living with dementia, which is not the primary focus of many traditional treatments. ^{4 5 10 11 12}

Research Team

Sam Fazio, PhD

Principal Investigator

Alzheimer's Association

Eligibility Criteria

This trial is for staff in long-term care communities who work with patients suffering from Alzheimer's Disease and Dementia. The goal is to see if coaching can improve their job satisfaction and confidence in providing dementia care.

Inclusion Criteria

Licensed skilled nursing facilities located in the state of Ohio

Licensed assisted living facilities located in the state of Ohio

Exclusion Criteria

Without documented endorsement for participation from facility leadership

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Coaching Intervention

Participants in the intervention group receive monthly coaching sessions to implement person-centered care practices

6 months

6 visits (1 per month, in-person or virtual)

Follow-up

Participants complete surveys to assess employee satisfaction, person-centered practices, and dementia care confidence

3 months

Surveys conducted pre, immediately post, and 3-month post

Long-term Monitoring

Staff turnover rates are assessed monthly from pre-intervention to 3 months after completion of the intervention

9 months

Treatment Details

Interventions

• Patient-Centered Dementia Care Practice Coaching Intervention

Trial Overview The study tests a 'Coaching Group' intervention, where staff receive monthly coaching visits. Surveys are taken before, immediately after, and three months post-intervention to measure its impact on employee satisfaction and dementia care confidence.

Participant Groups

Group I: Training Group Active Control 1 Intervention

This group will complete the same pre, immediate post and 3-month post surveys as the intervention group but will receive no intervention during the six month period.

Group II: Coaching Group Active Control 1 Intervention

The intervention group will be exposed to six coaching sessions (one a month for 6 months) as well as a nine month touch point to complete the 3-month post survey. This group will have access to a care community coach, resources and use these supports to create action steps towards adopting and implementing person-centered best practices based on an initial self-assessment of their current practices.

Who Is Running the Clinical Trial?

Alzheimer's Disease and Related Disorders Association, Inc

Lead Sponsor

Trials

2

Recruited

20,500+

University of Washington

Collaborator

Trials

1,858

Recruited

2,023,000+

Findings from Research

Person-centered outcome measures (PCOMs) can enhance shared decision-making in dementia care by helping to understand individual needs, set care priorities, and evaluate treatment decisions, based on a review of 10 studies involving 1064 participants.

While PCOMs show potential for improving communication and care outcomes, the evidence for their effectiveness in enhancing physical function and daily activities remains weak, indicating a need for further research and training for family caregivers.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

How do person-centered outcome measures enable shared decision-making for people with dementia and family carers?-A systematic review. Aworinde, J., Ellis-Smith, C., Gillam, J., et al.[2023]

A study involving 170 patients with dementia in a specialized acute hospital unit (CAMIE) showed significant improvements in functional status, well-being, and reduced agitation compared to a control group of 60 patients receiving usual care over a 6-month period.

The person-centered care approach in the CAMIE unit was found to be cost-effective, with an incremental cost-effectiveness ratio of USD 23,111, suggesting that this model of care could be beneficial for broader implementation in treating patients with dementia.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Person-centered care for older people with dementia in the acute hospital. Tay, FHE., Thompson, CL., Nieh, CM., et al.[2022]

Both digital and conventional life story books (LSB) significantly improved communication skills in individuals with dementia, with no notable differences between the two formats, based on a study involving 31 participants over 5 weeks.

However, neither format showed significant effects on quality of life, cognition, or depressive symptoms, indicating that while LSBs can enhance communication, their impact on other areas remains unclear.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Comparison of digital and conventional life story books on mood, communication, cognition and quality of life in people with dementia in nursing homes: A pilot study]. Doménech, S., Rojano I Luque, X., Sánchez-Martínez, I., et al.[2023]

The implementation of person-centred care (PCC) in German nursing homes faced significant barriers, including concerns about increased workload and insufficient time resources, which hindered its effectiveness in changing antipsychotic prescriptions.

Facilitators for successful PCC implementation included multi-professional teamwork and effective collaboration with physicians, highlighting the importance of a supportive environment and involvement of relatives in the care process.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Factors influencing the implementation of person-centred care in nursing homes by practice development champions: a qualitative process evaluation of a cluster-randomised controlled trial (EPCentCare) using Normalization Process Theory. Richter, C., Fleischer, S., Langner, H., et al.[2022]

An educational workshop for 41 old age psychiatrists was developed to enhance patient-centered care in dementia consultations, focusing on effective communication and consultation structure.

Three months post-workshop, a significant number of psychiatrists reported changes in their practice, with 59% altering consultation structure and 71% adopting new communication skills, indicating the workshop's potential efficacy in improving care delivery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Improving patient-centered care for people with dementia in medical encounters: an educational intervention for old age psychiatrists. Robinson, L., Bamford, C., Briel, R., et al.[2019]

Patients with dementia (n = 240) experienced significantly more adverse events during hospitalization, including falls, delirium, and incontinence, compared to those without dementia.

While patients with dementia received more allied health therapies like speech and physiotherapy, they did not show significant functional improvement, highlighting the need for tailored care models to address their unique health care needs.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Adverse Events, Functional Decline, and Access to Allied Health Therapies for Patients With Dementia During Acute Hospitalization. Fox, A., MacAndrew, M., Wyles, K., et al.[2021]

The Care Ecosystem (CE) program significantly reduced the use of potentially inappropriate medications (PIMs) among 490 community-dwelling individuals living with dementia over a 12-month period, with a notable decrease of 0.35 PIMs per participant compared to usual care.

The CE intervention not only lowered the overall number of PIMs, including anticholinergics, benzodiazepines, and opioids, but also led to more frequent adjustments in anti-dementia medication regimens, indicating an optimization of medication use in this population.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effect of collaborative dementia care on potentially inappropriate medication use: Outcomes from the Care Ecosystem randomized clinical trial. Liu, AK., Possin, KL., Cook, KM., et al.[2023]

There is a significant gap in research on nonpharmacological interventions for people living with dementia and their caregivers, particularly in various care settings like nursing homes and hospitals.

Embedded pragmatic clinical trials (ePCTs) within learning healthcare systems offer a promising approach to study and implement effective interventions in real-world settings, fostering collaboration between researchers, healthcare providers, and families of people living with dementia.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Transforming Dementia Care Through Pragmatic Clinical Trials Embedded in Learning Healthcare Systems. Tuzzio, L., Hanson, LR., Reuben, DB., et al.[2022]

Hospital-acquired complications like urinary tract infections, pressure areas, pneumonia, and delirium account for 6.4% of total hospital costs for patients over 50, with dementia patients experiencing these complications at a significantly higher rate (RR 2.5).

These complications lead to an eightfold increase in hospital length of stay and double the average episode cost, highlighting the need for improved care models to prevent such issues, especially in dementia patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The cost of hospital-acquired complications for older people with and without dementia; a retrospective cohort study. Bail, K., Goss, J., Draper, B., et al.[2022]

This systematic review identified 19 studies on person-centered care (PCC) interventions for dementia, revealing nine key intervention categories such as social contact, physical activities, and cognitive training, which can guide effective dementia care.

The review highlighted the heterogeneity of approaches in PCC interventions, suggesting that a clearer definition and evaluation of relationship-centered interventions may enhance the effectiveness of dementia care strategies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Key Intervention Categories to Provide Person-Centered Dementia Care: A Systematic Review of Person-Centered Interventions. Mohr, W., Rädke, A., Afi, A., et al.[2022]

Person-centered care practices are essential for improving the psychosocial experience of individuals living with dementia, emphasizing that people can lead fulfilling lives despite their condition.

Four key principles of person-centered care include valuing individuals' abilities, ensuring meaningful engagement, and upholding respect and dignity, which are crucial for enhancing quality of life and should be recognized as basic human rights.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Helping Individuals With Dementia Live More Fully Through Person-Centered Practices. Love, K., Femia, E.[2017]

A Swedish study involving in-depth interviews with family and professional carers of people with dementia highlighted the need for collaboration between these groups to achieve person-centred care.

The study identified both similarities and differences in how family and professional carers define 'best care', emphasizing the importance of understanding each group's perspectives to improve care for individuals with dementia.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

What constitutes good care for people with dementia? Ericson, I., Hellström, I., Lundh, U., et al.[2022]

References

1. United States pubmed.ncbi.nlm.nih.gov

How do person-centered outcome measures enable shared decision-making for people with dementia and family carers?-A systematic review. [2023]

2. United States pubmed.ncbi.nlm.nih.gov

Person-centered care for older people with dementia in the acute hospital. [2022]

3. Spain pubmed.ncbi.nlm.nih.gov

[Comparison of digital and conventional life story books on mood, communication, cognition and quality of life in people with dementia in nursing homes: A pilot study]. [2023]

4. England pubmed.ncbi.nlm.nih.gov

Factors influencing the implementation of person-centred care in nursing homes by practice development champions: a qualitative process evaluation of a cluster-randomised controlled trial (EPCentCare) using Normalization Process Theory. [2022]

5. England pubmed.ncbi.nlm.nih.gov

Improving patient-centered care for people with dementia in medical encounters: an educational intervention for old age psychiatrists. [2019]

6. United States pubmed.ncbi.nlm.nih.gov

Adverse Events, Functional Decline, and Access to Allied Health Therapies for Patients With Dementia During Acute Hospitalization. [2021]

7. United States pubmed.ncbi.nlm.nih.gov

Effect of collaborative dementia care on potentially inappropriate medication use: Outcomes from the Care Ecosystem randomized clinical trial. [2023]

8. United States pubmed.ncbi.nlm.nih.gov

Transforming Dementia Care Through Pragmatic Clinical Trials Embedded in Learning Healthcare Systems. [2022]

9. England pubmed.ncbi.nlm.nih.gov

The cost of hospital-acquired complications for older people with and without dementia; a retrospective cohort study. [2022]

10. Netherlands pubmed.ncbi.nlm.nih.gov

Key Intervention Categories to Provide Person-Centered Dementia Care: A Systematic Review of Person-Centered Interventions. [2022]

11. United States pubmed.ncbi.nlm.nih.gov

Helping Individuals With Dementia Live More Fully Through Person-Centered Practices. [2017]

12. England pubmed.ncbi.nlm.nih.gov

What constitutes good care for people with dementia? [2022]