Family care as collaboration: effectiveness of a multicomponent support program for elderly couples with dementia. Randomized controlled intervention study

Abstract

Objectives: To determine whether community care of people with dementia can be prolonged with a 2-year multicomponent intervention program and to analyze effects of the intervention on total usage and expenses of social and healthcare services.

Design: Randomized controlled trial.

Setting: Community-dwelling couples with one spouse caring for the other spouse with dementia.

Participants: Couples with dementia (N=125) were allocated at random to the intervention (n=63) or control group (n=62).

Intervention: Intervention couples were provided with a multicomponent intervention program with a family care coordinator, a geriatrician, support groups for caregivers, and individualized services.

Measurements: Time from enrollment to institutionalization of spouses with dementia and use of services and service expenditure of couples.

Results: At 1.6 years, a larger proportion in the control group than in the intervention group was in long-term institutional care (25.8% vs 11.1%, P=.03). At 2 years, the difference was no longer statistically significant. The 2-year adjusted hazard ratio for the intervention group was 0.53 (95% confidence interval (CI)=0.23-1.19, P=.12). Intervention led to reduction in use of community services and expenditures. The difference for the benefit of intervention group was -7,985 Euro (95% CI=-16,081 to -1,499, P=.03). When the intervention costs were included, the differences between the groups were not significant.

Conclusion: Although the intervention did not result in a significant difference in the need for institutional care after 2 years, individualizing services in collaboration with families may lead to reduction in use of and expenditures on municipal services.