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. 2014 Feb 28;6(1):9.
doi: 10.1186/alzrt242. eCollection 2014.

A controlled trial of Partners in Dementia Care: veteran outcomes after six and twelve months

David M Bass  1 , Katherine S Judge  2 , A Lynn Snow  3 , Nancy L Wilson  4 , Robert O Morgan  5 , Katie Maslow  6 , Ronda Randazzo  7 , Jennifer A Moye  8 , Germaine L Odenheimer  9 , Elizabeth Archambault  10 , Richard Elbein  11 , Paul Pirraglia  12 , Thomas A Teasdale  13 , Catherine A McCarthy  1 , Wendy J Looman  1 , Mark E Kunik  14
Affiliations

A controlled trial of Partners in Dementia Care: veteran outcomes after six and twelve months

David M Bass et al. Alzheimers Res Ther. .

Abstract

Introduction: "Partners in Dementia Care" (PDC) tested the effectiveness of a care-coordination program integrating healthcare and community services and supporting veterans with dementia and their caregivers. Delivered via partnerships between Veterans Affairs medical centers and Alzheimer's Association chapters, PDC targeted both patients and caregivers, distinguishing it from many non-pharmacological interventions. Hypotheses posited PDC would improve five veteran self-reported outcomes: 1) unmet need, 2) embarrassment about memory problems, 3) isolation, 4) relationship strain and 5) depression. Greater impact was expected for more impaired veterans. A unique feature was self-reported research data collected from veterans with dementia.

Methods and findings: Five matched communities were study sites. Two randomly selected sites received PDC for 12 months; comparison sites received usual care. Three structured telephone interviews were completed every 6 months with veterans who could participate.

Results: Of 508 consenting veterans, 333 (65.6%) completed baseline interviews. Among those who completed baseline interviews, 263 (79.0%) completed 6-month follow-ups and 194 (58.3%) completed 12-month follow-ups. Regression analyses showed PDC veterans had significantly less adverse outcomes than those receiving usual care, particularly for more impaired veterans after 6 months, including reduced relationship strain (B = -0.09; p = 0.05), depression (B = -0.10; p = 0.03), and unmet need (B = -0.28; p = 0.02; and B = -0.52; p = 0.08). PDC veterans also had less embarrassment about memory problems (B = -0.24; p = 0.08). At 12 months, more impaired veterans had further reductions in unmet need (B = -0.96; p < 0.01) and embarrassment (B = -0.05; p = 0.02). Limitations included use of matched comparison sites rather than within-site randomization and lack of consideration for variation within the PDC group in amounts and types of assistance provided.

Conclusions: Partnerships between community and health organizations have the potential to meet the dementia-related needs and improve the psychosocial functioning of persons with dementia.

Trial registry: NCT00291161.

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Figures

Figure 1
Figure 1
CONSORT flow chart. This diagram shows the flow of participants by group from identification to final 12-month assessment.
See this image and copyright information in PMC

References

    1. Office of Assistant Deputy Under-Secretary for Health. Projections of the Prevalence and Incidence of Dementias Including Alzheimer's Disease for the Total, Enrolled, and Patient Veteran Populations Age 65 and Over. Washington, DC: Department of Veterans Affairs; 2004.
    1. Sheets CJ, Mahoney-Gleason H. Caregiver support in the Veterans Health Administration: caring for those who care. Generations. 2010;6:92–98.
    1. US Congress. Senate. 111th Congress, 2nd Session: Caregivers and Veterans Omnibus Health Services Act of 2010. Washington, DC: GPO; 2010.
    1. Cooley SG, Asthana S. Dementia care for veterans: enhancing comprehensive, coordinated services. Generations. 2010;6:57–63.
    1. US Department of Health and Human Services. The national plan to address Alzheimer’s disease. Available at: http://alzheimers.gov/pdf/NationalPlantoAddressAlzheimersDisease.pdf.

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