Caring for Persons With Dementia and Their Caregivers in the Community

NCT04479033 | Unknown

• 1 other identifier: MOH/NIC/COG05/2017-00
• Study Type: interventional
• Target: 300
• Locations: 1 country
• Sites: 1

Brief Summary

The study consists of two phases - i) a comprehensive assessment of biopsychosocial needs among cognitively impaired persons and their family caregivers residing in the Whampoa residential estate in Singapore ; ii) a quasi-experimental evaluation of a pilot community-based dementia care programme administered by a multidisciplinary team of service providers. The intervention is a physician-enhanced dementia-specific care management programme that supports client dyads for up to six months and through community care management, person-centred communication, management of challenging behaviours, psychoeducation, geriatric medicine, and gerontological approaches. The intervention team consists of a nurse, social worker, care manager, physician, and 'Dementia Care Program Assistants' who specifically design personalised meaningful activities to engage persons living with dementia as well as provide caregivers with training in basic dementia caregiving.

Conditions

Dementia; Cognitive Impairment

Keywords

community based care; multidisciplinary team; comprehensive needs assessment; moderate to severe dementia; mixed-methods evaluation

Outcome Measures

Primary Outcomes (4)

• Change from baseline in cognitive impairment at week 24.

  Mini-Mental State Examination is a 30-point test to screen for cognitive impairment. Scores ranging from 20 to 26 indicate some cognitive impairment, 10-19 indicate moderate to severe cognitive impairment and below 10 indicate very severe cognitive impairment.

  Baseline, Week 24

• Change from baseline in caregiver stress and burden at week 24.

  Zarit Burden Interview is a 22-item instrument for measuring the caregiver's perceived burden of providing care. Questions focus on caregiver's health, psychological well-being, finances, social life and relationship between the caregiver and the PLWD.

  Baseline, Week 24

• Change from baseline in memory and behaviour problems at week 24.

  Revised Memory and Behavior Problems Checklist is a 24-item (scored on a scale of 0-4) caregiver-report to measure behavioral problems in PLWDs. The items can be summed as a total score and 3 subscale scores in the domains of memory, depression, and disruptive behaviors. Parallel scores for caregiver reaction are also obtained. Such disruptive and challenging behaviors undermine quality of life in PWDs and place both an emotional and financial burden on their caregivers.

  Baseline, Week 24

• Change from baseline in health-related quality of life at week 24.

  Euro-Qol-5D- EQ5D is a commonly used 5-item scale to measure health-related quality of life.

  Baseline, Week 24

Secondary Outcomes (1)

• Cost-effectiveness of intervention

  Baseline, Week 24

Study Arms (2)

Control

NO INTERVENTION

Participants assigned to the control group had screened positive for cognitive impairment but refused the intervention. They were provided with a GP referral letter and information on helplines and caregiver support. Follow-up interviews were scheduled at week 24.

Intervention

EXPERIMENTAL

Weekly meeting/communication sessions with members of intervention team for a total of 24 weeks.

Other: Multidisciplinary collaborative model of community care management

Interventions

Multidisciplinary collaborative model of community care management OTHER

An individualised care plan is developed for PLWDs-caregiver dyads who meet/communicate weekly with various members of the HMDCS team depending on the nature of their needs. Each dyad's care plan involves the diagnosis of problems (eg: memory problems, family conflicts, poor nutrition, fall risk, medication compliance, lack of long-term care arrangements), establishment of treatment goals (eg: caregiver education, awareness of long-term care planning, stabilising medical care at home, improving emotional support), and indicating specific interventions (eg: referrals to counsellors, specialist doctors, day rehabilitation centres; consultations at GP clinic; coordination of advanced care planning; installation of home safety devices; training caregivers to detect acute deterioration in PLWDs). Monitoring of the dyads' statuses and updating of care plans are performed throughout the duration of the programme.

Intervention

Eligibility Criteria

• Age: 60 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• years of age and above.
• Singapore citizens or permanent residents.
• Lives within catchment area of Whampoa Constituency
• Screened positively for cognitive impairment (MMSE score of 15 and above)
• PLWDs must have a primary caregiver.
• Caregivers must be 21 years of age and above.

You may not qualify if:

• PLWDs without a caregiver

Sponsors & Collaborators

• Duke-NUS Graduate Medical School: lead
• Ministry of Health, Singapore: collaborator
• The Tsao Foundation: collaborator

Study Sites (1)

Duke-NUS Medical School

Singapore, 169857, Singapore

RECRUITING

MeSH Terms

Conditions

Dementia; Cognitive Dysfunction

Condition Hierarchy (Ancestors)

Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Neurocognitive Disorders; Mental Disorders; Cognition Disorders

Study Officials

• Angelique Chan, PhD

  Duke-NUS Graduate Medical School

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Johan Suen, PhD

CONTACT

+65 97552066; johan@duke-nus.edu.sg

Angelique Chan, PhD

CONTACT

6516 5685; angelique.Chan@duke-nus.edu.sg

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NON RANDOMIZED
• Masking: DOUBLE
• Who Masked: PARTICIPANT, CARE PROVIDER
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Executive Director

Study Record Dates

• First Submitted: July 16, 2020
• First Posted: July 21, 2020
• Study Start: April 27, 2017
• Primary Completion: February 27, 2021
• Study Completion: February 27, 2021
• Last Updated: July 21, 2020

Record last verified: 2020-07

Locations

SG (1)