Person Profile Dementia Intervention in Long-Term Care: A Stepped-Wedge Cluster-Randomized Trial.

Abstract

Objectives: We aimed to assess the efficacy of a person-centered care intervention in improving quality of life (QoL) for people with dementia in long-term care facilities.

Design: This study was a stepped-wedge cluster-randomized clinical trial of monthly person-centered outcome measurements, followed by collaborative nurse-led person profile interventions involving nursing staff and family members, compared with monthly person-centered outcome measurements alone.

Setting and participants: We included people with a medical diagnosis of Alzheimer's disease or vascular dementia or with clinical symptoms of dementia from 23 long-term care facilities in the German-speaking part of Switzerland.

Methods: The primary outcome was QoL, as assessed using the QUALIDEM. Secondary outcomes were the QUALIDEM subscales and the Integrated Palliative Care Outcome Scale for People with Dementia subscales. The study duration was 15 months, and linear mixed-effect models were used for the analysis.

Results: We recruited 240 people with dementia from 23 long-term care facilities. Modeling 1143 observations, we found a statistically significant positive intervention effect of 2.6 points according to the QUALIDEM (95% CI, 1.34-3.86; P < .001; total QUALIDEM intervention: 67; 95% CI, 64.8-69.1 vs 64.4; 95% CI, 62.3-66.4 for the control). We also found positive effects of the intervention on all secondary outcomes.

Conclusions and implications: Once-a-month person profile interventions based on person-centered outcome measurements provided a small but significant improvement in QoL. Thus, our findings suggest a potential benefit to the broader implementation of person profiles involving nursing staff and family members in long-term care facilities.