A recent study investigating various methods of dementia care for Alzheimer’s disease and other forms of dementia revealed that there were no major differences in behavioral symptoms of patients or in caregiver stress levels, regardless of whether the care was delivered through a healthcare system, a community organization, or through standard practices over an 18-month span.
Nonetheless, the D-CARE study, which stands for Dementia Care Study, indicated that caregiver self-efficacy — or their confidence in coping with the challenges related to dementia and in seeking help — showed improvement in both healthcare system and community-based care models, with results outperforming those receiving standard care. This increased confidence was noticeable within six months of receiving care and continued to be stable throughout the study duration.
According to Dr. David Reuben, Archstone Professor of Geriatrics at the David Geffen School of Medicine at UCLA and the study’s principal investigator, “The D-CARE trial is the largest assessment we’ve done so far on various methods of dementia care. Caregivers are vital to the well-being of individuals with dementia, and their capacity to handle stress and feel assured in their caregiving roles is essential. Enhanced self-efficacy might lead to procuring additional resources and enabling more individuals with dementia to remain in their homes.”
The findings of this study will be published on January 29 in the peer-reviewed Journal of the American Medical Association (JAMA).
Backed by the Patient-Centered Outcomes Research Institute and the National Institute on Aging, the D-CARE project set out to assess the effectiveness of two well-established dementia care approaches against each other and against standard care. The study included 2,176 individuals with dementia and their caregivers, conducted from June 2019 to August 2023.
This research was led by experts from the University of California, Los Angeles, with data management and statistical analysis handled by the Yale Data Coordinating Center, and it took place at four clinical locations: Atrium Health Wake Forest Baptist, Baylor Scott & White Health, University of Texas Medical Branch, and Geisinger Health. Support also came from researchers at the Benjamin Rose Institute on Aging, University of Oklahoma Health Sciences Center, Cedars-Sinai Medical Center, and RAND. Participants were randomly assigned to one of three groups: care from Dementia Care Specialists through a healthcare system (based on the UCLA Alzheimer’s and Dementia Care Program), care from Care Consultants through a community-based organization (utilizing the Benjamin Rose Institute on Aging Care Consultation Program), or standard care.
Dr. Reuben stated, “The results of this study highlight the complexities associated with dementia care and the difficulties in comparing various models in a real-world context, particularly considering the disruptions caused by the COVID-19 pandemic. Additionally, some advantages provided by the models may not have been fully captured by the primary and secondary outcomes selected for the trial.” The impact of these interventions on healthcare utilization remains to be determined.
The D-CARE findings hold important implications for healthcare systems, medical groups, community organizations, policymakers, and insurance providers aiming to enhance dementia care. The study indicates that while dementia care programs based in healthcare systems and the community do not necessarily lessen caregiver strain or effectively manage patient behavioral issues more than standard care, they do assist caregivers in navigating the obstacles of dementia care with greater efficiency.
Reuben remarked, “These results remind us that diverse methods of dementia care can yield similar clinical outcomes, which may be particularly advantageous for institutions involved in the new Medicare Guide for Improving the Dementia Experience (GUIDE) program. Further analyses from D-CARE will shed more light on the effectiveness of both health system-based and community-based dementia care approaches.”
The D-CARE study is financed by the Patient-Centered Outcomes Research Institute (PCS-2017C1-6534), a nonprofit organization, and the National Institute on Aging (R01 AG061078). The funding includes four clinical trial sites. Additional backing was received from the Yale Program on Aging/Claude D. Pepper Older Americans Independence Center (P30AG021342), the National Center for Advancing Translational Science (NCATS), which is part of the National Institutes of Health (NIH) (UL1 TR000142), the Mexican Health and Aging Study (R01AG018016), the UTMB Claude D. Pepper Older Americans Independence Center (OAIC) (P30 AG024832), as well as the Dewey and Cynthia Robertson Fund for Wake Forest Geriatrics and the Wake Forest Alzheimer’s Disease Research Center (P30 AG049638).
