A landmark national clinical trial has revealed that dementia patient care delivered through health systems shows comparable effectiveness to community-based organizations and standard caregiver approaches, challenging assumptions about optimal care delivery models.
The comprehensive Dementia Care Study (D-CARE), spanning from June 2019 to August 2023, enrolled 2,176 persons with dementia and their caregivers across multiple healthcare institutions, including Atrium Health Wake Forest Baptist and Geisinger Health. The study, published in The Journal of the American Medical Association, compared three distinct care delivery approaches through randomized assignment.
Care Models and Key Findings
The trial evaluated three care delivery models:
- Health system-based care provided by Dementia Care Specialists, following the UCLA Alzheimer's and Dementia Care Program
- Community-based organization care delivered by care consultants using the Benjamin Rose Institute on Aging Care Consultation Program
- Standard usual care
Analysis of the results showed no significant evidence that specialist-provided dementia care in healthcare systems was more effective at managing patient behavioral symptoms compared to care consultants in community-based organizations. Additionally, measures of caregiver strain and depression remained consistent across all three approaches.
Impact on Caregiver Efficacy
A notable finding emerged regarding caregiver self-efficacy – the confidence caregivers have in managing dementia-related challenges and accessing support. Both health-system and community-based care approaches showed comparable improvements in this area, surpassing the outcomes observed in usual care. These positive effects were observed within six months of care initiation and maintained throughout the study period.
Dr. Jeff Williamson, professor of gerontology and geriatric medicine at Wake Forest University School of Medicine, emphasized the significance of these findings: "Caregiving for individuals with dementia can be stressful and can have a negative impact on well-being. By improving self-efficacy, we not only improve the care of the person with dementia, but also create a more positive caregiving experience."
Study Implications and Limitations
While the study provides valuable insights into care delivery models, researchers noted that certain benefits might not have been fully captured by the trial's primary and secondary outcome measures. The research team is still analyzing the interventions' effects on healthcare utilization patterns.
These findings have important implications for healthcare policy and resource allocation, suggesting that community-based care models may be as effective as more resource-intensive hospital-based programs in managing dementia-related behavioral symptoms.
