Effects of supporting community-living demented patients and their caregivers: A randomized trial

OBJECTIVES: To determine whether community care of demented patients can be prolonged by means of a 2-year support program based on nurse case managem ent. DESIGN: Randomized controlled intervention study with 2-year follow-up. SETTING: Demented patients entitled to payments from the Social Insurance I nstitution for community care, in five municipalities in eastern Finland. PARTICIPANTS: One hundred demented patients, age 65 and older, living at ho me with the primary support of informal caregivers, allocated at random to the intervention (n = 53) or control group (n = 47). INTERVENTION: Intervention patients and their caregivers were provided with a 2-year intervention program of systematic, comprehensive support by a de mentia family care coordinator. MEASUREMENTS: Time to institutionalization (period in community care) from enrollment of patients in the study to their placement in long-term institu tional care. RESULTS: During the first months, the rate of institutionalization was sign ificantly lower in the intervention group than in the control group (P = .0 42), but the benefit of the intervention decreased with time (P = .028). Es timated probability of staying in community care up to 6, 12, and 24 months was 0.98, 0.92, and 0.63 in the intervention group and 0.91, 0.81, and 0.6 8 in the control group, respectively. Results also suggest that the interve ntion used in the study might be especially beneficial to patients with sev ere dementia and those with problems threatening the continuity of communit y care. CONCLUSIONS: The placement of demented patients in long-term institutional care can be deferred with the support of a dementia family care coordinator . However, by the end of the 2-year intervention, the number of patients in stitutionalized was similar in the intervention and control group. It seems to be beneficial to direct this type of intensive support at severely deme nted patients and their caregivers. On the basis of our experiences, we sug gest that intervention by a dementia family care coordinator should be targ eted especially at patients with problems threatening the continuity of com munity care.