ABSTRACT Person-centered care (PCC) for people with dementia is a system of care that is based on... more ABSTRACT Person-centered care (PCC) for people with dementia is a system of care that is based on the belief that personhood can be maintained despite cognitive impairment. A recently conducted cluster randomized trial (Chenoweth et al., 2009) demonstrated that PCC was effective in reducing agitation in people with dementia who were in residential care. This article provides a detailed overview of the PCC intervention arm of the study and describes the training and procedures used to facilitate implementation of PCC. Training emphasized the impact of the social world on the person with dementia and promoted the skills of interpersonal engagement, especially in relation to feeling expression. Facilitated on-site learning involved care planning that included obtaining a life story of the person with dementia and observing social interactions. The success of the PCC intervention was related to this two-pronged approach, which included support from managers. Implementation of PCC requires a whole-of-system approach, which includes formal and informal learning.
There is good evidence of the positive effects of person-centered care (PCC) on agitation in deme... more There is good evidence of the positive effects of person-centered care (PCC) on agitation in dementia. We hypothesized that a person-centered environment (PCE) would achieve similar outcomes by focusing on positive environmental stimuli, and that there would be enhanced outcomes by combining PCC and PCE. 38 Australian residential aged care homes with scope for improvement in both PCC and PCE were stratified, then randomized to one of four intervention groups: (1) PCC; (2) PCE; (3) PCC +PCE; (4) no intervention. People with dementia, over 60 years of age and consented were eligible. Co-outcomes assessed pre and four months post-intervention and at 8 months follow-up were resident agitation, emotional responses in care, quality of life and depression, and care interaction quality. From 38 homes randomized, 601 people with dementia were recruited. At follow-up the mean change for quality of life and agitation was significantly different for PCE (p = 0.02, p = 0.05, respectively) and PCC (p = 0.0003, p = 0.002 respectively), compared with the non-intervention group (p = 0.48, p = 0.93 respectively). Quality of life improved non-significantly for PCC+PCE (p = 0.08), but not for agitation (p = 0.37). Improvements in care interaction quality (p = 0.006) and in emotional responses to care (p = 0.01) in PCC+PCE were not observed in the other groups. Depression scores did not change in any of the groups. Intervention compliance for PCC was 59%, for PCE 54% and for PCC+PCE 66%. The hypothesis that PCC+PCE would improve quality of life and agitation even further was not supported, even though there were improvements in the quality of care interactions and resident emotional responses to care for some of this group. The Australian New Zealand Clinical Trials Registry Number is ACTRN 12608000095369.
The Australian and New Zealand journal of psychiatry, 2014
To examine characteristics that predict the progression from mild cognitive impairment to dementi... more To examine characteristics that predict the progression from mild cognitive impairment to dementia. Of 970 patients recruited from nine memory clinics around Australia, 185 had mild cognitive impairment diagnosed. Measures of cognitive ability, functional ability, and neuropsychiatric symptoms were completed at baseline and over 3 years of follow up. Over 3 years, 52 (28%) patients with mild cognitive impairment developed dementia. Older age, lower cognitive ability at baseline, and faster decline in cognitive ability over the first 6 months of follow up, but not depression, predicted progression to dementia. The findings confirm that simple clinical data such as age, cognitive ability at baseline, and rate of cognitive decline are important predictors of progression from mild cognitive impairment to dementia over 3 years.
ABSTRACT Person-centered care (PCC) for people with dementia is a system of care that is based on... more ABSTRACT Person-centered care (PCC) for people with dementia is a system of care that is based on the belief that personhood can be maintained despite cognitive impairment. A recently conducted cluster randomized trial (Chenoweth et al., 2009) demonstrated that PCC was effective in reducing agitation in people with dementia who were in residential care. This article provides a detailed overview of the PCC intervention arm of the study and describes the training and procedures used to facilitate implementation of PCC. Training emphasized the impact of the social world on the person with dementia and promoted the skills of interpersonal engagement, especially in relation to feeling expression. Facilitated on-site learning involved care planning that included obtaining a life story of the person with dementia and observing social interactions. The success of the PCC intervention was related to this two-pronged approach, which included support from managers. Implementation of PCC requires a whole-of-system approach, which includes formal and informal learning.
There is good evidence of the positive effects of person-centered care (PCC) on agitation in deme... more There is good evidence of the positive effects of person-centered care (PCC) on agitation in dementia. We hypothesized that a person-centered environment (PCE) would achieve similar outcomes by focusing on positive environmental stimuli, and that there would be enhanced outcomes by combining PCC and PCE. 38 Australian residential aged care homes with scope for improvement in both PCC and PCE were stratified, then randomized to one of four intervention groups: (1) PCC; (2) PCE; (3) PCC +PCE; (4) no intervention. People with dementia, over 60 years of age and consented were eligible. Co-outcomes assessed pre and four months post-intervention and at 8 months follow-up were resident agitation, emotional responses in care, quality of life and depression, and care interaction quality. From 38 homes randomized, 601 people with dementia were recruited. At follow-up the mean change for quality of life and agitation was significantly different for PCE (p = 0.02, p = 0.05, respectively) and PCC (p = 0.0003, p = 0.002 respectively), compared with the non-intervention group (p = 0.48, p = 0.93 respectively). Quality of life improved non-significantly for PCC+PCE (p = 0.08), but not for agitation (p = 0.37). Improvements in care interaction quality (p = 0.006) and in emotional responses to care (p = 0.01) in PCC+PCE were not observed in the other groups. Depression scores did not change in any of the groups. Intervention compliance for PCC was 59%, for PCE 54% and for PCC+PCE 66%. The hypothesis that PCC+PCE would improve quality of life and agitation even further was not supported, even though there were improvements in the quality of care interactions and resident emotional responses to care for some of this group. The Australian New Zealand Clinical Trials Registry Number is ACTRN 12608000095369.
The Australian and New Zealand journal of psychiatry, 2014
To examine characteristics that predict the progression from mild cognitive impairment to dementi... more To examine characteristics that predict the progression from mild cognitive impairment to dementia. Of 970 patients recruited from nine memory clinics around Australia, 185 had mild cognitive impairment diagnosed. Measures of cognitive ability, functional ability, and neuropsychiatric symptoms were completed at baseline and over 3 years of follow up. Over 3 years, 52 (28%) patients with mild cognitive impairment developed dementia. Older age, lower cognitive ability at baseline, and faster decline in cognitive ability over the first 6 months of follow up, but not depression, predicted progression to dementia. The findings confirm that simple clinical data such as age, cognitive ability at baseline, and rate of cognitive decline are important predictors of progression from mild cognitive impairment to dementia over 3 years.
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Papers by Henry Brodaty