title: Does telecare prolong community living in dementia? A study protocol for a pragmatic, randomised controlled trial.
abstract: BACKGROUND
  Assistive technology and telecare (ATT) are relatively new ways of delivering care and support to people with social care needs. It is claimed that ATT reduces the need for community care, prevents unnecessary hospital admission, and delays or prevents admission into residential or nursing care. The current economic situation in England has renewed interest in ATT instead of community care packages. However, at present, the evidence base to support claims about the impact and effectiveness of ATT is limited, despite its potential to mitigate the high financial cost of caring for people with dementia and the social and psychological cost to unpaid carers.
  
  
  METHODS
  ATTILA (Assistive Technology and Telecare to maintain Independent Living At Home for People with Dementia) is a pragmatic, multi-centre, randomised controlled trial over 104 weeks that compares outcomes for people with dementia who receive ATT and those who receive equivalent community services but not ATT. The study hypothesis is that fewer people in the ATT group will go into institutional care over the 4-year period for which the study is funded. The study aims to recruit 500 participants, living in community settings, with dementia or significant cognitive impairment, who have recently been referred to social services.Primary outcome measures are time in days from randomisation to institutionalisation and cost effectiveness. Secondary outcomes are caregiver burden, health-related quality of life in carers, number and severity of serious adverse events, and data on acceptability, applicability and reliability of ATT intervention packages. Assessments will be undertaken in weeks 0 (baseline), 12, 24, 52 and 104 or until institutionalisation or withdrawal of the participant from the trial.
  
  
  CONCLUSIONS
  In a time of financial austerity, CASSRs in England are increasingly turning to ATT in the belief that it will deliver good outcomes for less money. There is an absence of robust evidence for the cost-effectiveness and benefit of using assistive technology and telecare. The ATTILA trial meets a pressing need for robust, generalisable evidence to either justify continuing investment or reappraise the appropriate scale of ATT use.
  
  
  BACKGROUND
  Current Controlled Trials ISRCTN86537017.
authors.affiliation: Institute of Brain, Behaviour and Mental Health, University of Manchester, Jean McFarlane Building, 3rd floor, Oxford Rd, Manchester M13 9PL, UK. Iracema.Leroi@manchester.ac.uk.
authors.forename: Iracema
authors.initials: I
authors.lastname: Leroi
authors.forename: John
authors.initials: J
authors.lastname: Woolham
authors.forename: Rebecca
authors.initials: R
authors.lastname: Gathercole
authors.forename: Robert
authors.initials: R
authors.lastname: Howard
authors.forename: Barbara
authors.initials: B
authors.lastname: Dunk
authors.forename: Chris
authors.initials: C
authors.lastname: Fox
authors.forename: John
authors.initials: J
authors.lastname: O'Brien
authors.forename: Andrew
authors.initials: A
authors.lastname: Bateman
authors.forename: Fiona
authors.initials: F
authors.lastname: Poland
authors.forename: Peter
authors.initials: P
authors.lastname: Bentham
authors.forename: Alistair
authors.initials: A
authors.lastname: Burns
authors.forename: Anna
authors.initials: A
authors.lastname: Davies
authors.forename: Kirsty
authors.initials: K
authors.lastname: Forsyth
authors.forename: Richard
authors.initials: R
authors.lastname: Gray
authors.forename: Martin
authors.initials: M
authors.lastname: Knapp
authors.forename: Stanton
authors.initials: S
authors.lastname: Newman
authors.forename: Rupert
authors.initials: R
authors.lastname: McShane
authors.forename: Craig
authors.initials: C
authors.lastname: Ritchie
mesh_terms: D002985:Clinical Protocols; D003153:Community Health Services / Q000191:economics; D003362:Cost-Benefit Analysis; D003704:Dementia / Q000175:diagnosis / Q000191:economics / Q000523:psychology / Q000628:therapy*; D004739:England; D017048:Health Care Costs; D006801:Humans; D057187:Independent Living / Q000191:economics; D007326:Institutionalization; D012107:Research Design; D017216:Telemedicine / Q000191:economics; D013997:Time Factors; D016896:Treatment Outcome