A controlled trial of Partners in Dementia Care: veteran outcomes after six and twelve months.
BACKGROUND
"Partners in Dementia Care" (PDC) tested the effectiveness of a care-coordination program integrating healthcare and community services and supporting veterans with dementia and their caregivers. Delivered via partnerships between Veterans Affairs medical centers and Alzheimer's Association chapters, PDC targeted both patients and caregivers, distinguishing it from many non-pharmacological interventions. Hypotheses posited PDC would improve five veteran self-reported outcomes: 1) unmet need, 2) embarrassment about memory problems, 3) isolation, 4) relationship strain and 5) depression. Greater impact was expected for more impaired veterans. A unique feature was self-reported research data collected from veterans with dementia.


RESULTS
Five matched communities were study sites. Two randomly selected sites received PDC for 12 months; comparison sites received usual care. Three structured telephone interviews were completed every 6 months with veterans who could participate.


RESULTS
Of 508 consenting veterans, 333 (65.6%) completed baseline interviews. Among those who completed baseline interviews, 263 (79.0%) completed 6-month follow-ups and 194 (58.3%) completed 12-month follow-ups. Regression analyses showed PDC veterans had significantly less adverse outcomes than those receiving usual care, particularly for more impaired veterans after 6 months, including reduced relationship strain (B = -0.09; p = 0.05), depression (B = -0.10; p = 0.03), and unmet need (B = -0.28; p = 0.02; and B = -0.52; p = 0.08). PDC veterans also had less embarrassment about memory problems (B = -0.24; p = 0.08). At 12 months, more impaired veterans had further reductions in unmet need (B = -0.96; p < 0.01) and embarrassment (B = -0.05; p = 0.02). Limitations included use of matched comparison sites rather than within-site randomization and lack of consideration for variation within the PDC group in amounts and types of assistance provided.


CONCLUSIONS
Partnerships between community and health organizations have the potential to meet the dementia-related needs and improve the psychosocial functioning of persons with dementia.


BACKGROUND
NCT00291161.
Benjamin Rose Institute on Aging, 11890 Fairhill Road, Cleveland, OH 44120, USA.
David M
DM
Bass
Department of Psychology, Cleveland State University, 2121 Euclid Ave., Cleveland, OH 44115, USA.
Katherine S
KS
Judge
Center for Mental Health and Aging and Department of Psychology, University of Alabama, Box 870315, Tuscaloosa, AL 35487, USA ; Tuscaloosa Veterans Affairs Medical Center, 3701 Loop Rd., Tuscaloosa, AL 35404, USA.
A Lynn
AL
Snow
Houston Veterans Affairs Health Services Research & Development Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, (MEDVAMC 152), 2002 Holcombe Blvd., Houston, TX 77030, USA ; Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA.
Nancy L
NL
Wilson
The University of Texas School of Public Health, 1200 Herman Pressler, Rm. E-343, Houston, TX 77030, USA.
Robert O
RO
Morgan
Institute of Medicine, 2101 Constitution Ave. NW, Washington, DC 20418, USA.
Katie
K
Maslow
Alzheimer's Association of Massachusetts/New Hampshire, 480 Pleasant St., Watertown, MA 02472, USA ; Alzheimer's Association of Massachusetts/New Hampshire, 5 Bedford Farms Drive, Ste. 201, Bedford, NH 03110, USA.
Ronda
R
Randazzo
Geriatric Mental Health, Veterans Affairs Boston Healthcare System, Brockton Division, 940 Belmont St., 35C, Brockton, MA 02301, USA ; Department of Psychiatry, Harvard Medical School, 2 West - Rm. 305, 401 Park Drive, Brockton, MA 02215, USA.
Jennifer A
JA
Moye
Oklahoma City Veterans Affairs Medical Center, 921 NE 13th St., Oklahoma City, OK 73106, USA ; Donald W. Reynolds Department of Geriatric Medicine, College of Medicine, University of Oklahoma Health Sciences Center, P.O. Box 26901, ORB 1200, Oklahoma City, OK 73117, USA.
Germaine L
GL
Odenheimer
Veterans Affairs Boston Health Care System, West Roxbury Division, 1400 VFWParkway, West Roxbury, MA 02132, USA.
Elizabeth
E
Archambault
Houston & Southeast Texas Chapter, Alzheimer's Association, 2242 W. Holcombe Blvd., Houston, TX 77030, USA.
Richard
R
Elbein
Providence Veterans Affairs Medical Center, 830 Chalkstone Ave., Providence, RI 02908, USA ; Brown University, 1 Prospect St., Providence, RI 02912, USA.
Paul
P
Pirraglia
Oklahoma City Veterans Affairs Medical Center, 921 NE 13th St., Oklahoma City, OK 73106, USA ; Donald W. Reynolds Department of Geriatric Medicine, College of Medicine, University of Oklahoma Health Sciences Center, P.O. Box 26901, ORB 1200, Oklahoma City, OK 73117, USA ; South Central Veterans Affairs Mental Illness Research, Education and Clinical Center, 2002 Holcombe Blvd, Houston, TX 77030, USA.
Thomas A
TA
Teasdale
Benjamin Rose Institute on Aging, 11890 Fairhill Road, Cleveland, OH 44120, USA.
Catherine A
CA
McCarthy
Benjamin Rose Institute on Aging, 11890 Fairhill Road, Cleveland, OH 44120, USA.
Wendy J
WJ
Looman
Houston Veterans Affairs Health Services Research & Development Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, (MEDVAMC 152), 2002 Holcombe Blvd., Houston, TX 77030, USA ; Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA ; South Central Veterans Affairs Mental Illness Research, Education and Clinical Center, 2002 Holcombe Blvd, Houston, TX 77030, USA.
Mark E
ME
Kunik