title: A randomized controlled trial of a community-based dementia care coordination intervention: effects of MIND at Home on caregiver outcomes.
abstract: OBJECTIVE
  To assess whether MIND at Home, a community-based, multicomponent, care coordination intervention, reduces unmet caregiving needs and burden in informal caregivers of persons with memory disorders.
  
  
  METHODS
  An 18-month randomized controlled trial of 289 community-living care recipient (CR)-caregiver (informal caregivers, i.e., unpaid individuals who regularly assisted the CR) dyads from 28 postal code areas of Baltimore, Maryland was conducted. All dyads and the CR's primary care physician received the written needs assessment results and intervention recommendations. Intervention dyads then received an 18-month care coordination intervention delivered by nonclinical community workers to address unmet care needs through individualized care planning, referral and linkage to dementia services, provision of caregiver dementia education and skill-building strategies, and care progress monitoring by an interdisciplinary team. Primary outcome was total percent of unmet caregiver needs at 18 months. Secondary outcomes included objective and subjective caregiver burden measures, quality of life (QOL), and depression.
  
  
  RESULTS
  Total percent of unmet caregiver needs declined in both groups from baseline to 18 months, with no statistically significant between-group difference. No significant group differences occurred in most caregiver burden measures, depression, or QOL. There was a potentially clinically relevant reduction in self-reported number of hours caregivers spent with the CR for MIND participants compared with control subjects.
  
  
  CONCLUSIONS
  No statistically significant impacts on caregiver outcomes were found after multiple comparison adjustments. However, MIND at Home appeared to have had a modest and clinically meaningful impact on informal caregiver time spent with CRs.
authors.affiliation: Johns Hopkins School of Medicine, Baltimore, MD.
authors.forename: Jeremy A
authors.initials: JA
authors.lastname: Tanner
authors.affiliation: Department of Psychiatry and Behavioral Sciences, School of Medicine, The Johns Hopkins University, Baltimore, MD.
authors.forename: Betty S
authors.initials: BS
authors.lastname: Black
authors.affiliation: Department of Psychiatry and Behavioral Sciences, School of Medicine, The Johns Hopkins University, Baltimore, MD.
authors.forename: Deirdre
authors.initials: D
authors.lastname: Johnston
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Johns Hopkins Bayview, The Johns Hopkins University, Baltimore, MD.
authors.forename: Edward
authors.initials: E
authors.lastname: Hess
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Johns Hopkins Bayview, The Johns Hopkins University, Baltimore, MD.
authors.forename: Jeannie-Marie
authors.initials: JM
authors.lastname: Leoutsakos
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Johns Hopkins Bayview, The Johns Hopkins University, Baltimore, MD; School of Medicine, and Department of Community Public Health Nursing, School of Nursing, The Johns Hopkins University, Baltimore, MD.
authors.forename: Laura N
authors.initials: LN
authors.lastname: Gitlin
authors.affiliation: Department of Psychiatry and Behavioral Sciences, School of Medicine, The Johns Hopkins University, Baltimore, MD.
authors.forename: Peter V
authors.initials: PV
authors.lastname: Rabins
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Johns Hopkins Bayview, The Johns Hopkins University, Baltimore, MD.
authors.forename: Constantine G
authors.initials: CG
authors.lastname: Lyketsos
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Johns Hopkins Bayview, The Johns Hopkins University, Baltimore, MD. Electronic address: qmiles@jhmi.edu.
authors.forename: Quincy M
authors.initials: QM
authors.lastname: Samus
mesh_terms: D000368:Aged; D017028:Caregivers / Q000523:psychology*; D017281:Cost of Illness; D003376:Counseling / Q000458:organization & administration*; D003704:Dementia / Q000451:nursing*; D003863:Depression; D005260:Female; D006701:Home Nursing / Q000458:organization & administration*; D006801:Humans; D008297:Male; D020380:Needs Assessment; D011788:Quality of Life; D012111:Residence Characteristics
keywords: Dementia; care coordination; caregiver; community-based; intervention