West LA Times

New research on dementia care has found no significant differences in patient behavioral symptoms or caregiver strain across three types of care approaches. The study, known as the Dementia Care Study (D-CARE), compared health system-based care, community-based organization care, and usual care over an 18-month period.

Despite this finding, the study revealed that caregiver self-efficacy improved in both health-system and community-based care approaches. Self-efficacy refers to caregivers' confidence in managing dementia-related challenges and accessing support. This improvement was noted within six months of starting care and remained stable throughout the study.

“The D-CARE trial is the largest evaluation, to date, of different approaches to providing dementia care,” said Dr. David Reuben, Archstone Professor of Geriatrics at UCLA and principal investigator of the study. He emphasized the importance of caregivers' ability to manage stress and feel confident in their roles, suggesting that higher self-efficacy could lead to better resource acquisition and keeping individuals with dementia at home longer.

The study was published in the Journal of the American Medical Association. It involved 2,176 persons with dementia and their caregivers from June 2019 to August 2023. Funded by the Patient-Centered Outcomes Research Institute and the National Institute on Aging, it aimed to compare two established dementia care approaches against each other and usual care.

Conducted by UCLA investigators with data management by Yale Data Coordinating Center, it took place at four clinical sites: Atrium Health Wake Forest Baptist, Baylor Scott & White Health, University of Texas Medical Branch, and Geisinger Health. Participants were randomly assigned to one of three groups: health system-based care delivered by Dementia Care Specialists; community-based organization-based care delivered by Care Consultants; or usual care.

“The study’s results underscore the complexities of dementia care," Reuben noted. He mentioned that some benefits might not have been fully captured due to primary and secondary outcome measures chosen for the trial.

The implications for healthcare systems are significant as they work towards improving dementia care through various programs like Medicare's GUIDE program. “These findings remind us that different approaches can lead to comparable clinical outcomes,” Reuben stated.

Further analyses from D-CARE are expected to provide more insights into these models' effectiveness.

For more information about D-CARE findings visit https://www.dcare-study.org/ or contact Dr. David Reuben at [email protected].

This research was funded by grants from the National Institute on Aging under award number R01AG061078 and contract number PCS-2017C1-6534 from Patient-Centered Outcomes Research Institute.