The Dementia Symptom Management at Home Program (DSM-H)

The Dementia Symptom Management at Home Program: A Bundled Interprofessional Intervention to Improve Dementia Patient-Caregiver Dyad Quality of Care and Quality of Life Through Home Healthcare.

Persons with dementia and their caregivers are often cared for in the community through home healthcare (HHC). While these patients and their caregivers need significant help and often have difficulty maintaining their quality of life, home healthcare clinicians are often unprepared to care for this population. This study will therefore examine the ability of an integrated, multi-pronged evidence-based practice intervention for home healthcare registered nurses, occupational therapists and physical therapists, the DSM-H, to improve the quality of care and quality of life for persons with dementia and their family caregiver. The investigators will enroll persons with dementia and their family caregiver upon admission to the HHC agency and examine their quality of life over 60 days following admission, comparing those who receive the intervention to those who serve as controls.

Study Overview

• Status: Withdrawn
• Conditions: Dementia
• Intervention / Treatment: Behavioral: Dementia Symptom Management at Home Program

Detailed Description

The Dementia Symptom Management at Home (DSM-H) Program is an integrated bundled implementation science intervention to improve interprofessional care in home healthcare (HHC). It consists of training, assessment instruments, patient-caregiver centered care plans and workflow changes. The investigators will perform a cluster randomized controlled clinical trial at a single, urban, non-profit HHC agency, randomizing care teams to either be trained in performing the intervention or serve as controls. The aims of this program are to examine the efficacy of this program to:

Aim 1: Measure the effects of DSM-H on pain, neuropsychiatric symptoms, and caregiver rated QOL in the person with dementia receiving HHC.

Aim 2: Assess the effects of DSM-H on QOL, burden and depression for the informal caregiver of persons with dementia receiving HHC.

Aim 3: Assess the effects of DSM-H on the number of emergency room visits and hospital admissions.

• Study Type: Interventional
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • New York
    • New York, New York, United States, 10001
      • The New Jewish Home
    • New York, New York, United States, 10010
      • New York University College of Nursing

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 65 years and older (Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• patient-caregiver dyad admitted to the HHC agency
• Patients must be 65 or older and speak English and/or Spanish.
• Patient must have an informal caregiver who is at least 18 years old and spends at least 8 hours per week with the patient.
• Patients must score greater than 4 on the cognitive subscale of the Healthy Aging Brain Care Monitor signifying at least mild impairment

Exclusion Criteria:

• Patients with concomitant axis I disorders other than dementia, depression, adjustment disorders, sleep disorders.
• Patients being seen only in the behavioral health unit without another skilled need.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Supportive Care
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Triple

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Intervention; Dyads in this arm will receive care provided by an interprofessional team trained through the DSM-H to provide patient/caregiver-centered dementia care through home healthcare.	Behavioral: Dementia Symptom Management at Home Program; The DSM-H is a multi-modal interprofessional intervention that includes: 1. intensive training of clinician mentors; 2. disseminated online training for Registered Nurses, Physical Therapists, Occupational Therapists; 3. implementation of evidence-based care plans, assessment instruments, and teaching handouts.; Other Names: DSM-H
No Intervention: Control; Dyads in this arm will receive usual care provided in the home healthcare setting.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Person With Dementia Quality of Life	Quality of Life in Alzheimer's Disease survey instrument	60 Days
Caregiver Quality of Life	Caregiver Targeted Quality of Life survey instrument	60 Days

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Person with Dementia Pain	Pain Assessment in Advanced Dementia or Brief Pain Inventory survey instrument	60 days
Person with Dementia Neuropsychiatric Symptom Burden	Healthy Aging Brain Care Monitor survey instrument	60 days
Caregiver Depression	Public Health Questionnaire-9 survey instrument	60 days
Person with Dementia ER Visits	Resource Utilization Inventory survey instrument	30, 60 days
Person with Dementia Hospital Admissions	Resource Utilization Inventory survey instrument	30, 60 days
Person with Dementia Functional Status	Katz Activities of Daily Living and Lawton Instrumental Activities of Daily Living assessments	60 days

Collaborators and Investigators

• Sponsor: New York University
• Collaborators: Visiting Nurse Service of New York
• Investigators: Principal Investigator: Abraham A Brody, RN, PhD, GNP-BC, Assistant professor

Study record dates

Study Major Dates

• Study Start (Actual): August 1, 2017
• Primary Completion (Actual): March 1, 2018
• Study Completion (Actual): March 1, 2018

Study Registration Dates

• First Submitted: June 23, 2015
• First Submitted That Met QC Criteria: June 25, 2015
• First Posted (Estimate): June 26, 2015

Study Record Updates

• Last Update Posted (Actual): November 2, 2022
• Last Update Submitted That Met QC Criteria: October 31, 2022
• Last Verified: September 1, 2018

More Information

Terms related to this study

• Keywords: pain; depression; neuropsychiatric symptoms; Dementia; implementation science
• Additional Relevant MeSH Terms: Mental Disorders; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Neurocognitive Disorders; Dementia
• Other Study ID Numbers: i14-01960

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No