The dementia and aged care study (DACS): a cluster randomised trial of the effectiveness of multicomponent cognitive behaviour therapy for reducing depressive and anxiety symptoms in older adults living with dementia in nursing homes.

内容摘要

Depressive and anxiety symptoms are common in older adults living with dementia in nursing homes. This study examined if a multicomponent form of cognitive behaviour therapy (m-CBT) was effective for improving such symptoms and quality of life in this cohort. The cluster-randomised trial involved 21 nursing homes, randomly allocated to m-CBT or usual care. The sample comprised 128 residents with dementia aged 65 or above with clinically significant levels of depressive or anxiety symptoms. The intervention comprised 20 individual sessions with residents, a dementia education workshop for families and staff, a family support group program and staff consultation sessions. Outcomes were assessed by research assistants, blinded to allocation, at baseline, post-treatment (6-month post-randomisation) and follow-up (9-month post-randomisation). Linear mixed effects models were used to compare changes in outcomes by group. By post-treatment, anxiety reduced significantly for participants receiving m-CBT (n = 66, 11 homes) compared to controls (n = 62, 10 homes; f = 0.11). The reduction in depressive symptoms was not significantly different between groups, f = .04. Quality of life did not change significantly in either group. By 9-month follow-up, outcomes between groups were not significantly different. Poor treatment attendance, inadequate fidelity assessment and low statistical power in the current study highlight the need for adequately powered trials to confirm these findings. This is the first study to support CBT as a potentially effective treatment for anxiety symptoms in older adults living with dementia in nursing homes.Trial registration. Australian New Zealand Clinical Trials Registry: ACTRN12618000241235. Multicomponent cognitive behaviour therapy (m-CBT) may be more effective than usual care for reducing anxiety symptoms in nursing home residents living with dementia.m-CBT was not more effective than usual care in improving depressive symptoms or quality of life in residents living with dementia.This is the first study to support m-CBT as a potentially effective treatment for anxiety symptoms in older adults living with dementia in nursing homes. However, several methodological limitations of the current study need to be resolved to improve confidence in this finding.