TY - JOUR
T1 - Respectful Caring for the Agitated Elderly (ReCAGE)
T2 - A Multicentre, Prospective, Observational Study to Evaluate the Effectiveness of Special Care Units for People with Dementia
AU - Mendes, Aline
AU - Bergh, Sverre
AU - Cesana, Bruno Mario
AU - Handels, Ron
AU - Ciccone, Alfonso
AU - Cognat, Emmanuel
AU - Fabbo, Andrea
AU - Fascendini, Sara
AU - Frisoni, Giovanni B
AU - Froelich, Lutz
AU - Jori, Maria Cristina
AU - Mecocci, Patrizia
AU - Merlo, Paola
AU - Peters, Oliver
AU - Tsolaki, Magdalini
AU - Defanti, Carlo Alberto
PY - 2023/11/21
Y1 - 2023/11/21
N2 - Background: Behavioral and psychological symptoms of dementia (BPSD) bring complexity in the clinical management of people with dementia; therefore, it is important to evaluate different models of care, such as Special Care Units (SCU-B). Objective: To evaluate the SCU-B effectiveness toward alleviating BPSD and improving the quality of life (QoL) of patients and their caregivers. Methods: ReCAGE was a multicenter, controlled, longitudinal study where 508 patients with BPSD were enrolled in two cohorts: 262 patients from centers endowed with a SCU-B, and 246 from centers without SCU-B. Statistical analyses included factorial ANCOVA for comparison among centers. The primary endpoint was effectiveness of the SCU-B, measured through the Neuropsychiatric Inventory (NPI) changes. Secondary endpoints were change in QoL of patients and caregivers, and the tertiary endpoint was time to nursing home admission. Results: The NPI scores decreased in both arms, with a statistically significant difference from baseline to 36 months (p < 0.0001) in both cohorts. Over time, NPI decreased more steeply during the first year in the SCU-B arm, but in the following two years the slope was clearly in favor of the control arm. This different pattern of the two cohorts reached statistical significance at the interaction “cohort by time” (p < 0.0001). Conflicting results were found regarding the outcomes of quality of life, while there were no differences in time to institutionalization in both cohorts. Conclusions: The RECage study did not confirm the long-term superiority of the pathway comprising a SCU-B. A post-hoc analysis revealed data supporting their acute effectiveness during behavioral crises.
AB - Background: Behavioral and psychological symptoms of dementia (BPSD) bring complexity in the clinical management of people with dementia; therefore, it is important to evaluate different models of care, such as Special Care Units (SCU-B). Objective: To evaluate the SCU-B effectiveness toward alleviating BPSD and improving the quality of life (QoL) of patients and their caregivers. Methods: ReCAGE was a multicenter, controlled, longitudinal study where 508 patients with BPSD were enrolled in two cohorts: 262 patients from centers endowed with a SCU-B, and 246 from centers without SCU-B. Statistical analyses included factorial ANCOVA for comparison among centers. The primary endpoint was effectiveness of the SCU-B, measured through the Neuropsychiatric Inventory (NPI) changes. Secondary endpoints were change in QoL of patients and caregivers, and the tertiary endpoint was time to nursing home admission. Results: The NPI scores decreased in both arms, with a statistically significant difference from baseline to 36 months (p < 0.0001) in both cohorts. Over time, NPI decreased more steeply during the first year in the SCU-B arm, but in the following two years the slope was clearly in favor of the control arm. This different pattern of the two cohorts reached statistical significance at the interaction “cohort by time” (p < 0.0001). Conflicting results were found regarding the outcomes of quality of life, while there were no differences in time to institutionalization in both cohorts. Conclusions: The RECage study did not confirm the long-term superiority of the pathway comprising a SCU-B. A post-hoc analysis revealed data supporting their acute effectiveness during behavioral crises.
KW - Alzheimer’s disease
KW - Neuropsychiatric Inventory
KW - behavioral and psychological symptoms of dementia
KW - caregiver burden
KW - dementia
KW - special care unit
U2 - 10.3233/JAD-230708
DO - 10.3233/JAD-230708
M3 - Article
SN - 1387-2877
VL - 96
SP - 1083
EP - 1096
JO - Journal of Alzheimer's Disease
JF - Journal of Alzheimer's Disease
IS - 3
M1 - JAD-230708
ER -