INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY
Int. J. Geriatr. Psychiatry 2007; 22: 1127–1134.
Published online 29 March 2007 in Wiley InterScience
(www.interscience.wiley.com) DOI: 10.1002/gps.1801
A cluster randomised controlled trial to reduce the unmet
needs of people with dementia living in residential care
Martin Orrell1*, Geraldine Hancock1, Juanita Hoe1, Bob Woods2,
Gill Livingston1 and David Challis3
1
Department of Mental Health Sciences, University College London, London, UK
DSDC, University of Wales Bangor, Bangor, UK
3
PSSRU, School of Medicine, University of Manchester, Manchester, UK
2
SUMMARY
Background Older people with dementia living in residential care have complex unmet needs and decreased quality of life.
Aim To reduce unmet needs in older people with dementia in residential care compared to a ‘care as usual’ control group.
Method A single blind, multicentre, cluster randomised controlled trial recruited 238 people aged 60þ with dementia
living in 24 residential homes from three areas. Unmet needs were measured using the Camberwell Assessment of Needs for
the Elderly (CANE) and quality of life using the Quality of Life in Alzheimer’s Disease (QoL-AD). Homes were randomised
to the control (care as usual) or the intervention group 1 hour per week liaison input per home to deliver a personalised
intervention package over a 20 weeks to meet the unmet needs.
Results A single blind follow-up included 192 (81%) available participants. At follow-up the total number of unmet needs
was reduced in both the intervention and control groups, but analysing the groups by clusters there were no significant
differences in either unmet needs or quality of life.
Conclusions The unmet needs of people with dementia can be identified using the CANE. The CANE assessment may
have led to unmet needs being reduced at follow up, but the liaison intervention did not significantly reduce total unmet needs
relative to the control group. Unmet needs such as sensory problems, mobility, drugs, and psychological distress were
especially reduced in the intervention group at follow up. Copyright # 2007 John Wiley & Sons, Ltd.
key words — dementia; needs; older people; CANE; interventions; residential care
INTRODUCTION
Approximately 75% of older people living in care
homes in the UK have dementia (Macdonald et al.,
2002). People who live in residential care are also
frailer and more dependent than ever before (Stern
et al., 1993; Martin et al., 2002). People with dementia in care homes have varied and complex needs
(Hancock et al., 2006) which may have proved
difficult to meet at home. The National Service
Framework for Older People (Department of Health,
*Correspondence to: Prof. M. Orrell, Department of Mental Health
Sciences, University College London, Charles Bell House, 67-73
Riding House Street, London, W1W 7EY 8AA, UK.
E-mail: m.orrell@ucl.ac.uk
Copyright # 2007 John Wiley & Sons, Ltd.
2001) states that individuals should receive care
packages that provide for their individual needs,
regardless of their living situation or mental health
status. However, care homes have not specifically
been designed to provide care for people with complex
needs such as those with severe dementia. This means
that residents with dementia often have multiple
unmet needs (Martin et al., 2002) such as inadequate
daytime activities, isolation and anxiety and depression (Hancock et al., 2006). Unmet needs can lead to
decreased quality of life and increased costs of care
(UK 700 Group, 1999; Mozley et al., 2004). At present
we do not know whether these complex unmet needs
can be met within the residential care setting. The aim
of this study was to evaluate whether, in comparison
with usual care, a liaison outreach intervention would
Received 9 August 2006
Accepted 13 February 2007
1128
m. orrell
reduce the unmet needs of people with dementia in
residential care.
METHOD
The design was a cluster randomised controlled trial of
a liaison intervention package to meet unmet needs of
residents with dementia in a group of homes compared
to care as usual in the control group homes. Researchers carrying out pre- and post-intervention assessments were blind to the allocation of homes to
intervention and control groups. The relevant local
ethics committees approved the study.
Participants
A total of 24 residential care homes (ten London, eight
North Wales, six Manchester) were recruited into the
study. As far as possible homes were recruited in pairs,
matched for size, locality and registering body. Where
available, the family was also contacted and asked for
their views on the resident being included in the study.
Inclusion criteria
Over 60 years old and permanent resident
Met DSM-IV criteria for dementia (American Psychiatric Association, 1994)
Lived in the home for the past month and likely to
stay in the home for the following 6 months
Able to give informed consent or assent in line with
their level of cognitive abilities.
Instruments
Primary outcome variable—Camberwell Assessment
of Needs in Elderly (CANE; Reynolds et al., 2000;
Orrell and Hancock, 2004). A comprehensive assessment covering 24 areas of social, medical, psychological, and environmental needs plus two areas of
carers needs. Researchers were trained using the
CANE manual (Orrell and Hancock, 2004). The
CANE was administered as a structured interview
with the individual, key staff member(s) and a family
carer whenever possible. Finally, the researcher came
to an overall rating on the CANE based on all the
information gathered throughout the assessment.
Secondary outcome variable––Quality of Life in
Alzheimers Disease (QOL-AD). This scale can be
completed by both persons with dementia and
caregivers (Logsdon et al., 1999). There are 13-items
covering domains relevant to physical and mental
Copyright # 2007 John Wiley & Sons, Ltd.
ET AL.
health, personal relationships, finances and overall life
quality. Higher scores indicate better quality of life.
The QOL-AD has good reliability and validity and can
be used with people with mild, moderate and severe
dementia (Thorgrimsen et al., 2003; Hoe et al., 2005).
Mini Mental State Examination (MMSE; Folstein
et al., 1975). A well established short test of cognitive
function with higher scores denoting better functioning.
Clinical Dementia Rating (CDR; Hughes et al.,
1982). A global rating of severity of dementia rated
from no problem (0) to severe dementia (3).
Clifton Assessment Procedures for Elderly-Behaviour
Rating Scale (CAPE-BRS; Pattie and Gilleard, 1979).
An informant rated scale assessing a wide range of
behaviours and activities of daily living with higher
scores indicating higher dependency.
Barthel Scale of Activities of Daily Living (Mahoney
and Barthel, 1965). This measures activities of daily
living with lower scores indicating greater dependency.
Challenging Behaviour Scale (CBS) (Moniz-Cook
et al., 2001). A 25-item checklist that rates the
frequency and severity of challenging behaviour
presented by older people with dementia with higher
scores indicating more problematic behaviour.
Cornell Scale for Depression in Dementia (Alexopoulos et al., 1988). A 19-item scale assessing
depression in dementia. Scores of 7 or more indicate
depression.
Rating of Anxiety in Dementia (RAID; Shankar et al.,
1999). A short scale assessing anxiety in dementia.
Scores of 11 or more indicate clinical anxiety.
Procedure
Following initial screening of individuals to ensure
they met the inclusion criteria, a minimum of eight to
eleven people with dementia from each of the two
residential homes in each pair were randomly selected.
The participating staff member from the care home
was usually a key worker or a staff member who
knew the resident well. An attempt was made to
interview the participant first in order to obtain
consent/assent. When two homes had been assessed, a
multidisciplinary (mental health nurse/clinical psychologist) research team meeting discussed the home
Int. J. Geriatr. Psychiatry 2007; 22: 1127–1134.
DOI: 10.1002/gps
1129
a cluster rct to reduce the unmet needs of people with dementia
environment and procedures, and the unmet needs of
residents were summarised in care plans outlining the
unmet needs and possible interventions to meet them.
Remote randomisation with an administrator not
connected with the study was used to determine
which of the two homes was the intervention home. A
meeting was arranged with the intervention home to
provide feedback on the care plans. The control home
received feedback after the follow-up assessments
were conducted. On the rare occasion that serious
problems were identified by the assessment (e.g.
previously unidentified severe medical or safety
issues), these were fed back to the control homes
immediately as would be expected in safe clinical
practice, but otherwise homes were left to continue
care as usual. Plans for action included prioritisation
of interventions, names of contact people, and review
dates. The researcher visited the homes for two hours
every fortnight to review the individualised summaries. After a 20-week intervention period the
follow-up assessments in the two homes were
conducted by a researcher blind to the randomisation
status of the home. Summaries by the blind researcher
were based on unmet needs on the CANE. General
observations and recommendations for the two homes
were provided as feedback to both the control and
intervention homes.
(M ¼ 38 months, SD 31) had lived in the homes for
longer than the control group participants (M ¼ 29,
SD 28) and had a higher proportion of male residents
(24.2% vs 14.4%). At baseline the control group had
slightly more met needs (12.4, SD 2.3 vs 11.7 SD 2.8),
but fewer unmet needs (4.12, SD 2.32 vs 4.77,
SD 2.89) than the intervention group (Table 1).
As shown in Figure 1, of the 238 residents at
baseline 192 residents were followed-up (completers)
and excluding deaths the follow-up rate was 96.5%
(192/199). Table 2 shows that at baseline, noncompleters were older, and more severely impaired in
cognition (MMSE) and disability (CDR, CAPE-BRS,
Barthel). There were similar numbers of baseline
unmet needs for completers and non-completers.
Change between baseline and follow-up
Quality of life. Quality of life as rated by the person
with dementia decreased by a mean 1.6 (SD 7.6)
points in the intervention group and increased by 0.5
(SD 6.3) points in the control group. However, the
high standard deviations indicated that there was a
great variability in QoL change in both groups. Staff
rated QoL again decreased a little in the intervention
group (mean 1.7, SD 6.1) but showed no change of
note in the control group (mean þ 0.1, SD 6.5) but
again there was very high variability within groups.
Data analysis
Randomisation was between homes (cluster randomisation), as within home randomisation might have led
to the control group having their needs met due to staff
being more aware of their needs and what could be
done to help. As the method of choice to provide an
unbiased estimate of treatment effects, analysis was
done on an intention to treat basis, and the difference
between groups used analysis of covariance in which
the baseline was fitted as an explanatory factor. A
summary measures approach was used whereby the
results for each centre were reduced to a single statistic
(a mean).
RESULTS
There were 238 participants, 118 in 12 homes
randomised to the intervention and 120 in 12 homes
randomised to the control condition. Only 37% of
participants had a diagnosis of dementia recorded in
their care home notes. The groups were well matched
for age, severity of dementia (CDR/MMSE), mood
(Cornell/RAID), quality of life, and level of dependency (CAPE/Barthel). The intervention group
Copyright # 2007 John Wiley & Sons, Ltd.
Mood. There was minimal change in level of
depression at follow-up, and no difference between
the groups (intervention M ¼ 0.0, SD 6.3, control
M þ 0.7, SD 6.8). At baseline 30 (25%) people in the
intervention and 26 (22%) in the control group were
above the cut off for depression on the Cornell scale
Table 1. Characteristics and mean scores of participants at baseline (SD) (n ¼ 238)
Intervention (n ¼ 118)
Mean age
Male (%)
MMSE
CDR
Cornell
RAID
CAPE-BRS
Barthel
CBS
QoL-AD (user)
QoL-AD (staff)
unmet needs
87.3
29
8.03
2.0
5.5
5.9
17.4
60.4
23.8
32.0
28.9
4.77
(6.8)
(24.2%)
(8.1)
(0.8)
(4.7)
(6.3)
(5.4)
(18.5)
(27.3)
(7.4)1
(6.7)
(2.87)
Control (n ¼ 120)
85.6
17
9.3
2.0
6.0
6.4
16.2
67.2
29.7
33.2
29.8
4.12
(7.9)
(14.4%)
(7.4)
(0.7)
(5.2)
(5.8)
(5.0)
(17.9)
(32.7)
(6.7)2
(6.6)
(2.32)
1
n ¼ 56.
n ¼ 67.
2
Int. J. Geriatr. Psychiatry 2007; 22: 1127–1134.
DOI: 10.1002/gps
1130
m. orrell
ET AL.
238 residents from 12 paired homes
recruited into the study
12 homes randomly assigned to
intervention group, N = 118
12 homes randomly assigned
to control group, N = 120
26 lost to follow-up
23 died
3 transferred
20 lost to follow-up
16 died
3 transferred
1 withdrew consent
92 completed follow-up at 20
weeks
100 completed follow-up at 20
weeks
Figure 1. Flow of participants through the randomised controlled trial.
compared to 16 (17%) and 26 (26%) at follow-up
respectively. At follow-up, the intervention group
(M ¼ 1.1, SD 8.0) had a slight reduction in anxiety
overall, as measured by the RAID compared to the
control group (M ¼ þ0.9, sd 8.0) which saw a slight
increase in anxiety. For the RAID scale at baseline 19
(16%) of people in the intervention and 20 (17%) of
the control group were above the cut off for anxiety,
compared to 6 (7%) and 19 (19%) at follow-up
respectively.
Behaviour, dependency and cognition. Table 4 shows
the change in the cognition (MMSE), dependency
(CAPE-BRS, Barthel) and behaviour (CBS) scores
between baseline and follow-up for the control and
intervention groups. In both groups there was an
Table 2. Comparison between completers and non-completers at
baseline
Age
CAPE-BRS
Barthel
CDR
MMSE
Unmet need
Completers
Non completers
mean (SD)
mean (SD)
85.8
16.2
66.0
1.9
9.5
4.4
89.3
19.1
54.7
2.3
5.3
4.5
(7.59)
(5.27)
(18.4)
(0.8)
(7.9)
(2.6)
(5.8)
(4.3)
(15.9)
(0.7)
(6.3)
(2.6)
Copyright # 2007 John Wiley & Sons, Ltd.
t
p-value
2.86
3.80
3.84
3.15
3.51
0.04
0.005
0.000
0.000
0.002
0.001
0.97
increase in dependency levels indicating a decrease in
functional ability (CAPE-BRS increased, and Barthel
decreased) although again there was a high level of
variability between participants. Cognition also
declined by 1.9 (SD 6.4) points in the intervention
and 0.9 (SD 6.7) points in the control groups. There
was also minimal change in the CBS scores indicating
that the level of behaviour problems remained the
same.
Needs. At follow-up the mean number of unmet needs
for people with dementia in the intervention homes
reduced by 3.1 (SD 2.0), compared to a reduction of
0.7 (SD 2.9) unmet needs in the control group
(Table 4). Table 3 shows how unmet needs changed at
follow up for each of the CANE items. The five
commonest unmet needs in older people (Iliffe et al.,
2004): memory, eyesight/hearing, continence, mobility and psychological distress were all very common
in this population, and were reduced by between 13%
and 28% at follow up in the intervention group. This
compared to between 0 and 11% reductions in these
unmet needs in the control group. Unmet needs for
daytime activities reduced by around 20% in both
groups. Unmet needs in the areas of both psychotic
symptoms and behaviour problems also reduced
considerably. In the intervention group, four domains
improved in over 10% of participants at follow up,
relative to any change in the control group (eyesight/
Int. J. Geriatr. Psychiatry 2007; 22: 1127–1134.
DOI: 10.1002/gps
1131
a cluster rct to reduce the unmet needs of people with dementia
Table 3. Unmet needs by intervention and control group at baseline and follow-up
Baseline (%)
Control (n ¼ 120)
Accommodation
Household Activities
Food
Self-Care
Caring for Another
Daytime Activities
Memory*
Eyesight/Hearing*
Mobility*
Continence*
Physical Health
Drugs
Psychotic Symptoms
Psychological Distress*
Information
Deliberate self-harm
Accidental self-harm
Abuse/Neglect
Behaviour
Alcohol
Company
Intimate Relationships
Money
Benefits
Total Needs
4
0
13
8
2
89
48
40
25
25
15
22
10
53
18
1
17
5
33
1
47
14
3
1
494
Follow-up (%)
Intervention (n ¼ 118)
(3)
(0)
(11)
(7)
(2)
(74)
(40)
(33)
(21)
(21)
(13)
(18)
(8)
(44)
(15)
(0.8)
(14)
(4)
(28)
(0.8)
(39)
(12)
(3)
(1)
(4.12)
11
2
18
2
3
92
45
53
35
32
24
40
16
61
12
2
12
2
31
0
50
14
4
2
563
Control (n ¼ 100)
(9)
(2)
(15)
(2)
(3)
(78)
(38)
(45)
(30)
(27)
(20)
(34)
(14)
(52)
(10)
(2)
(10)
(2)
(26)
(0)
(42)
(12)
(3)
(2)
(4.77)
3
2
9
3
0
57
30
22
22
12
16
20
8
40
7
1
15
4
16
0
33
9
1
0
330
(3)
(2)
(9)
(3)
(0)
(57)
(30)
(22)
(22)
(12)
(16)
(20)
(8)
(40)
(7)
(1)
(15)
(4)
(16)
(0)
(33)
(9)
(1)
(0)
(3.30)
Intervention (n ¼ 92)
1
0
6
1
0
53
23
16
17
13
18
18
5
34
2
0
7
1
11
0
28
6
4
1
265
(1)
(0)
(7)
(1)
(0)
(58)
(25)
(17)
(18)
(14)
(20)
(20)
(5)
(37)
(2)
(0)
(7)
(1)
(12)
(0)
(30)
(6)
(4)
(1)
(2.88)
*Five most common unmet needs in older people (Iliffe et al., 2004).
hearing 17%; mobility 13%; drugs 16%; psychological distress 11%).
Analysis of variance by cluster for primary (unmet
needs) and secondary (quality of life) outcome
measures. As a cluster randomisation process was used
by home (rather than by participant) the appropriate
analysis to compare the intervention and control homes
was a random effects model, treating the cluster effects
as random, comparing the intervention homes vs the
control homes. For the primary outcome variable a
REML (Restricted Maximum Likelihood) variance
components analysis was carried out comparing the
unmet needs at follow up between the groups with the
baseline unmet needs, with group and home pair as
fixed factors and individual home as a random factor.
Level of baseline unmet needs was significantly
associated with level of unmet needs at follow up
Table 4. Intervention and control group: mean (SD) change from baseline to follow-up
Change
Intervention (n ¼ 92)
MMSE
Cornell
RAID
CAPE-BRS
Barthel
CBS
Unmet needs
QoL-AD (staff)
QoL-AD (user)
1
2
1.9
0.0
1.1
þ0.9
7.2
0.7
3.1
1.7
1.6
(6.4)
(6.3)
(8.0)
(4.8)
(14.9)
(28.4)
(2.0)
(6.1)
(7.6)1
Change
Control (n ¼ 100)
0.9
þ0.7
þ0.9
þ0.4
4.1
þ0.3
0.7
þ0.1
þ0.5
(6.7)
(6.8)
(8.0)
(4.6)
(12.9)
(33.7)
(2.9)
(6.5)
(6.3)2
Mean difference
intvn vs control
1.0
þ0.7
þ2.0
þ0.5
3.1
1.0
2.4
1.8
2.1
n ¼ 40.
n ¼ 55.
Copyright # 2007 John Wiley & Sons, Ltd.
Int. J. Geriatr. Psychiatry 2007; 22: 1127–1134.
DOI: 10.1002/gps
1132
m. orrell
(Wald 5.32, df 1, p ¼ 0.021) but neither home pair
(Wald 17.64, df 11, p ¼ 0.090) nor group (Wald 2.41,
df 1, p ¼ 0.121) predicted number of unmet needs at
follow up. At follow up control homes had 0.87
(standard error 0.56) more unmet needs per person
compared to intervention homes when baseline unmet
need was controlled for. Thus the liaison service based
on the CANE assessments did not lead to a significant
reduction in unmet needs.
For the secondary outcome variable a REML
variance components analysis was also carried out
comparing quality of life (QoL-AD) at follow-up
between the groups with the baseline QoL, and pair as
fixed factors and individual home as a random factor.
Baseline QoL was significantly associated with QoL
at follow up (Wald 12.04, df 1, p < 0.001) as was
pair (Wald 20.99, df 11, p ¼ 0.033) however group
(Wald 1.10, df 1, p ¼ 0.294) was not significantly
associated with QoL at follow up. Thus there is no
evidence that the liaison service led to improved
quality of life.
DISCUSSION
This was the first RCT to systematically assess unmet
needs in people with dementia living in care homes
and use a liaison intervention to attempt to meet those
needs. The groups were generally well matched at
baseline, though the intervention group had lived in
the homes for somewhat longer than the control group.
The intervention was delivered in half of the homes
and was designed to use only a modest amount of
resources per home (1 h per week) to show that (if
effective) a similar approach could be used in clinical
practice by local community services working closely
with certain care homes in their area. The follow-up
rate for an RCT was exceptionally high at 96.5%, after
excluding deaths. The people who did not complete
the follow-up were older and had more severe
dementia, and therefore a higher death rate would
be expected. However, in other respects (such as
baseline number of unmet needs) the completers and
non-completers did not differ.
In accordance with the randomisation procedure the
analysis was conducted by cluster, and there were no
significant differences between the control homes and
the intervention homes in either level of unmet need or
quality of life at follow-up. Although unmet needs
were reduced considerably in the intervention homes
they also reduced to a lesser extent in the control
homes providing no convincing evidence that this
level of intervention may be of benefit in reducing
unmet needs over a 5-month time-period. The pattern
Copyright # 2007 John Wiley & Sons, Ltd.
ET AL.
was similar in each region. There were wide variations
between homes in the change in the mean number of
unmet needs, with some control and intervention
homes showing dramatic reductions in unmet needs
(e.g. mean decrease by 4 þ unmet needs at follow-up),
whereas other homes in both groups had increases in
unmet needs (e.g. mean increase of 1 þ unmet needs at
follow-up). Six of the homes showed an increase in
unmet needs at follow-up and five of these were in the
control group. The particular areas of unmet need
which were reduced at follow-up, tended to be those
which were more prevalent at baseline (e.g. daytime
activities, memory, eyesight/hearing, continence,
mobility and psychological distress) but also those
areas which would be amenable to interventions
planned by mental health professionals (e.g. behaviour
problems, psychotic symptoms). Overall, unmet needs
tended to reduce more in the intervention groups
particularly in the four areas of eyesight/hearing,
mobility, drugs and psychological distress. However,
neither QoL (secondary outcome variable) nor any of
the other measures improved in the intervention
homes compared with the control homes that received
care as usual, indicating that the intervention did not
have the predicted effects. Although the mean levels of
depression and anxiety changed little at follow-up, the
number of people with caseness depression or anxiety
fell appreciably in the intervention group suggesting
that the liaison intervention may be helpful for mood
disorders in dementia.
LIMITATIONS
The overall reduction in unmet needs, irrespective of
intervention is of interest since dementia tends to
deteriorate over time. The study may have been
underpowered to detect a difference between the
groups, and although from the methodological point of
view there was a case for randomisation by cluster, this
approach meant that larger differences between the
groups were required to achieve a significant result.
The sensitivity of the CANE to identify more subtle
changes is not known, and for the QoL-AD, as completed by participants, the available sample size was
reduced further. Using the CANE with the care staff
may have helped coach them about the range of needs
and interventions available, and the awareness of a
follow-up visit could also have prompted them to
address the needs (e.g. some care staff were made
aware of a lack of daytime activities and sensory
problems and indicated they might take action such as
arranging a hearing test or organising more activities).
The intervention was also of low intensity at two
Int. J. Geriatr. Psychiatry 2007; 22: 1127–1134.
DOI: 10.1002/gps
a cluster rct to reduce the unmet needs of people with dementia
KEY POINTS
The Camberwell Assessment of Need for the
Elderly (CANE) is an effective method for
identifying unmet needs in older people with
dementia living in care homes.
At follow-up unmet needs had improved in both
the intervention and care as usual groups
suggesting that the systematic assessment
(rather than the intervention) may have led to
the reduction in unmet needs.
Assessing needs at baseline may have led to care
staff in the control homes to intervene to meet
those needs reducing the potential differences
between the groups at follow-up.
As some interventions were planned or in
progress at the follow up assessment a longer
follow-up period may have been useful but this
would also have resulted in a higher rate of loss
to follow-up.
hours fortnightly per home (i.e. about 5 min per
participant per week). Other factors operating in
homes had potentially much greater effects; changes
in management, staff sickness/absences, inspection
visits. Additionally, it may take more time for the liaison
intervention to become effective and many interventions
were still in progress at follow-up: establishing an
activity co-ordinator; setting up activities, staff training
(e.g. staff training on communication with people with
dementia was cancelled three times by one home
because of staff shortages). A previous study treating
depression in care homes found that there was no
difference between groups at three months although
there was at one year (Ames, 1990). Homes varied in
their willingness to participate, but also in more
practical aspects such as staff numbers, use of agency
staff, access to community resources, and budgets, and
these factors could have affected how the interventions
were delivered and consequently the numbers of unmet
needs at follow-up.
Aspects of the homes’ policies and practices may be
influential in determining whether or not liaison
interventions are effective. For example, in this study
some homes asked researchers not to contact primary
care services about medication issues. Past research
has indicated the effects of many factors on the care
needs of people with dementia and on the staff caring
for them (Lintern et al., 2000). An analysis of different
practices between care homes could shed light on the
best methods for bringing about positive change and
improving quality of care (Mozley et al., 2004).
Copyright # 2007 John Wiley & Sons, Ltd.
1133
CONCLUSION
This RCT provided a systematic assessment of unmet
of needs in people with dementia in care homes and a
liaison intervention feasible for use in local services.
The results did not indicate that the intervention
reduced unmet needs or improved quality of life at
follow-up. However, unmet needs reduced in both the
intervention and the control homes, and in the intervention homes there were important reductions in
some common areas of unmet needs including eyesight/hearing, mobility, drugs, and psychological
distress. Further research is needed to show if
increased intensity or duration of an intervention
would be effective.
ACKNOWLEDGEMENTS
We thank the Wellcome Trust for funding this research
through a health services research project grant
awarded to Prof Orrell. We would also like to thank
Claire O’Donoghue, Bridie Baines and Joanne Baker
for help with collecting the data. Thanks to Professor
Stephen Senn for constructing the block randomisation tables and planning and conducting the cluster
analyses, and also to Janice Dickson for administering
the randomisation of the home pairs. Also thanks to
the residents, staff, and families of residential homes
we visited.
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