Attending day care centres with programs specifically designed for patients with dementia is believed to postpone admittance to nursing home as well as increase quality of life and well-being for both patients and their family carers. Therefore, the Norwegian Ministry of Health and Care Services is presently offering funding to all municipalities that wish to establish day care centre programs for this group of patients. There is only limited knowledge on the effectiveness of day care centre programs designed for persons with dementia. The aims of our research were to investigate to what degree attendance in day care centres with programs designed for people with dementia is effective in postponing admittance to nursing home care, enhancing quality of life for the service users and relieving burden of care for the family carers.
The study is a quasi-experimental trial with a comparison group and a qualitative inquiry. Assessments will be made at baseline, after one and two years. At baseline 261 patients with dementia and their family caregivers have been included in the trial. Data collection is made at three levels; at patient level with measures of cognition, depression, coping, quality of life, functioning in activities of daily living, neuropsychiatric symptoms and time of death; at family carer level with measures of depression, coping and burden; and at societal level with measures of nursing home admittance, hospital stays and use of other health and social care resources. For the qualitative analysis, 17 dyads of patients receiving a day care program and their family carers have been interviewed. The main focus of the interviews is to explore how the day care centre programs affect daily life, both for the person with dementia and their family carers. The results from the baseline assessment and the qualitative interviews are published in international scientific journals. The results from the quantitative follow-up assessments are analysed and in the process for publication.
We want to carry out a controlled trial to study the effects and costs of a day centre care program designed for people with dementia. Previous research is sparse and the results of published studies, which are of rather poor quality, are inconclusive. Du e to the fact that the Norwegian Ministry of Health and Care Services has given priority to the establishment of day care centers in all Norwegian municipalities as a component of the Norwegian Dementia Plan 2015, the present study is of utmost importance . Due to a power analysis 200 patients with dementia receiving day centre care services in 20-30 day care centres will be compared with 200 patients from municipalities without such a service. For ethical reasons we cannot carry out a randomized controlle d trial, not even with a stepped wedge design. We cannot withdraw patients from the day care program they have been offered, or let them wait for up til 24 months for this service. We will:
1.Prior to the controlled trial carry out a feasiability study w ith 20 patients
2. Conduct a controlled trial and matched the patients with regard to neuropsychiatric syptoms, cognition and living alone vs with someone. The number of patients admitted to nursing homes within 24 months will be the primary outcome. Seco ndary outcomes will be days spent in nursing homes, use of health resources and the costs of care. Further outcomes wil be patients' ADL, QoL, depression, neuropsychiatric symptoms cognition, death and carers'stress, depression and QoL.
3. A description o f the organization of the day care centers, including a description of which activities are offered to the patients will be made
4.Co-operation between patients, the family carers and health personnel in the day care centers will be made with by use of qu stionnaires.
5. To examine the patients and carers needs and opinion about the day care program a qualitative study of 20patients and family carers will be carried out