Reminiscence groups for people with dementia and their family care-givers: pragmatic 8-centre trial of joint reminiscence and maintenance versus usual treatment

• United Kingdom

Department of Health (DH)

1812941

01-12-2007

42

• Alzheimer’s disease and other dementias

Alzheimer Disease; Dementia,Memory

Reminiscence groups, run by professionals & volunteers, which use photographs, recordings & other objects to trigger personal memories are probably the most popular therapeutic approach to working with people with dementia, but there is little evidence for their effectiveness. The inclusion of family carers in groups with people with dementia has generated informal evidence that this joint approach improves relationships between people with dementia & their carers, and benefits both. REMCARE involves a rigorous evaluation of this approach. Pairs of people with mild to moderate dementia & their carers within 8 centres, both urban & rural, in England & Wales will take part in this pragmatic 2-arm randomised trial. They will be allocated at random between the intervention group who will attend joint reminiscence groups, meeting weekly for 12 weeks and then continuing the reminiscence work monthly for a further 7 months; and ‘usual treatment’. To compare the effectiveness of these approaches, 10 months after recruiting the people with dementia we shall ask them about their quality of life and their carers about their psychological distress. Secondary outcome measures include a simple measure of the quality of relationship between patient & carer, completed by both, and a measure of ‘autobiographical memory’, the specific aspect of memory that should respond to reminiscence work. To evaluate the cost-effectiveness of reminiscence groups their costs & consequences will be analysed. The target sample size is 400 pairs completing the 10 month assessment, requiring around 576 pairs to be recruited, involving 24 treatment groups (each with 12 pairs participating). Three groups will be run in each of the 8 participating centres, which include Wales, London, Bradford, Hull and Manchester.

The growing number of people with dementia, and the increasing cost of caring for them, provide a major incentive to develop & test methods of supporting them in the community for longer. Drug treatment has received most attention , but there is increasing evidence that psychological & social interventions may be equally effective, even preferable where medication has negative side-effects. Reminiscence groups, run by professionals & volunteers, which use photographs, recordings & other objects to trigger personal memories are probably the most popular therapeutic approach to working with people with dementia, but there is little evidence for their effectiveness. Hence rigorous evaluation is essential. Fortunately the recent inclusion of family carers in groups with people with dementia, notably in our own pilot studies, has generated informal evidence that this joint approach improves relationships between people with dementia & their carers, and benefits both. We therefore propose to invite pairs of people with dementia & their carers within 8 centres, both urban & rural, in England & Wales to take part in this trial. We shall allocate those who give their informed consent at random between the intervention group who will attend joint reminiscence groups, meeting weekly for 12 weeks and then continuing the reminiscence work monthly for a further 7 months; and ‘usual treatment’ for example in day care centres. To compare the effectiveness of these approaches, 10 months after recruiting the people with dementia we shall ask them about their quality of life and their carers about their stress. Our pilot studies also developed a simple measure of the quality of relationship between patient & carer, completed by both. They also refined, for this study, an existing measure of ‘autobiographical memory’, the specific aspect of memory that should respond to reminiscence work. To judge whether reminiscence groups give ‘value for money’, we shall analyse all their costs & consequences, and be able to indicate the benefits, if any, of these joint groups. Our multi-disciplinary team includes expertise in clinical psychology, old age psychiatry, nursing, trial methods, social psychology & health economics, with extensive experience in this area. A large study size and sample is required for a rigorous definitive evaluation, as any benefits occur in the context of a condition that leads to declining function, and in an age group where other physical health conditions are common.

• Clinical research