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dc.contributor.authorLivingston, G
dc.contributor.authorBarber, J
dc.contributor.authorMarston, L
dc.contributor.authorStringer, A
dc.contributor.authorPanca, M
dc.contributor.authorHunter, R
dc.contributor.authorCooper, C
dc.contributor.authorLaybourne, A
dc.contributor.authorLa Frenais, F
dc.contributor.authorReeves, S
dc.contributor.authorManela, M
dc.contributor.authorLambe, K
dc.contributor.authorBanerjee, S
dc.contributor.authorRapaport, P
dc.date.accessioned2020-05-12T08:44:06Z
dc.date.issued2019-04
dc.identifier.issn2215-0366
dc.identifier.issn2215-0374
dc.identifier.urihttp://hdl.handle.net/10026.1/15655
dc.description.abstract

BACKGROUND: Many people with dementia living in care homes have distressing and costly agitation symptoms. Interventions should be efficacious, scalable, and feasible. METHODS: We did a parallel-group, cluster-randomised controlled trial in 20 care homes across England. Care homes were eligible if they had 17 residents or more with dementia, agreed to mandatory training for all eligible staff and the implementation of plans, and more than 60% of eligible staff agreed to participate. Staff were eligible if they worked during the day providing face-to-face care for residents with dementia. Residents were eligible if they had a known dementia diagnosis or scored positive on screening with the Noticeable Problems Checklist. A statistician independent of the study randomised care homes (1:1) to the Managing Agitation and Raising Quality of Life (MARQUE) intervention or treatment as usual (TAU) using computer-generated randomisation in blocks of two, stratified by type of home (residential or nursing). Care home staff were not masked to the intervention but were asked not to inform assessors. Residents with dementia, family carers, outcome assessors, statisticians, and health economists were masked to allocation until the data were analysed. MARQUE is an evidence-based manualised intervention, delivered by supervised graduate psychologists to staff in six interactive sessions. The primary outcome was agitation score at 8 months, measured using the Cohen-Mansfield Agitation Inventory (CMAI). Analysis of the primary outcome was done in the modified intention-to-treat population, which included all randomly assigned residents for whom CMAI data was available at 8 months. Mortality was assessed in all randomly assigned residents. This study is registered with the ISRCTN registry, number ISRCTN96745365. FINDINGS: Between June 14, 2016, and July 4, 2017, we randomised ten care homes (189 residents) to the MARQUE intervention and ten care homes (215 residents) to TAU. At 8 months, primary outcome data were available for 155 residents in the MARQUE group and 163 residents in the TAU group. At 8 months, no significant differences in mean CMAI scores were identified between the MARQUE and TAU groups (adjusted difference -0·40 [95% CI -3·89 to 3·09; p=0·8226]). In the intervention care homes, 84% of all eligible staff completed all sessions. The mean difference in cost between the MARQUE and TAU groups was £204 (-215 to 623; p=0·320) and mean difference in quality-adjusted life-years was 0·015 (95% CI -0·004 to 0·034; p=0·127). At 8 months, 27 (14%) of 189 residents in the MARQUE group and 41 (19%) of 215 residents in the TAU group had died. The prescription of antipsychotic drugs was not significantly different between the MARQUE group and the TAU group (odds ratio 0·66; 95% CI 0·26 to 1·69, p=0·3880). INTERPRETATION: The MARQUE intervention was not efficacious for agitation although feasible and cost-effective in terms of quality of life. Addressing agitation in care homes might require resourcing for delivery by professional staff of a more intensive intervention, implementing social and activity times, and a longer time to implement change. FUNDING: UK Economic and Social Research Council and the National Institute of Health Research.

dc.format.extent293-304
dc.format.mediumPrint-Electronic
dc.languageen
dc.language.isoen
dc.publisherElsevier BV
dc.subjectAged, 80 and over
dc.subjectAntipsychotic Agents
dc.subjectBurnout, Professional
dc.subjectCaregivers
dc.subjectCost-Benefit Analysis
dc.subjectDementia
dc.subjectEvidence-Based Medicine
dc.subjectFamily
dc.subjectFeasibility Studies
dc.subjectFemale
dc.subjectFollow-Up Studies
dc.subjectHealth Personnel
dc.subjectHumans
dc.subjectMale
dc.subjectPsychomotor Agitation
dc.subjectQuality of Life
dc.subjectQuality-Adjusted Life Years
dc.subjectResidential Facilities
dc.subjectSingle-Blind Method
dc.subjectTreatment Failure
dc.titleClinical and cost-effectiveness of the Managing Agitation and Raising Quality of Life (MARQUE) intervention for agitation in people with dementia in care homes: a single-blind, cluster-randomised controlled trial
dc.typejournal-article
dc.typeArticle
plymouth.author-urlhttps://www.ncbi.nlm.nih.gov/pubmed/30872010
plymouth.issue4
plymouth.volume6
plymouth.publisher-urlhttp://dx.doi.org/10.1016/s2215-0366(19)30045-8
plymouth.publication-statusPublished
plymouth.journalThe Lancet Psychiatry
dc.identifier.doi10.1016/s2215-0366(19)30045-8
plymouth.organisational-group/Plymouth
plymouth.organisational-group/Plymouth/Faculty of Health
plymouth.organisational-group/Plymouth/Faculty of Health/Peninsula Medical School
plymouth.organisational-group/Plymouth/Faculty of Health/Peninsula Medical School/PMS - Manual
plymouth.organisational-group/Plymouth/REF 2021 Researchers by UoA
plymouth.organisational-group/Plymouth/REF 2021 Researchers by UoA/UoA03 Allied Health Professions, Dentistry, Nursing and Pharmacy
plymouth.organisational-group/Plymouth/Users by role
plymouth.organisational-group/Plymouth/Users by role/Academics
plymouth.organisational-group/Plymouth/Users by role/Researchers in ResearchFish submission
dc.publisher.placeEngland
dcterms.dateAccepted2019-03-01
dc.rights.embargodate2020-5-16
dc.identifier.eissn2215-0374
dc.rights.embargoperiodNot known
rioxxterms.versionofrecord10.1016/s2215-0366(19)30045-8
rioxxterms.licenseref.urihttp://www.rioxx.net/licenses/all-rights-reserved
rioxxterms.licenseref.startdate2019-04
rioxxterms.typeJournal Article/Review


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