No significant differences in patients’ clinical outcomes emerged between two dementia care interventions and between the interventions and usual patient care, a pragmatic trial reported. Caregivers receiving the interventions, however, were more satisfied with their dementia caregiving and reported greater self-efficacy.David B. Reuben, MDDavid B. Reuben, MD, Archstone professor of medicine and chief of the Division of Geriatrics in the David Geffen School of Medicine at the University of California, Los Angeles, found that health system-based dementia care (HSDC) and community-based dementia care (CBDC) did not differ from usual care (UC) on most measures for a person living with dementia and their caregiver. “These findings can help further refine comprehensive dementia care programs,” Reuben’s group wrote in JAMA Internal Medicine.Although several models of comprehensive dementia care have been tested, their relative effectiveness is unknown, Reuben told Medscape Medical News. “If one model is superior, then efforts to disseminate it widely should be a focus of improving dementia care. Conversely, if no model is clearly superior, then health systems have a choice to select the model that best fits the resources, workflow, and culture of their organization.”Most previous research has not used randomized clinical trials.The Dementia Care Study (D-CARE) is an 18-month, three-armed, assessor-blinded randomized trial conducted from June 2019 through August 2023 at four clinical trial sites in North Carolina, Texas, and Pennsylvania. It was based on 2176 dyads of a community-dwelling person living with dementia and a caregiver, with prespecified outcomes measuring cognition, functional status, and quality of life for affected individuals as well as caregiver burden and perceived benefits of caregiving.HSDC involved comanagement by nurse practitioners or physician assistants, while CBDC was provided via telephone by a social worker, nurse, or licensed therapist. UC was home-based with routine doctor visits and access to the Alzheimer’s Association helpline for caregivers.Of the persons living with dementia, 58.4% were women, as were 75.8% of caregivers. Mean ages in the dyads were 80.6 years and 65.2 years, respectively.Caregiver satisfaction with care was higher with both interventions than with the UC group. For HSDC, the least-squares mean difference was 2.6 points (98.3% CI, 1.0-4.2; P < .001). For CBDC, the least-squares mean difference was 3.3 points (98.3% CI, 1.7-4.9; P < .001). The difference in caregiver satisfaction with care between the interventions and UC was apparent by 3 months and persisted through the study. Caregiver-rated quality of care was higher in the CBDC group than the UC group (least-squares mean ratio, 1.1; 98.3% CI, 1.0-1.3; P = .046).“We expected larger differences in clinical outcomes, for example, behavioral symptoms and quality of life, caregiver strain, depressive symptoms, as well as positive feelings about caregiving between the two interventions compared with the usual care group,” Reuben said. “Caregivers receiving either of these comprehensive dementia care models are more satisfied with the care of the person living with dementia and have greater self-efficacy — that is, confidence in being able to manage the person’s care.”Julie P. Bynum, MD, MPHOffering a nonparticipant’s perspective on the study’s disappointing clinical results, Julie P. Bynum, MD, MPH, geriatrician and professor of internal medicine at the University of Michigan in Ann Arbor, Michigan, told Medscape Medical News that “we may have been overly enthusiastic in expectations for what changing the care model can achieve in the face of progressive neurological disease without commonly available disease treatments.”Looking forward, she added, clinicians can double down on interventions to prevent negative health outcomes such as emergency visits, hospitalizations, and early nursing home placement. “We also may also want to try taking a more targeted approach with a graduated set of interventions that align with risks by stage of disease rather than an everyone, all-at-once approach.”Writing in an accompanying editorial, Laura N. Gitlin, PhD, applied research sociologist and distinguished professor at Drexel University in Philadelphia, and a colleague, called the D-CARE trial “a milestone in pragmatic dementia care research.”Laura N. Gitlin, PhDNoting the lack of effectiveness of the interventional models in improving clinical or quality-of-life outcomes, they said one possible reason is that what constituted “usual care” was unclear. “[UC] may have been more robust than anticipated, narrowing the margin for detectable improvements,” Gitlin and her associate wrote. “If baseline care quality was already high, the intervention arms may not have offered sufficient added value to show differential effects.”Another potential factor in the null clinical findings is variable fidelity — the interventions may not have been implemented faithfully and consistently across sites and dyads. “The extent to which fidelity was measured, monitored, and enhanced in the D-CARE trial is unclear, limiting our understanding of model performance in different sites and with diverse study populations,” they wrote.The trial underscores the complexity of dementia care, the editorial commentators added. While the study signals the importance of a family-centric orientation in dementia care delivery, “…much more work remains to translate this knowledge into effective care models that truly make life better for affected individuals and their caregivers.”Added Bynum, “What needs to be done is fundamental work on changing the clinical environment such that we not only provide what I would call add-on support for caregivers but also embrace and facilitate the role of caregivers for older adults.”Reuben’s group is planning a major analysis of the D-CARE study to compare the two interventions vs UC on healthcare utilization and costs. “Even if the major clinical outcomes are not different, if these models of care can reduce hospitalizations, entry into long-term nursing homes, and costs of care, they may have a major impact on future care of persons with dementia and support of their caregivers,” Reuben said.The D-CARE is funded by the Patient-Centered Outcomes Research Institute and the National Institute on Aging. Additional support was provided by the Yale Program on Aging/Claude D. Pepper Older Americans Independence Center, the National Center for Advancing Translational Science, the University of Texas Medical Branch Claude D. Pepper Older Americans Independence Center, the Dewey and Cynthia Robertson Fund for Wake Forest Geriatrics, the Wake Forest Alzheimer’s Disease Research Center, and the Baylor Scott & White Central Texas Foundation.Reuben and several coauthors reported receiving grants from the National Institute on Aging and/or Patient-Centered Outcomes Research Institute during the conduct of the study. Lee A. Jennings, MD, MSHS, is an adviser to the Alzheimer’s Association. Other coauthors reported employment with or receiving personal fees from the private sector. Bynum disclosed having no conflicts of interest relevant to her comments. Gitlin reported developing an online instruction program for healthcare professionals, which generates fees for her and her institution.0CreditsLead image: Digital Vision/Getty ImagesImage 1: UCLAImage 2: Michigan MedicineImage 3: Drexel UniversityMedscape Medical News © 2025 WebMD, LLCSend comments and news tips to news@medscape.net.Cite this: Interventions Help Dementia Caregivers More Than Patients – Medscape – September 08, 2025.
