Respectful Caring for the Agitated Elderly (ReCAGE): A Multicentre, Prospective, Observational Study to Evaluate the Effectiveness of Special Care Units for People with Dementia

Article type: Research Article

Authors: Mendes, Aline^{a; *} | Bergh, Sverre^b | Cesana, Bruno Mario^c | Handels, Ron^d | Ciccone, Alfonso^e | Cognat, Emmanuel^f | Fabbo, Andrea^g | Fascendini, Sara^h | Frisoni, Giovanni B.ⁱ | Froelich, Lutz^j | Jori, Maria Cristina^k | Mecocci, Patrizia^{l; m} | Merlo, Paolaⁿ | Peters, Oliver^o | Tsolaki, Magdalini^p | Defanti, Carlo Alberto^h

Affiliations: [a] Division of Geriatrics and Rehabilitation, University Hospitals of Geneva and University of Geneva, Geneva, Switzerland | [b] Research Center for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway | [c] Department of Clinical Sciences and Community Health, Unit of Medical Statistics, Biometry and Bioinformatics “Giulio A. Maccacaro” Faculty of Medicine and Surgery, University of Milan, Milan, Italy | [d] Faculty of Health Medicine and Life Sciences, Department of Psychiatry and Neuropsychology School for Mental Health and Neuroscience Alzheimer Centre Limburg Maastricht University Medical Centre Maastricht the Netherlands | [e] Department of Neurology with Neurosurgical Activity “Carlo Poma” Hospital, ASST di Mantova, Mantua, Italy | [f] Cognitive Neurology Centre, Lariboisière-Fernand Widal Hospital GHU AP-HP Nord, Paris, France | [g] Department of Primary Care, Geriatric Service-Cognitive Disorders and Dementia, Local Health Authority of Modena (AUSL), Modena, Italy | [h] FERB Alzheimer Centre, Gazzaniga, Italy | [i] Memory Centre, Division of Geriatrics and Rehabilitation, University Hospitals of Geneva and University of Geneva, Geneva, Switzerland | [j] Department of Geriatric Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany | [k] Mediolanum Cardio Research, Milano, Italy | [l] Department of Medicine and Surgery, Institute of Gerontology and Geriatrics, University of Perugia, Italy | [m] Division of Clinical Geriatrics; NVS Department, Karolinska Institutet Stockholm, Sweden | [n] Neurological Unit (PM), U.V.A. Centre, Humanitas Gavazzeni, Bergamo, Italy | [o] Department of Psychiatry, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany | [p] Greek Association of Alzheimer’s Disease and Related Disorders (GAADRD), Thessaloniki, Makedonia, Hellas. 1st Department of Neurology, School of Medicine, Aristotle University of Thessaloniki (AUTh), Macedonia, Hellas

Correspondence: [*] Correspondence to: Aline Mendes, Division of Geriatrics and Rehabilitation, Chemin du Pont-Bochet 3, 1226 Thônex, Switzerland. Tel.: +41 223056111; E-mail: aline.mendes@hcuge.ch.

Abstract: Background:Behavioral and psychological symptoms of dementia (BPSD) bring complexity in the clinical management of people with dementia; therefore, it is important to evaluate different models of care, such as Special Care Units (SCU-B).∥ Objective:To evaluate the SCU-B effectiveness toward alleviating BPSD and improving the quality of life (QoL) of patients and their caregivers.∥ Methods:ReCAGE was a multicenter, controlled, longitudinal study where 508 patients with BPSD were enrolled in two cohorts: 262 patients from centers endowed with a SCU-B, and 246 from centers without SCU-B. Statistical analyses included factorial ANCOVA for comparison among centers. The primary endpoint was effectiveness of the SCU-B, measured through the Neuropsychiatric Inventory (NPI) changes. Secondary endpoints were change in QoL of patients and caregivers, and the tertiary endpoint was time to nursing home admission.∥ Results:The NPI scores decreased in both arms, with a statistically significant difference from baseline to 36 months (p < 0.0001) in both cohorts. Over time, NPI decreased more steeply during the first year in the SCU-B arm, but in the following two years the slope was clearly in favor of the control arm. This different pattern of the two cohorts reached statistical significance at the interaction “cohort by time” (p < 0.0001). Conflicting results were found regarding the outcomes of quality of life, while there were no differences in time to institutionalization in both cohorts.∥ Conclusion:The RECage study did not confirm the long-term superiority of the pathway comprising a SCU-B. A post-hoc analysis revealed data supporting their acute effectiveness during behavioral crises.

Keywords: Alzheimer’s disease, behavioral and psychological symptoms of dementia, caregiver burden, dementia, Neuropsychiatric Inventory, special care unit

DOI: 10.3233/JAD-230708

Journal: Journal of Alzheimer's Disease, vol. 96, no. 3, pp. 1083-1096, 2023