This is disappointing but probably reflects a recognised problem in the uptake of people from black, Asian and minority ethnic communities of mainstream dementia services.įrom a technical point of view, when the critical appraisal skills programme (CASP) ‘questions to help you make sense of a trial’ are applied this paper comes out well: clearly focused issue, randomised assignment to intervention, groups all similar, well matched for age, ethnicity, marital status and gender, all participants accounted for at the end. Secondly, the participants in this study were 96% white ethnicity.The average age of the people with dementia is 77.5 years old which is an older cohort, so the results can’t be taken as applying to people with young onset dementia.However, apart from the lack of cost effectiveness, there are two main limitations of this study when considering applying the findings to practice: The study broadly satisfies the CASP criteria for economic evaluation. These results should encourage reappraisal of the move towards encouraging joint interventions which reflect the current emphasis on relationship centred care…the expectation that interventions in dementia care should always have a sustained benefit outside the immediate context may also need to be re considered… (p17) Strengths and limitations
REMINISCE GROUP TRIAL
This trial does not support the clinical effectiveness or cost-effectiveness of joint reminiscence groups. This trial found that the possible benefits of reminiscence groups for people with dementia were offset by raised anxiety and stress in their carers.
REMINISCE GROUP FULL
The study reports useful cost data for RYCT, but that full results for the cost-effectiveness analysis were not presented because the intervention was not found to be effective. However, there is also a significant increase in carer stress and anxiety with more sessions attended at ten months.
They also report a significant increase in self-reported quality of life for people with dementia at 10 months, which was linked with the number of sessions attended.Autobiographical memory for people with dementia and the quality of carer/patient relationships was better at 3 months in those who attended more regularly.70% (245 pairs) attended at least 6 groups over the 12 weeks but this reduced for follow up attendance where 57% attended at least 3 of the 7 follow up sessions.The cost-effectiveness analysis used conventional methods except that it was conducted from a perspective that is not societal, but instead incorporates both NHS and local government costs. Adherence checklists by the facilitators and meetings with the trainer in different centres helped maintain consistency between the groups. This was followed by seven monthly maintenance group sessions. school days, working life or holidays), utilising a variety of methods such as art, re-enactment of memories and singing. There were 12 sessions over 12 consecutive weeks focused on different themes (e.g.
REMINISCE GROUP MANUAL
It is reported that the reminiscence group (of 2 hours duration) was delivered by two trained facilitators using the ‘Remembering Yesterday, Caring Today’ (RYCT) manual developed ‘in the trial platform for this study’. The assessments were conducted at baseline, three months and then again at a ten month follow up. stress, cognition, autobiographical memory). quality of life and carer mental health) and another nine to assess secondary outcomes (e.g. Two standardised tools were utilised to assess primary outcomes (i.e.
350 pairs (spousal or non-spousal dyads) who had been randomly allocated to reminiscence group work (intervention) or to carry on with their care as usual (control group) completed the study. People with dementia and carers were recruited over time (3-5 waves) from mainly community mental health services and third sector organisations in Manchester, Hull, Bangor, Bradford, London and Newport.
Reminiscence groups work with early memories, often intact in dementia, drawing on preserved abilities, rather than emphasising impairments.
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