D-CARE (community-based care)
Trial question
What is the role of community-based care in community-dwelling persons living with dementia?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
57.0% female
43.0% male
N = 1160
1160 patients (660 female, 500 male).
Inclusion criteria: community-dwelling persons living with dementia and their caregivers.
Key exclusion criteria: nursing home resident; hospice care; paid caregiver not a relative or close friend; cognitively impaired caregiver; unwilling or unable to provide self-reported outcome measures for 18 months.
Interventions
N=1016 community-based care (care provided by a social worker, nurse, or licensed therapist care consultant).
N=144 usual care (care corresponding to traditional care).
Primary outcome
Least squares means for Neuropsychiatric Inventory Questionnaire severity score
9.5 points
10.1 points
10.1 points
7.6 points
5.0 points
2.5 points
0.0 points
Community-based
care
Usual
care
No significant
difference ↔
No significant difference in least squares means for Neuropsychiatric Inventory Questionnaire severity score (9.5 points vs. 10.1 points; MD -0.62, 95% CI -1.61 to 0.37).
Secondary outcomes
No significant difference in least squares means for Modified Caregiver Strain Index (10.5 points vs. 10.6 points; MD -0.1, 95% CI -0.94 to 0.74).
No significant difference in PHQ-8 score (4.42 points vs. 4.69 points; MD -0.27, 95% CI -0.81 to 0.27).
Significant increase in Caregiver Self-Efficacy score (15.2 points vs. 14.4 points; MD 0.85, 95% CI 0.42 to 1.29).
Safety outcomes
No significant difference in death and hospitalizations.
Conclusion
In community-dwelling persons living with dementia and their caregivers, community-based care was not superior to usual care with respect to least squares means for Neuropsychiatric Inventory Questionnaire severity score.
Reference
David B Reuben, Thomas M Gill, Alan Stevens et al. Health System, Community-Based, or Usual Dementia Care for Persons With Dementia and Caregivers: The D-CARE Randomized Clinical Trial. JAMA. 2025 Mar 18;333(11):950-961.
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