Does telecare prolong community living in dementia? A study protocol for a pragmatic, randomised controlled trial
1 Institute of Brain, Behaviour and Mental Health, University of Manchester, Jean McFarlane Building, 3rd floor, Oxford Rd, Manchester M13 9PL, UK
2 Faculty of Health & Life Sciences, Charles Ward Building, Coventry University, Coventry CV1 5FB, UK
3 Department of Old Age Psychiatry, King’s College London, Institute of Psychiatry, De Crespigny Park, Box 070, London SE5 8AF, UK
4 Department of Old Age Psychiatry, Institute of Psychiatry, De Crespigny Park, Box 070, London SE5 8AF, UK
5 South London & Maudsley NHS Foundation Trust, 115 Denmark Hill, The Maudsley, London SE5 8AZ, UK
6 School of Medicine, Health Policy and Practice, University of East Anglia, Norwich, Norfolk NR4 7TJ, UK
7 Department of Psychiatry, University of Cambridge, Level E4, Box 189, Addenbrookes Hospital, Hills Road, Cambridge CB2 0QQ, UK
8 Oliver Zangwill Centre for Neuropsychological Rehabilitation, Princess of Wales Hospital, Ely CB6 1DN, UK
9 School of Allied Health Professionals, University of East Anglia, Norwich, Norfolk NR7 4TJ, UK
10 The Barberry Centre, 25 Vincent Drive, Birmingham B15 2FG, UK
11 School of Community Based Medicine, University of Manchester, Jean McFarlane Building, 3rd floor, Oxford Rd, Manchester M139PL, UK
12 School of Community and Health Science, City University, University Building A224, St John St, London EC1V 0HB, UK
13 Queen Margaret University, Edinburgh EH21 6UU, UK
14 Clinical Trial Service Unit, Richard Doll Building, Old Road Campus, Roosevelt Drive, Oxford OX3 7TF, UK
15 Personal Social Services Research Unit, London School of Economics and Political Science, Houghton St, London WC2A 2AE, UK
16 School of Community and Health Sciences, City University, Northampton Square, London EC1V 0HB, UK
17 Oxfordshire & Buckinghamshire Mental Health NHS Foundation Trust, Warneford Hospital, Old Road, Headington, Oxford OX3 7JX, UK
18 Centre for Mental Health, Imperial College London, Claybrook Centre, Charing Cross Campus 37 Claybrook Rd, London W6 8LN, UK
Trials 2013, 14:349 doi:10.1186/1745-6215-14-349Published: 23 October 2013
Assistive technology and telecare (ATT) are relatively new ways of delivering care and support to people with social care needs. It is claimed that ATT reduces the need for community care, prevents unnecessary hospital admission, and delays or prevents admission into residential or nursing care. The current economic situation in England has renewed interest in ATT instead of community care packages. However, at present, the evidence base to support claims about the impact and effectiveness of ATT is limited, despite its potential to mitigate the high financial cost of caring for people with dementia and the social and psychological cost to unpaid carers.
ATTILA (Assistive Technology and Telecare to maintain Independent Living At Home for People with Dementia) is a pragmatic, multi-centre, randomised controlled trial over 104 weeks that compares outcomes for people with dementia who receive ATT and those who receive equivalent community services but not ATT. The study hypothesis is that fewer people in the ATT group will go into institutional care over the 4-year period for which the study is funded. The study aims to recruit 500 participants, living in community settings, with dementia or significant cognitive impairment, who have recently been referred to social services.
Primary outcome measures are time in days from randomisation to institutionalisation and cost effectiveness. Secondary outcomes are caregiver burden, health-related quality of life in carers, number and severity of serious adverse events, and data on acceptability, applicability and reliability of ATT intervention packages. Assessments will be undertaken in weeks 0 (baseline), 12, 24, 52 and 104 or until institutionalisation or withdrawal of the participant from the trial.
In a time of financial austerity, CASSRs in England are increasingly turning to ATT in the belief that it will deliver good outcomes for less money. There is an absence of robust evidence for the cost-effectiveness and benefit of using assistive technology and telecare. The ATTILA trial meets a pressing need for robust, generalisable evidence to either justify continuing investment or reappraise the appropriate scale of ATT use.
Current Controlled Trials ISRCTN86537017