Recommendations for research
The guideline committee has made the following recommendations for research. The committee's full set of research recommendations is detailed in the full guideline.
What is the effectiveness and cost effectiveness of high-intensity case management compared with usual care on quality of life (for the person living with dementia and for their carers) and the timing of entry to long-term care?
There is evidence that case management is an effective intervention for people living with dementia. However, the effectiveness and cost effectiveness of high-intensity case management has not been tested in the UK. It has a high upfront cost, but there is some evidence from settings outside the UK that it may reduce the use of other services, leading to cost savings across the whole system. Because of the cost, robust evidence of effectiveness and cost effectiveness from a UK setting is needed.
What is the cost effectiveness of using a dementia-specific addition to the Care Certificate for community staff, including dementia-specific elements on managing anxiety, communication, nutritional status and personal care?
Robust evidence demonstrates the effectiveness of intensive training for staff heavily involved in providing care and support for people living with dementia. However, it is not clear if it is effective to provide basic training to all staff who come into contact with people living with dementia, or how this training should be provided. One possibility is an expanded version of the Care Certificate that includes additional dementia-specific elements. Because this training would need to be given to a large number of staff, there needs to be good evidence of benefits, specifically in improving quality of life for people living with dementia and their carers, to justify the upfront costs.
Does actively reducing anticholinergic burden in people living with dementia improve cognitive outcomes compared with usual care?
Many people living with dementia are still prescribed medicines with a high anticholinergic burden (which can be caused by individual medicines or by combinations of medicines). It is often unclear if this prescribing is appropriate, or whether actively reducing the number of these medicines would improve cognition. Randomised controlled trials could be conducted, using structured tools to assess anticholinergic burden and actively switching medicines if possible. This would help to identify whether cognition can be improved without adversely affecting the management of the conditions these medicines are prescribed for.
What are the most clinically and cost-effective non-pharmacological interventions for helping the long-term recovery of people with delirium superimposed on dementia?
The acute management of delirium superimposed on dementia is likely to be similar to the management of delirium in people without dementia. However, there may be differences in the interventions needed to aid long-term recovery, particularly because people with different severities of dementia will have different baseline cognitive status. Research on the most effective non-pharmacological methods of promoting long-term recovery would help to identify whether alternative approaches are needed for people living with dementia.
What are the most effective methods of care planning for people who do not have regular contact with an informal carer?
Many randomised controlled trials of care planning or case management specifically exclude people without an informal carer. Conducting similar studies on case management and care planning for people without an informal carer would fill this gap in the evidence base, and help to identify whether these people have different needs.