Pollux Petra M J, Surr Claire, Cohen Judith, Huang Chao, Wolverson Emma, Mountain Pauline, Clarke Rebecca, Hawkesford-Webb Emma, Winter Bethany, Hudson John M
University of Lincoln, Campus Way, Lincoln, LN6 7 TS, UK.
City Campus University of Leeds-Beckett, Calverley, 521, Leeds, LS18 4RQ, UK.
Pilot Feasibility Stud. 2025 May 10;11(1):66. doi: 10.1186/s40814-025-01637-1.
Many residents in care homes for older adults live with dementia. Understanding the unique profiles of cognitive impairments for each resident is important for person-centred care, yet information about specific cognitive problems is limited, and knowledge varies. This study explored the feasibility of implementing the Cognitive Daisy (COG-D) intervention, which provide a visual summary in the shape of a 15-petal flower derived from the scores on a neuropsychological assessment battery, in care homes for older adults.
A parallel-group feasibility cluster randomised controlled trial (cRCT) was conducted over 24 months. Eight care homes were randomised in a 1:1 ratio to either usual care plus the Cognitive Daisy intervention (COG-D) or usual care (control). Care staff were trained on how to use Cognitive Daisies and/or on how to conduct the COG-D assessments with residents. Cognitive Daisies were displayed in residents' rooms and included in care plans. COG-D assessments were repeated after 6 months. The primary objective was to explore areas of uncertainty for a future large-scale trial including recruitment rates and intervention implementation and adherence. Secondary objectives were to explore signals of effects in candidate outcome measures for residents and staff, obtained at baseline and 6- and 9-month post-randomisation. A process evaluation explored barriers and facilitators to intervention implementation through care-plan audits (to explore recommendations in response to COG-D assessments), interviews and focus groups with staff, residents and relatives.
Resident recruitment (n = 115) and staff recruitment (n = 99) in 8 care homes exceeded targets (100 and 50, respectively, in 8-10 care homes). Staff training was perceived positively with high completion rates (77.1% and 83.3% for basic and advanced training, respectively). Completion rates were also high for COG-D assessments (75.5% for assessment 1, and 72.5% of these residents completed assessment 2), and COG-D scores remained stable across the two assessment points. No clear signals of effects were found for candidate outcome measures. Number of recommendations in care plans varied across care homes, and interviews/focus groups highlighted several barriers to staff's use of the Cognitive Daisies in daily practice.
Findings indicate trial delivery was feasible. However, the COG-D requires modification if it is to be feasibly implemented in care home settings.
This trial was registered on (date) (ISRCTN15208844).
许多养老院中的老年人患有痴呆症。了解每位居民认知障碍的独特特征对于以患者为中心的护理很重要，但有关特定认知问题的信息有限，且知识水平参差不齐。本研究探讨了在老年人护理院中实施认知雏菊（COG-D）干预措施的可行性，该干预措施以一朵由神经心理评估量表得分衍生出的15瓣花朵的形式提供视觉总结。
进行了一项为期24个月的平行组可行性整群随机对照试验（cRCT）。八所养老院以1:1的比例随机分为接受常规护理加认知雏菊干预（COG-D）组或常规护理组（对照组）。护理人员接受了如何使用认知雏菊和/或如何对居民进行COG-D评估的培训。认知雏菊展示在居民房间并纳入护理计划。6个月后重复进行COG-D评估。主要目标是探索未来大规模试验中存在不确定性的领域，包括招募率、干预措施的实施和依从性。次要目标是探索在基线以及随机分组后6个月和9个月时获得的居民和工作人员候选结局指标中的效应信号。一项过程评估通过护理计划审核（以探索针对COG-D评估的建议）、与工作人员、居民和亲属进行访谈及焦点小组讨论，探讨了干预措施实施的障碍和促进因素。
八所养老院的居民招募（n = 115）和工作人员招募（n = 99）超过了目标（分别为8 - 10所养老院中的100人和50人）。工作人员培训得到了积极评价，完成率很高（基础培训和高级培训的完成率分别为77.1%和83.3%）。COG-D评估的完成率也很高（评估1的完成率为75.5%，其中72.5%的居民完成了评估2），并且COG-D分数在两个评估点保持稳定。在候选结局指标中未发现明显的效应信号。护理计划中的建议数量因养老院而异，访谈/焦点小组讨论突出了工作人员在日常实践中使用认知雏菊的几个障碍。
研究结果表明试验实施是可行的。然而，如果要在养老院环境中切实可行地实施COG-D，则需要进行修改。
本试验于（日期）注册（ISRCTN15208844）。
