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A cluster-randomised trial of staff education to improve the quality of life of people with dementia living in residential care: the DIRECT study


Beer, Christopher, Horner, Barbara, Flicker, Leon, Scherer, Samuel, Lautenschlager, Nicola T., Bretland, Nick, Flett, Penelope, Schaper, Frank, Almeida, Osvaldo P.


Plos One, Volume: 6, No.: 11, Pages.: e28155-e28155

Year of Publication



Background: The Dementia In Residential care: EduCation intervention Trial (DIRECT) was conducted to determine if delivery of education designed to meet the perceived need of GPs and care staff improves the quality of life of participants with dementia living in residential care.; Methodology/principal Findings: This cluster-randomised controlled trial was conducted in 39 residential aged care facilities in the metropolitan area of Perth, Western Australia. 351 care facility residents aged 65 years and older with Mini-Mental State Examination ≤ 24, their GPs and facility staff participated. Flexible education designed to meet the perceived needs of learners was delivered to GPs and care facility staff in intervention groups. The primary outcome of the study was self-rated quality of life of participants with dementia, measured using the QOL-Alzheimer’s Disease Scale (QOL-AD) at 4 weeks and 6 months after the conclusion of the intervention. Analysis accounted for the effect of clustering by using multi-level regression analysis. Education of GPs or care facility staff did not affect the primary outcome at either 4 weeks or 6 months. In a post hoc analysis excluding facilities in which fewer than 50% of staff attended an education session, self-rated QOL-AD scores were 6.14 points (adjusted 95%CI 1.14, 11.15) higher at four-week follow-up among residents in facilities randomly assigned to the education intervention.; Conclusion: The education intervention directed at care facilities or GPs did not improve the quality of life ratings of participants with dementia as a group. This may be explained by the poor adherence to the intervention programme, as participants with dementia living in facilities where staff participated at least minimally seemed to benefit.; Trial Registration: ACTRN12607000417482.;

Bibtex Citation

@article{Beer_2011, doi = {10.1371/journal.pone.0028155}, url = {}, year = 2011, month = {nov}, publisher = {Public Library of Science ({PLoS})}, volume = {6}, number = {11}, pages = {e28155}, author = {Christopher Beer and Barbara Horner and Leon Flicker and Samuel Scherer and Nicola T. Lautenschlager and Nick Bretland and Penelope Flett and Frank Schaper and Osvaldo P. Almeida}, editor = {Rochelle E. Tractenberg}, title = {A Cluster-Randomised Trial of Staff Education to Improve the Quality of Life of People with Dementia Living in Residential Care: The {DIRECT} Study}, journal = {{PLoS} {ONE}} }


adult, aged, aged, 80 and over, dementia, demography, education, guideline adherence, health care surveys, humans, medical staff, methods, middle aged, nursing, quality of life, residential facilities, standards, western australia

Countries of Study


Types of Dementia

Dementia (general / unspecified)

Types of Study

Cluster RCT

Type of Outcomes

Quality of Life of Person With Dementia


Nursing Homes

Type of Interventions

Workforce oriented interventions

Workforce Interventions

Professional Training / Continuing Professional Development