A cluster randomised controlled trial to reduce the unmet needs of people with dementia living in residential care Martin Orrell 1 * , Geraldine Hancock 1 , Juanita Hoe 1 , Bob Woods 2 , Gill Livingston 1 and David Challis 3 1 Department of Mental Health Sciences, University College London, London, UK 2 DSDC, University of Wales Bangor, Bangor, UK 3 PSSRU, School of Medicine, University of Manchester, Manchester, UK SUMMARY Background Older people with dementia living in residential care have complex unmet needs and decreased quality of life. Aim To reduce unmet needs in older people with dementia in residential care compared to a ‘care as usual’ control group. Method A single blind, multicentre, cluster randomised controlled trial recruited 238 people aged 60þ with dementia living in 24 residential homes from three areas. Unmet needs were measured using the Camberwell Assessment of Needs for the Elderly (CANE) and quality of life using the Quality of Life in Alzheimer’s Disease (QoL-AD). Homes were randomised to the control (care as usual) or the intervention group 1 hour per week liaison input per home to deliver a personalised intervention package over a 20 weeks to meet the unmet needs. Results A single blind follow-up included 192 (81%) available participants. At follow-up the total number of unmet needs was reduced in both the intervention and control groups, but analysing the groups by clusters there were no significant differences in either unmet needs or quality of life. Conclusions The unmet needs of people with dementia can be identified using the CANE. The CANE assessment may have led to unmet needs being reduced at follow up, but the liaison intervention did not significantly reduce total unmet needs relative to the control group. Unmet needs such as sensory problems, mobility, drugs, and psychological distress were especially reduced in the intervention group at follow up. Copyright # 2007 John Wiley & Sons, Ltd. key words — dementia; needs; older people; CANE; interventions; residential care INTRODUCTION Approximately 75% of older people living in care homes in the UK have dementia (Macdonald et al., 2002). People who live in residential care are also frailer and more dependent than ever before (Stern et al., 1993; Martin et al., 2002). People with deme- ntia in care homes have varied and complex needs (Hancock et al., 2006) which may have proved difficult to meet at home. The National Service Framework for Older People (Department of Health, 2001) states that individuals should receive care packages that provide for their individual needs, regardless of their living situation or mental health status. However, care homes have not specifically been designed to provide care for people with complex needs such as those with severe dementia. This means that residents with dementia often have multiple unmet needs (Martin et al., 2002) such as inadequate daytime activities, isolation and anxiety and depres- sion (Hancock et al., 2006). Unmet needs can lead to decreased quality of life and increased costs of care (UK 700 Group, 1999; Mozley et al., 2004). At present we do not know whether these complex unmet needs can be met within the residential care setting. The aim of this study was to evaluate whether, in comparison with usual care, a liaison outreach intervention would INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY Int. J. Geriatr. Psychiatry 2007; 22: 1127–1134. Published online 29 March 2007 in Wiley InterScience (www.interscience.wiley.com) DOI: 10.1002/gps.1801 *Correspondence to: Prof. M. Orrell, Department of Mental Health Sciences, University College London, Charles Bell House, 67-73 Riding House Street, London, W1W 7EY 8AA, UK. E-mail: m.orrell@ucl.ac.uk Copyright # 2007 John Wiley & Sons, Ltd. Received 9 August 2006 Accepted 13 February 2007