International Journal of Clinical Case Reports, 2025, Vol.15, No.1, 12-23 http://medscipublisher.com/index.php/ijccr 18 support and resources, helping caregivers navigate the complexities of dementia care more effectively (Müller et al., 2017; Moore and Crawley, 2020; Gonella et al., 2021). 8 Evaluation of the Effectiveness of Integrated Care Interventions 8.1 Improvement in quality of life Integrated care interventions have shown significant improvements in the quality of life for dementia patients. Studies indicate that nurse-led interventions and systematic nursing care can enhance daily living abilities and overall life satisfaction. For instance, a study found that patients receiving systematic nursing interventions had higher scores on the Barthel index and SF-36, indicating better daily activity function and quality of life compared to those receiving routine care (Zheng et al., 2021). Similarly, another study reported that rehabilitation nursing interventions significantly improved the Mini-Mental State Examination (MMSE) and daily life ability scale (ADL) scores, reflecting enhanced cognitive function and self-care abilities (Yuan et al., 2012). These findings underscore the positive impact of comprehensive nursing interventions on the quality of life for dementia patients. 8.2 Behavioral and emotional improvements Behavioral and emotional improvements are critical outcomes of integrated care interventions. Nurse-led interventions have been particularly effective in alleviating depression and improving overall mental health. A meta-analysis highlighted that such interventions significantly reduced depression levels in dementia patients (Huang et al., 2023). Additionally, person-centered care approaches have been shown to reduce agitation and neuropsychiatric symptoms, including anxiety and aggressive behavior. For example, the WHELD intervention, which includes person-centered care and psychosocial activities, demonstrated significant reductions in agitation and overall neuropsychiatric symptoms (Table 1) (Ballard et al., 2018). These interventions not only improve the emotional well-being of patients but also contribute to a more stable and supportive care environment. Table1 Effect estimates of the WHELD intervention in comparison to treatment as usual for key outcome measures (multiple imputation analysis): Sub-analysis evaluating impact of WHELD in mild to moderate, moderately severe, and severe dementia (Adopted from Ballard et al., 2018) Outcome Adjusted effect (SE) p-Value Mean difference (SEM) 95% confidence interval of mean difference DEMQOL-Proxy Severe dementia R=0.00; Z=0.03 0.97 -0.06 (1.72) -3.43, 3.32 Moderately severe dementia R=0.20; Z=3.62 <0.001 4.28 (1.16) 2.01, 6.56 Mild to moderate dementia R=0.06; Z=0.61 0.54 1.11 (1.83) -2.47, 4.69 CMAI Severe dementia R=-0.06; Z=0.55 0.58 -2.24 (4.05) -10.17, 5.69 Moderately severe dementia R=-0.12; Z=2.08 0.04 -4.52 (2.17) -8.77, -0.27 Mild to moderate dementia R=-0.18; Z=1.93 0.05 -4.57 (2.34) -9.15, 0.01 NPI-NH Severe dementia R=0.19; Z=1.91 0.05 -5.73 (2.90) -11.42, -0.04 Moderately severe dementia R=0.15; Z=2.74 0.006 -4.83 (1.75) -8.26, -1.39 Mild to moderate dementia R=0.14; Z=1.54 0.13 -3.05 (1.99) -6.94, 0.84 Note: *Adjusted effect takes into account baseline value, age, sex, Clinical Dementia Rating, site, and clustering within care homes; CMAI, Cohen-Mansfield Agitation Inventory; NPI-NH, Neuropsychiatric Inventory-Nursing Home Version (Adopted from Ballard et al., 2018) 8.3 Changes in cognitive function The impact of integrated care interventions on cognitive function has been mixed. While some studies report significant improvements, others show limited effects. For instance, systematic nursing interventions have been found to improve cognitive function as measured by the Montreal Cognitive Assessment Scale (MoCA) (Zheng et al., 2021). However, a meta-analysis of nurse-led interventions indicated that while these interventions were effective in improving quality of life and reducing depression, they did not significantly enhance cognitive
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