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Health System, Community-Based, or Usual Dementia Care for Persons With Dementia and Caregivers: The D-CARE Randomized Clinical Trial
Reuben DB, Gill TM, Stevens A, Williamson J, Volpi E, Lichtenstein M, Jennings LA, et al.. JAMA, 2025-03-18
Topic: Risk, prevention and care in population studies
Results Among 2176 dyads (individuals with dementia, mean age, 80.6 years; 58.4%, female; and 20.6%, Black or Hispanic; caregivers, mean age, 65.2 years; 75.8%, female; and 20.8% Black or Hispanic), primary outcomes were assessed for more than 99% of participants, and 1343 participants (62% of those enrolled and 91% still alive and had not withdrawn) completed the study through 18 months. No significant differences existed between the 2 treatments or between treatments vs usual care for the primary outcomes. Overall, the least squares means (LSMs) for NPI-Q scores were 9.8 for health system, 9.5 for community-based, and 10.1 for usual care. Only the secondary outcome of caregiver self-efficacy was significantly higher for both treatments vs usual care but not between treatments: LSMs were 15.1 for health system, 15.2 for community-based, and 14.4 for usual care. Conclusions and relevance In this randomized trial of dementia care programs, no significant differences existed between health system-based and community-based care interventions nor between either active intervention or usual care regarding patient behavioral symptoms and caregiver strain.
Key findings
- Results Among 2176 dyads (individuals with dementia, mean age, 80.6 years; 58.4%, female; and 20.6%, Black or Hispanic; caregivers, mean age, 65.2 years; 75.8%, female; and 20.8% Black or Hispanic), primary outcomes were assessed for more than 99% of participants, and 1343 participants (62% of those enrolled and 91% still alive and had not withdrawn) completed the study through 18 months.
- No significant differences existed between the 2 treatments or between treatments vs usual care for the primary outcomes.
- Overall, the least squares means (LSMs) for NPI-Q scores were 9.8 for health system, 9.5 for community-based, and 10.1 for usual care.
- Only the secondary outcome of caregiver self-efficacy was significantly higher for both treatments vs usual care but not between treatments: LSMs were 15.1 for health system, 15.2 for community-based, and 14.4 for usual care.
- Conclusions and relevance In this randomized trial of dementia care programs, no significant differences existed between health system-based and community-based care interventions nor between either active intervention or usual care regarding patient behavioral symptoms and caregiver strain.
Why it matters
Neither health system-based nor community-based dementia care differed significantly from usual care, or from each other, on patient behavioral symptoms and caregiver strain. Only caregiver self-efficacy was significantly higher for both treatments versus usual care, so the main goals of the programs were not met.
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Study details
- Study designRCT
- Participants2,176
- Effect sizeNPI-Q difference health-system vs community 0.30 (97.5% CI -0.18 to 0.78); caregiver self-efficacy vs usual care +0.70 (health system) and +0.85 (community), both significant
- Evidence strengthHigh
Limitations
Usual-care arm was small (n=144) limiting power for that comparison; outcomes were caregiver-reported; 18-month horizon; conducted partly during the COVID-19 pandemic.
How this study scored 79/100
Published in a top-tier journal, and it is a randomised controlled trial. We have no data on senior author's track record and free to read, so those were left out: it earned 74 of the 94 points we could judge it on, which is 79 out of 100.
| Component | Points | Why |
|---|---|---|
| Journal tier | 10 / 10 | Tier 1 — top-tier general journal (JAMA) |
| Journal's citation record | 4 / 4 | JAMA: journal h-index 1,011 (OpenAlex, 2026-10-29) |
| Study design | 11 / 12 | A randomised controlled trial |
| Strength of evidence | 5 / 5 | Rated “high” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 4 / 5 | 2025 — within 3 year(s) of the newest study here |
| Sample size | 3 / 4 | 2,176 participants |
| Effect reported | 3 / 3 | Effect reported with a statistic (interval, p-value, ratio or similar) |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 1 / 2 | Randomised (as stated in the record) |
| Times cited | 3 / 7 | Cited 27 times (OpenAlex, 2026-10-10) |
| Citations per year | 3 / 5 | 9.0 citations a year over 3 year(s) since 2025 |
| Impact for its field and year | 4 / 6 | Cited 17.2× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 1 / 6 | Cited by 2 other studies in this library |
| Still being cited | 2 / 4 | Cited 27 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | — / 4 | Senior author's record not available — left out of this score |
| Institution's track record | 2 / 3 | Yale University: institution h-index 1,927 (OpenAlex) |
| Multi-centre collaboration | 3 / 3 | OpenAlex lists 12 institution(s) in 1 country |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 39878968) |
| Free to read | — / 2 | Access not recorded — left out of this score |
| Points | 74 / 94 | Scored on 18 of 20 parts. We have no data for the rest, so they are left out: 74 of the 94 points we could judge it on is 79 out of 100. |
| Total | 79 / 100 | — |
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Read the original
Full text: free to read — PubMed Central lists this copy as free to read: the link above (checked 10 Oct 2026).
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. The record's author list ends in “et al.”, so not every author is named. Check the citation against the original before you use it.
APA 7th
Reuben, D. B., Gill, T. M., Stevens, A., Williamson, J., Volpi, E., Lichtenstein, M., et al. (2025). Health System, Community-Based, or Usual Dementia Care for Persons With Dementia and Caregivers: The D-CARE Randomized Clinical Trial. JAMA. https://doi.org/10.1001/jama.2024.25056
Vancouver
Reuben DB, Gill TM, Stevens A, Williamson J, Volpi E, Lichtenstein M, et al. Health System, Community-Based, or Usual Dementia Care for Persons With Dementia and Caregivers: The D-CARE Randomized Clinical Trial. JAMA. 2025. doi:10.1001/jama.2024.25056. PMID: 39878968.
BibTeX
@article{reuben2025-39878968,
author = {Reuben, D. B. and Gill, T. M. and Stevens, A. and Williamson, J. and Volpi, E. and Lichtenstein, M. and Jennings, L. A. and others},
title = {{Health System, Community-Based, or Usual Dementia Care for Persons With Dementia and Caregivers: The D-CARE Randomized Clinical Trial}},
journal = {JAMA},
year = {2025},
doi = {10.1001/jama.2024.25056},
pmid = {39878968},
url = {https://doi.org/10.1001/jama.2024.25056}
}
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