Development of a Care Model for Elderly with Late-Stage Dementia Using Family and Community-Based Approaches

Abstract

Introduction: Late-stage dementia places substantial burdens on caregivers and families, yet Thailand lacks a clearly defined community-based care model for this population.

Research objectives: 1) To survey the situation and care needs of elderly with late-stage dementia; 2) To develop a family and community-based care model; and 3) To evaluate its effectiveness.

Research methodology: This research and development study was conducted in selected community  in Pathumthani Province (February–August 2025) across three phases. Phase 1 (situation analysis, 8 weeks): 100 participants across five groups (elderly persons, caregivers, community members, community leaders/village health volunteers, and healthcare personnel; 20 per group). Phase 2 (model development, 12 weeks): 20 experts and community leaders using the PAOR cycle. Phase 3 (implementation and evaluation, 4 weeks): 60 participants comprising caregivers of elderly with late-stage dementia, elderly persons, and community leaders/village health volunteers (20 per group) selected by purposive sampling. Instruments included a knowledge questionnaire (KR-20 = .82), care ability assessment (α = .89), and satisfaction questionnaire (α = .91), analyzed using descriptive statistics, paired t-test, and Cohen's d.

Results: Focus groups revealed that most caregivers lacked knowledge and skills for late-stage dementia care and experienced high caregiver burden. The developed model comprised five components: patient and family assessment, knowledge and skills training, symptom management, multidisciplinary team coordination, and community support networks. Post-implementation, participants showed significantly higher knowledge and care ability scores (both p < .05, medium effect sizes), and reported high overall satisfaction (M = 85, SD = 9.60).

Conclusions: This family and community-based care model effectively improved caregiver knowledge and care abilities and may be adapted for communities with similar contexts.

Implications: The model may be implemented by community health units, nursing institutions, and local authorities to improve late-stage dementia care.