Skip to main content

Research Repository

Advanced Search

The Cognitive Daisy (COG-D) for improving care for residents with dementia in care homes: protocol of a feasibility RCT

Pollux, Petra M.J.; Surr, Claire; Cohen, Judith; Huang, Chao; Wolverson, Emma; Mountain, Pauline; Turner, Rebecca; Hawkesford-Webb, Emma; Winter, Bethany; Hudson, John M.


Petra M.J. Pollux

Claire Surr

Profile Image

Dr Emma Wolverson
Reader in Ageing and Dementia. Research Lead for Dementia UK.

Pauline Mountain

Rebecca Turner

Emma Hawkesford-Webb

Bethany Winter

John M. Hudson


Background: Cognitive problems associated with dementia affect a large proportion of older adults living in residential care. Knowledge of cognitive impairments is important for providing person-centred care (PCC). The impact of specific cognitive impairments on residents’ needs is often overlooked in dementia training and information about residents’ individual cognitive profiles are frequently underspecified in care-plans, potentially undermining the delivery of PCC. This can lead to reduced resident quality of life and increased distressed behaviours—a major cause of staff stress and burnout. The COG-D package was developed to fill this gap. Daisies provide a visual representation of a resident’s individual cognitive strengths and weaknesses in a colourful flower (Daisy) representing five cognitive domains. By viewing a resident’s Daisy, care-staff can flexibly adjust in-the-moment care-decisions and can consult Daisies in care-plans for longer-term planning. The primary aim of this study is to assess the feasibility of implementing the COG-D package in residential care homes for older adults. Methods/design: This 24-month feasibility cluster randomized controlled trial involves a 6-month intervention of the use of Cognitive Daisies in 8–10 residential care homes for older adults after training of care staff on the use of Cognitive Daisies in daily care (basic training) and on conducting the COG-D assessments with residents (advanced training). The key feasibility outcomes include % residents recruited, % COG-D assessments completed, and % staff completing the training. Candidate outcome measures for residents and staff will be obtained at baseline, and at 6 and 9months post-randomization. COG-D assessments of residents will be repeated 6months after the first assessment. A process evaluation will assess intervention implementation and barriers and facilitators to this through care-plan audits, interviews and focus groups with staff, residents, and relatives. Feasibility outcomes will be analysed against progression criteria to a full trial. Discussion: The results of this study will provide important information about the feasibility of using COG-D in care homes and will inform the design of a future large-scale cluster RCT to assess the effectiveness and cost-effectiveness of the COG-D intervention in care homes. Trial registration: This trial was registered on 28/09/2022 (ISRCTN15208844) and is currently open to recruitment.


Pollux, P. M., Surr, C., Cohen, J., Huang, C., Wolverson, E., Mountain, P., …Hudson, J. M. (2023). The Cognitive Daisy (COG-D) for improving care for residents with dementia in care homes: protocol of a feasibility RCT. Pilot and Feasibility Studies, 9(1), Article 34.

Journal Article Type Article
Acceptance Date Jan 31, 2023
Online Publication Date Mar 3, 2023
Publication Date Dec 1, 2023
Deposit Date Mar 3, 2023
Publicly Available Date Mar 13, 2023
Journal Pilot and Feasibility Studies
Electronic ISSN 2055-5784
Publisher BioMed Central
Peer Reviewed Not Peer Reviewed
Volume 9
Issue 1
Article Number 34
Keywords Dementia; Person-centred care; Cognition-focussed assessment and care-planning; Care homes
Public URL


Published article (2.2 Mb)

Publisher Licence URL

Copyright Statement
© The Author(s) 2023.
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated in a credit line to the data.

You might also like

Downloadable Citations