Design and Implementation of a Smart Home in a Box to Monitor the Wellbeing of Residents With Dementia in Care Homes

There is a global challenge related to the increasing number of People with Dementia (PwD) and the diminishing capacity of governments, health systems, and caregivers to provide the best care for them. Cost-effective technology solutions that enable and ensure a good quality of life for PwD via monitoring and interventions have been investigated comprehensively in the literature. The objective of this study was to investigate the challenges with the design and deployment of a Smart Home In a Box (SHIB) approach to monitoring PwD wellbeing within a care home. This could then support future SHIB implementations to have an adequate and prompt deployment allowing research to focus on the data collection and analysis aspects. An important consideration was that most care homes do not have the appropriate infrastructure for installing and using ambient sensors. The SHIB was evaluated via installation in the rooms of PwD with varying degrees of dementia at Kirk House Care Home in Belfast. Sensors from the SHIB were installed to test their capabilities for detecting Activities of Daily Living (ADLs). The sensors used were: (i) thermal sensors, (ii) contact sensors, (iii) Passive Infrared (PIR) sensors, and (iv) audio level sensors. Data from the sensors were collected, stored, and handled using a ‘SensorCentral’ data platform. The results of this study highlight challenges and opportunities that should be considered when designing and implementing a SHIB approach in a dementia care home. Lessons learned from this investigation are presented in addition to recommendations that could support monitoring the wellbeing of PwD. The main findings of this study are: (i) most care home buildings were not originally designed to appropriately install ambient sensors, and (ii) installation of SHIB sensors should be adapted depending on the specific case of the care home where they will be installed. It was acknowledged that in addition to care homes, the homes of PwD were also not designed for an appropriate integration with ambient sensors. This study provided the community with useful lessons, that will continue to be applied to improve future implementations of the SHIB approach.

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Using A Smart Home In A Box To Monitor the Wellbeing of Residents with Dementia in Care Homes (Preprint)

10.2196/preprints.18375 ◽

2020 ◽

Author(s):

Matias Fernando Garcia-Constantino ◽

Jonathan Synnott ◽

Andrew Ennis ◽

Joseph Rafferty ◽

Claire Elaine Orr ◽

...

Keyword(s):

Smart Home ◽

Care Home ◽

Cost Effective ◽

Lessons Learned ◽

Care Homes ◽

Global Challenge ◽

Dementia Patients ◽

People With Dementia ◽

Challenges And Opportunities ◽

Contact Sensors

BACKGROUND There is a global challenge related to the increase in the number of people with dementia (PwD) and the diminishing capacity of governments, health systems, and caregivers to provide the best care for them. Cost-effective technology solutions that enable and ensure a good quality of life for PwD via monitoring patients and interventions have been investigated comprehensively in the literature. OBJECTIVE The objective of this study was to investigate the challenges with the design, deployment and functioning of a Smart Home In a Box (SHIB) approach to monitoring PwD wellbeing within a care home. This could then support future implementations and present further opportunities for the SHIB approach. An important consideration was that most care homes do not have the appropriate infrastructure for installing and using ambient sensors. METHODS The SHIB was evaluated via installation in the rooms of 3 PwD with varying degrees of dementia. Sensors from the SHIB were installed in the rooms of the PwD to test the capabilities of these sensors for detecting Activities of Daily Living (ADLs). The sensors used were: (i) thermal sensors, (ii) contact sensors, (iii) Passive Infrared (PIR) sensors, and (iv) audio level sensors. Data was collected, stored and handled using a ‘SensorCentral’ data platform. RESULTS This study highlighted challenges and opportunities that should be considered when installing and using a SHIB approach in a dementia care home. Lessons learned from this investigation are presented in addition to recommendations that could support the wellbeing monitoring of PwD. This study also presents results from initial data analysis and demonstrates how activities, falls and abnormal behaviors could be detected and acted upon. CONCLUSIONS This study was conducted by Ulster University’s Pervasive Computing Research Group (PCRG) as part of the Northern Ireland Connected Health Innovation Centre (NI-CHIC) project. The design, deployment and functioning of the SHIB approach within Kirk House Care Home in Belfast provided the community with useful lessons, that will continue to be applied to improve future implementations of the SHIB approach. Several challenges arose during the installation, functioning and data collection at Kirk House Care Home, for example, regarding the adaption of technology to a building that was not originally designed for the integration of ambient sensors. The main findings of this study are: (i) most care home buildings were not originally designed to appropriately install ambient sensors, and (ii) installation of SHIB sensors should be adapted depending on the specific case of the care home where they will be installed. It was acknowledged that in addition to care homes, the homes of dementia patients were also not designed for an appropriate integration with ambient sensors. Hence, another possible use of a SHIB approach.

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409 - Trends in Involvement, Perceived Role, Role Overload and Self-efficacy of Family Carers of People with Dementia in Care Homes

International Psychogeriatrics ◽

10.1017/s1041610220002628 ◽

2020 ◽

Vol 32 (S1) ◽

pp. 125-125

Author(s):

Marleen Prins ◽

Bernadette Willemse ◽

Marlous Tuithof ◽

Henriëtte van der Roest ◽

Anne Margriet Pot

Keyword(s):

Self Efficacy ◽

Care Home ◽

Care Homes ◽

Role Overload ◽

Family Carers ◽

Change Over Time ◽

Person Centered Care ◽

People With Dementia ◽

Centered Care ◽

Over Time

IntroductionThe quality of long-term care provided to people with dementia (PwD) in care homes can be improved by implementing person-centered care. Family carers of PwD living in care homes are an important part of person-centered care. However, they often experience high levels of burden, even when a family member with dementia lives in a care home. This study examines trends in the involvement of family carers and their perceived role, role overload and self-efficacy.MethodsData from the Living Arrangements for People with Dementia study, a cross-sectional monitoring study that evaluates developments in care for PwD in care homes in the Netherlands, with four measurement cycles between 2008-2017 was used. Data from the three most current measurement cycles were used, with respectively 144, 47 and 49 participating care homes and 888, 392 and 401 participating family carers. Family involvement was measured by the number of hours per week that family carers visited the PwD and the type of activities they undertook. Perceived caregiving role was measured with the Family Perceptions of Caregiving Role instrument. We used the Self-Perceived Pressure by Informal Care to measure role overload and a 37-item questionnaire was used to measure self-efficacy. We investigated the changes over time (e.g., measurement cycles) of these measures.ResultsThe number of hours that family carers visited the PwD did not change over time. However, there was a trend towards an increase in the variety of activities they undertook. Their perceived caregiving role did not change over time. Self-efficacy of family carers increased over time and they reported more feelings of role overload.ConclusionsDuring the past decade, there has been an increasing trend towards family carers doing more diverse activities with PwD in carer homes. Family carers did feel more competent in their caring role, although their feelings of role overload also increased. Continuing attention is therefore needed for the psychological well-being of family carers after a person with dementia moves to a care home.

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Olanzapine and risperidone prescriptions for people with dementia in care

Psychiatric Bulletin ◽

10.1192/pb.bp.106.012484 ◽

2007 ◽

Vol 31 (12) ◽

pp. 459-462 ◽

Cited By ~ 1

Author(s):

Darren Malone ◽

Paul Bradley ◽

James Lindesay

Keyword(s):

Older People ◽

Psychological Symptoms ◽

Care Home ◽

Cost Effective ◽

Community Mental Health Team ◽

Mental Health Team ◽

Health Team ◽

People With Dementia ◽

Audit Period ◽

Gp Care

AIMS AND METHODTo determine what has happened to care home residents with dementia who were on risperidone or olanzapine prior to the Committee on the Safety of Medicines (CSM) guidance, and to compare with a previous audit of the practice within a community mental health team (CMHT) for older people. Residents with dementia were identified from 10 randomly selected care homes in Leicestershire, and prescriptions before and 9 months after the CSM guidance were assessed. Carers were interviewed to determine who was reviewing residents and how often a review occurred.RESULTSIn total, 330 residents' medication charts were assessed; 164 (50%) had documentation which identified them as having a dementia; 75 of these residents with dementia (46%) were on an antipsychotic at some time during the audit period. Before CSM advice 69% (37 out of 54) of the antipsychotics prescribed to residents with dementia were either risperidone or olanzapine; this reduced to 39% (19 out of 49) after the CSM advice. Out of those who continued on risperidone or olanzapine, the majority were under GP care only (15 out of 19) and overwhelmingly seen on an as-required basis and infrequently. In two-thirds of cases the prescriptions for antipsychotics were for behavioural and psychological symptoms of dementia. Compared with the CMHT for older people, primary care was less successful at withdrawing risperidone or olanzapine.CLINICAL IMPLICATIONSFurther research is needed to clarify what approach would be most acceptable and cost-effective to assist British GPs in the management of this patient population.

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Comparing proxy rated quality of life of people living with dementia in care homes

Psychological Medicine ◽

10.1017/s0033291718003987 ◽

2019 ◽

Vol 50 (1) ◽

pp. 86-95 ◽

Cited By ~ 5

Author(s):

S. Robertson ◽

C. Cooper ◽

J. Hoe ◽

K. Lord ◽

P. Rapaport ◽

...

Keyword(s):

Quality Of Life ◽

Neuropsychiatric Symptoms ◽

Care Home ◽

Multilevel Modelling ◽

Native English Speakers ◽

Care Homes ◽

English Speakers ◽

People With Dementia ◽

Home Placement

AbstractBackgroundImproving quality of life (QOL) for people with dementia is a priority. In care homes, we often rely on proxy ratings from staff and family but we do not know if, or how, they differ in care homes.MethodsWe compared 1056 pairs of staff and family DEMQOL-Proxy ratings from 86 care homes across England. We explored factors associated with ratings quantitatively using multilevel modelling and, qualitatively, through thematic analysis of 12 staff and 12 relative interviews.ResultsStaff and family ratings were weakly correlated (ρs = 0.35). Median staff scores were higher than family's (104 v. 101; p < 0.001). Family were more likely than staff to rate resident QOL as ‘Poor’ (χ2 = 55.91, p < 0.001). Staff and family rated QOL higher when residents had fewer neuropsychiatric symptoms and severe dementia. Staff rated QOL higher in homes with lower staff:resident ratios and when staff were native English speakers. Family rated QOL higher when the resident had spent longer living in the care home and was a native English. Spouses rated residents’ QOL higher than other relatives. Qualitative results suggest differences arise because staff felt good care provided high QOL but families compared the present to the past. Family judgements centre on loss and are complicated by decisions about care home placement and their understandings of dementia.ConclusionProxy reports differ systematically between staff and family. Reports are influenced by the rater:staff and family may conceptualise QOL differently.

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An evaluation of group reminiscence arts sessions for people with dementia living in care homes

Dementia ◽

10.1177/1471301218787655 ◽

2018 ◽

Vol 19 (3) ◽

pp. 805-821 ◽

Cited By ~ 3

Author(s):

Frank Keating ◽

Laura Cole ◽

Robert Grant

Keyword(s):

Quality Of Life ◽

Social Inclusion ◽

Care Home ◽

Well Being ◽

Care Homes ◽

Primary Data ◽

Evaluation Team ◽

People With Dementia ◽

Group Reminiscence

Dementia has been identified as one of the major challenges in the 21st Century. The detrimental effects of dementia can jeopardise personhood, thus person-centred interventions including reminiscence and arts practice have been recommended as tools to promote social inclusion and improve the quality of life. This study aimed to evaluate the effectiveness of group reminiscence arts sessions for people living with dementia in care homes (residential and nursing homes) using a comparative and time series design to collect data on quality of life. The intervention was conducted in six care homes in London over a period of 24 weeks and compared with six care homes not receiving the intervention (control). Dementia Care Mapping was used as the primary data collection instrument to measure positive behaviours and rate quality of life before, during and after group reminiscence arts sessions. The evaluation team observed the sessions at three-weekly intervals. Statistical modelling found that positive behaviours and quality of life of care home residents participating in group reminiscence arts sessions increased over the 24-week period. Well-being increased sharply during each session and plateaued at 50 minutes with a sustained positive effect after the sessions. On a longer timescale, well-being and quality of life increased slowly and steadily from one session to the next. The findings were statistically significant ( p < 0.001). The study concludes that group reminiscence arts sessions can have a positive and sustained impact on the quality of life of people with dementia. However, the evidence on the sustainability of the effect over time remains unknown. More research is needed to assess in much greater depth the association between quality of life and group reminiscence arts sessions.

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Staff training using STAR: a pilot study in UK care homes

International Psychogeriatrics ◽

10.1017/s1041610211002559 ◽

2012 ◽

Vol 24 (6) ◽

pp. 911-920 ◽

Cited By ~ 22

Author(s):

Judith Goyder ◽

Martin Orrell ◽

Jennifer Wenborn ◽

Aimee Spector

Keyword(s):

Pilot Study ◽

Behavioral Problems ◽

Staff Training ◽

Large Scale ◽

Controlled Trial ◽

Care Home ◽

Care Staff ◽

Care Homes ◽

People With Dementia ◽

Star Program

ABSTRACTBackground: Symptoms such as depression, anxiety, and behavioral problems are very common in people with dementia living in care homes. Staff training has been identifed as a promising psychosocial intervention. This pilot study investigated the feasibility of implementing the Staff Training in Assisted Living Residences (STAR) program in UK care homes.Methods: The eight-week STAR program was delivered in two care homes. Twenty-five care staff attended the training. Thirty-two residents, with dementia and clinically significant anxiety, depression, or behavioral problems, were included in the study. Residents and staff were assessed at baseline and eight-week follow-up.Results: Residents demonstrated significantly reduced symptoms of depression and behavioral problems following the implementation of the program, although resident-rated quality of life and anxiety symptoms did not improve significantly. Staff sense of hopefulness towards people with dementia also improved significantly and staff rated themselves as significantly more competent at forming relationships with residents.Conclusion: Delivering the STAR program to care staff can have an impact on the behavioral and psychological symptoms of dementia displayed by care home residents. The program was feasible to implement and was rated highly by care staff. A large-scale randomized controlled trial is now required to evaluate the effectiveness of this training intervention.

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Living in a care home during COVID-19: a case study of one person living with dementia

Quality in Ageing and Older Adults ◽

10.1108/qaoa-02-2021-0024 ◽

2021 ◽

Vol ahead-of-print (ahead-of-print) ◽

Author(s):

Ian Davies-Abbott ◽

Catrin Hedd Jones ◽

Gill Windle

Keyword(s):

Study Design ◽

Single Case ◽

Care Home ◽

Care Homes ◽

Single Case Study ◽

Content Type ◽

Case Study Design ◽

People With Dementia ◽

The Impact

Purpose This paper aims to understand the lived experience of a person living with dementia in a care home during the COVID-19 pandemic. It responds to the absence in research of the voices of people with dementia living in care homes during the pandemic. Design/methodology/approach The paper adopts a single case study design applied thematic analysis to semi-structured interview data to discover the experiences of one person living with dementia in a care home during a period of lockdown. Findings Five themes reveal how the participant responded to the practical and emotional challenges of the pandemic: autonomy; fears; keeping connected; keeping safe and other people living with dementia. These themes highlight the participant’s ability to adapt, accept and dispute lockdown restrictions, revealing considerable insight into their situation. Research limitations/implications The pandemic has restricted access to care homes, which informed the single case study design. This approach to the research may restrict the generalisability of the findings. Other researchers are encouraged to include the voices of people with dementia living in care homes in further studies. Practical implications Implications for practice, presented in this paper, promote quality psychosocial approaches when health-care workers engage with people living with dementia during periods of restricted activity. Originality/value Unlike other studies about the impact of the pandemic on care homes, this paper explores the experience of the pandemic in care homes from the perspective of a person living with dementia.

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Restraints and Restrictive Interventions during Essential Personal Care in Elderly People Living with Dementia in Care Homes

International Neuropsychiatric Disease Journal ◽

10.9734/indj/2021/v15i230150 ◽

2021 ◽

pp. 26-38

Author(s):

Matthew Crooks ◽

Katherine Wakenshaw ◽

Julie Young ◽

Kayleigh Purvis ◽

Karin Smith ◽

...

Keyword(s):

Care Home ◽

Legal Framework ◽

Care Staff ◽

Care Homes ◽

Personal Care ◽

Personal Assistance ◽

Care Home Staff ◽

People With Dementia ◽

Training Materials ◽

Materials Used

Care home staff are frequently required to provide invasive personal care for their residents, and on occasions need to use restraint and restrictive practices with people with dementia. This often occurs in situations where the residents no longer have the insight that they require help and may misperceive the personal assistance as an assault. On a practical level, a significant number of people with dementia are currently being admitted to inpatient units due to their level of resistance around essential personal care. Often these same people are settled at all other times. This paper provides practical advice on how to support residents and their caregivers, and gives clinical, legal and ethical guidance. Previous work undertaken by the present authors have shown that care staff require supervision and coaching on this topic. The paper includes training materials used by the authors. This includes a composite, fictitious case example that illustrates approaches that are compliant with UK guidelines. It addresses the training of staff working in care homes. As such this paper provides a review and practical example of the appropriate use of restraint for residents unable to consent to the ‘intimate’ care they are receiving. It describes a method delivered in a person-centred manner and within a legal framework. Having read this paper, care home staff should feel more confident, competent and secure in the assistance they are providing in this contentious area.

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Understanding COVID-19 testing pathways in English care homes to identify the role of point-of-care testing: an interview-based process mapping study

10.1101/2020.11.02.20224550 ◽

2020 ◽

Author(s):

Massimo Micocci ◽

Adam L Gordon ◽

A. Joy Allen ◽

Timothy Hicks ◽

Patrick Kierkegaard ◽

...

Keyword(s):

Infection Prevention ◽

Point Of Care ◽

Care Home ◽

Care Homes ◽

List Type ◽

Process Mapping ◽

Point Of Care Testing ◽

Testing Procedures ◽

People With Dementia

AbstractIntroductionCare home residents are at high risk of dying from COVID-19. Regular testing producing rapid and reliable results is important in this population because infections spread quickly and presentations are often atypical or asymptomatic. This study evaluated current testing pathways in care homes to explore the role of point-of-care tests (POCTs).MethodsTen staff from eight care homes, purposively sampled to reflect care organisational attributes that influence outbreak severity, underwent a semi-structured remote videoconference interview. Transcripts were analysed using process mapping tools and framework analysis focussing on perceptions about, gaps within, and needs arising from, current pathways.ResultsFour main steps were identified in testing: infection prevention, preparatory steps, swabbing procedure, and management of residents. Infection prevention was particularly challenging for mobile residents with cognitive impairment. Swabbing and preparatory steps were resource-intensive, requiring additional staff resource. Swabbing required flexibility and staff who were familiar to the resident. Frequent approaches to residents were needed to ensure they would participate at a suitable time. After-test management varied between sites. Several homes reported deviating from government guidance to take more cautious approaches, which they perceived to be more robust.ConclusionSwab-based testing is organisationally complex and resource-intensive in care homes. It needs to be flexible to meet the needs of residents and provide care homes with rapid information to support care decisions. POCT could help address gaps but the complexity of the setting means that each technology must be evaluated in context before widespread adoption in care homes.Key-pointsTesting for COVID-19 in care homes is complex and requires reconfiguration of staffing and environment.Isolation and testing procedures are challenged when providing person-centred care to people with dementia.Point-of-care testing results could give care homes greater flexibility to test in person-centred ways.There was evidence that care home staff interpret testing guidance, rather than follow it verbatim.Each POCT must be evaluated in the context of care homes to understand its effect on care home processes.

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MEDREV: feasibility study of a combined pharmacy–health psychology intervention to improve care for people with dementia with behaviour that challenges in care homes

British Journal of General Practice ◽

10.3399/bjgp19x703253 ◽

2019 ◽

Vol 69 (suppl 1) ◽

pp. bjgp19X703253

Author(s):

Ian Maidment

Keyword(s):

Feasibility Study ◽

Qualitative Interviews ◽

Care Home ◽

Training Session ◽

Dementia Care ◽

Training Data ◽

Care Staff ◽

Care Homes ◽

Inappropriate Use ◽

People With Dementia

Background‘Behaviour that Challenges’ is common in older people with dementia in care homes and treated with antipsychotics. Policy is focused on reducing the use of antipsychotics in people with dementia and therefore reducing harm. This submission reports results on a NIHR-funded feasibility study MEDREV.AimTo assess the feasibility of medication review by a specialist dementia care pharmacist combined with staff training with the objective of limiting the inappropriate use of psychotropics.MethodCare homes were recruited. People meeting the inclusion (dementia; medication for behaviour that challenges), or their personal consultee, were approached. A specialist dementia care pharmacist reviewed medication and made recommendations. Care staff received a 3-hour training session promoting person-centred care and GPs’ brief training. Data were collected on recruitment and retention, and implementation of recommendations. Other outcomes included the Neuropsychiatric Inventory-Nursing Home version, quality of life (EQ-5D/DEMQoL), cognition (sMMSE), and health economic (CSRI). Qualitative interviews explored expectations and experiences.ResultsMedication reviews were conducted in 29 of 34 residents recruited and the pharmacist recommended reviewing medication in 21 of these. Fifteen (71.4%) of these were antidepressants: 57.1% (12 of 21) of recommendations were implemented and implementation took a mean of 98.4 days. Non-implementation themes for will be presented. One hundred and sixty-four care staff received training (care homes = 142; primary care = 22). Twenty-one participants (care home managers = 5; GPs = 3; nurses = 2; care staff = 11) were interviewed.ConclusionThe study was feasible, although the approach would need modification to improve the uptake of reviews and reduce the delay in implementation. Most of the recommendations related to antidepressants.

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