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

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.

scholarly journals Improving care for people with dementia: development and initial feasibility study for evaluation of life story work in dementia care

2016 ◽  
Vol 4 (23) ◽  
pp. 1-298 ◽  
Author(s):  
Kate Gridley ◽  
Jenni Brooks ◽  
Yvonne Birks ◽  
Kate Baxter ◽  
Gillian Parker
Keyword(s):  
Feasibility Study ◽  
Best Practice ◽  
Social Care ◽  
Life Story ◽  
Good Practice ◽  
Dementia Care ◽  
Care Staff ◽  
Care Homes ◽  
Staff Attitudes ◽  
People With Dementia

BackgroundImproving dementia care quality is an urgent priority nationally and internationally. Life story work (LSW) is an intervention that aims to improve individual outcomes and care for people with dementia and their carers. LSW gathers information and artefacts about the person, their history and interests, and produces a tangible output: the ‘life story’.ObjectiveTo establish whether or not full evaluation of LSW was feasible.DesignMixed-methods feasibility study.MethodsIn-depth interviews and focus groups explored experiences of LSW and best practice with people with dementia, family members and dementia care staff. A systematic review explored best practice and theories of change for LSW. These stages helped to identify the outcomes and resources to explore in the feasibility study. A representative sample survey of health and social care dementia care providers in England established LSW practice in different settings. A survey of a self-selected sample of family members of people with dementia explored how LSW is experienced. Two small outcome studies (stepped-wedge study in six care homes and pre-test post-test study in inpatient specialist dementia care wards) explored the feasibility of full evaluation of LSW in these settings.SettingsSurvey: generalist and specialist care homes; NHS dementia care settings; and community dementia services. Feasibility study: care homes and NHS inpatient dementia care wards.ParticipantsNHS and social care services, people with dementia, family carers, care home staff and NHS staff.InterventionsLSW.Main outcome measuresSpread of LSW and good practice, quality of life (QoL) for the person with dementia and carers, relationships between people with dementia and family carers, staff attitudes about dementia, staff burnout, resource use and costs.Review methodsNarrative review and synthesis, following Centre for Review and Dissemination guidelines.ResultsGood practice in LSW is identifiable, as are theories of change about how it might affect given outcomes. Indicators of best practice were produced. LSW is spreading but practice and use vary between care settings and are not always in line with identified good practice. Two different models of LSW are evident; these are likely to be appropriate at different stages of the dementia journey. The feasibility study showed some positive changes in staff attitudes towards dementia and, for some people with dementia, improvements in QoL. These may be attributable to LSW but these potential benefits require full evaluation. The feasibility work established the likely costs of LSW and highlighted the challenges of future evaluation in care homes and inpatient dementia care settings.LimitationsThere was insufficient evidence in the literature to allow estimation of outcome size. We did not carry out planned Markov chain modelling to inform decisions about carrying out future evaluation because of the dearth of outcome data in the literature; low levels of data return for people with dementia in the hospital settings; lack of detected effect for most people with dementia; and questions about implementation in the research settings.ConclusionsLSW is used across different health and social care settings in England, but in different ways, not all of which reflect ‘good practice’. This large, complex study identified a wide range of challenges for future research, but also the possibility that LSW may help to improve care staff attitudes towards dementia and QoL for some people with dementia.Future workFull evaluation of LSW as an intervention to improve staff attitudes and care is feasible with researchers based in or very close to care settings to ensure high-quality data collection.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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

2012 ◽  
Vol 24 (6) ◽  
pp. 911-920 ◽  
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.

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

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.

scholarly journals Developing an intervention to promote person-centred care to improve management of behaviours that challenge among people living with dementia

2020 ◽  
Author(s):  
Rachel Shaw ◽  
Niyah Campbell ◽  
Kirsty Killick ◽  
Nichola Seare ◽  
Ian Maidment
Keyword(s):  
Care Home ◽  
Unmet Need ◽  
Training Session ◽  
Complex Interventions ◽  
Care Staff ◽  
Training Intervention ◽  
Financial Investment ◽  
Care Home Staff ◽  
People With Dementia ◽  
The Uk

Abstract Background: This paper reports the development work conducted for a feasibility study (MEDREV) conducted in the UK evaluating: (i) a medication review to reduce the prescription of psychotropic medication for managing behaviours that challenge among people living with dementia: and (ii) a training intervention for care home staff designed to improve the management of behaviours that challenge without medication using person-centred care. This paper reports the development of (ii) the training intervention for care home staff.Methods: The intervention development was informed by the MRC guidelines for complex interventions and the phases of the Behaviour Change Wheel. We used an iterative approach responding to and consultations with stakeholders throughout the process. Results: The target behaviours of the intervention were: responding to challenging behaviour as an expression of unmet need; communicating with compassion. The intervention was required to educate about psychotropics and their side-effects, to help care staff relate to people with dementia as individuals with individual needs and wants, to reflect upon how one might deliver the values of person-centred care in care scenarios, and to promote good team communication and self-care. An interactive, brief, in-house training session was developed with a number of recommendations for systemic change. Conclusions: The intervention was developed in a systematic way taking into account the particularities of the care home context and the target population. These factors prompted many challenges as did the manner in which residential care home interventions are funded in the UK. An ideal intervention package would have incorporated environmental elements, more systemic support from the care home management, and more financial investment to offer a more detailed, longer lasting training intervention.

scholarly journals Facilitating creativity in dementia care: the co-construction of arts-based engagement

2018 ◽  
Vol 40 (6) ◽  
pp. 1155-1174 ◽  
Author(s):  
Jane M. Robertson ◽  
Vikki McCall
Keyword(s):  
Care Home ◽  
Secondary Analysis ◽  
Dementia Care ◽  
Care Staff ◽  
Relational Model ◽  
Embodied Learning ◽  
People With Dementia ◽  
The Individual ◽  
Creative Self ◽  
Prior Experiences

AbstractThis paper seeks to understand the engagement of people with dementia in creative and arts-based activities by applying a relational model of citizenship and incorporating concepts of contextual and embodied learning from adult learning theory. A theoretically driven secondary analysis of observational and interview data focuses on the engagement of staff, volunteers and people with dementia during an arts-based intervention in a day centre and care home. The processes through which learning is co-constructed between the person with dementia, staff/volunteer facilitators and peers in the group to co-produce a creative engaged experience involves: increasing confidence for learning, facilitating social and physical connections, and affirming creative self-expression. The role of facilitator is central to the process of creative engagement to reinforce a sense of agency amongst participants and recognise people's prior experiences of learning and engagement in creative activities. People with dementia continue to learn and grow through engagement in creative activities to produce positive outcomes for the individual participants and for the care staff who observe and participate in this creativity. Facilitating creativity requires attention to lifelong experiences of learning in addition to the immediate interactional context to integrate arts-based interventions in dementia care successfully.

Enjoying the front-line of dementia care: an integrative analysis of what care home staff report makes them happy at work

2014 ◽  
Vol 18 (4) ◽  
pp. 167-175 ◽  
Author(s):  
Jill Manthorpe
Keyword(s):  
Job Satisfaction ◽  
Social Care ◽  
Care Home ◽  
Dementia Care ◽  
Care Homes ◽  
Front Line ◽  
Content Type ◽  
Care Home Staff ◽  
People With Dementia

Purpose – High turnover of staff in the long-term dementia care sector contributes to poor quality care and lack of continuity of care in the UK and many other countries. The purpose of this paper is to explore the research evidence on what care assistants report they enjoy when working in front-line dementia care jobs in long-term care facilities. Design/methodology/approach – An integrative analysis was used to study research findings focusing on the front-line workforce in care homes. The literature review sought to capture key findings, including overviews of research, from studies from 1990 to mid-2014 that have considered the positive experiences of front-line care home staff working with people with dementia. Findings – There is a great deal of research investigating care home staff's job satisfaction. Much of this highlights the importance of personal, social and managerial relationships. Common themes continue to be reported. There is potential for work on improving care assistant experiences in care homes but also a need to address long-standing inequities affecting the care home sector. Research limitations/implications – Some studies are not precise about which staff groups they are investigating in studies about care homes and many concentrate on the problems staff report. Measures of job satisfaction vary. When exploring dementia-related care not all studies are clear if care home residents have dementia or not. Practical implications – Many studies have investigated the views of care assistants working with people with dementia in care homes that address happiness in their work, often reported as job or work satisfaction, and these should be consulted when developing dementia services or managing care homes. As with other parts of the social care workforce, employers and managers need to be aware of effective and acceptable workforce reforms and ways to reduce turnover. Originality/value – This review suggests the value of investigating positive aspects of care work with people with dementia living in care homes. Greater attention could be paid to job satisfaction in social care more widely.

Enhanced healthcare in care homes for people with dementia: the Admiral nursing offer

2021 ◽  
Vol 23 (7) ◽  
pp. 1-10
Author(s):  
Karen Harrison Dening ◽  
Zena Aldridge
Keyword(s):  
Primary Care ◽  
Residential Care ◽  
Social Care ◽  
Care Home ◽  
Dementia Care ◽  
Care Homes ◽  
Complex Needs ◽  
Care Home Staff ◽  
People With Dementia ◽  
Health And Social Care

Background The UK older population is higher than the global average. Over the next 20 years, England will see an increase in the number of older people who have higher levels of dependency, dementia and comorbidity, many of whom will require 24-hour residential care. It is estimated that 70% of residents in nursing and residential care homes either have dementia on admission or develop it while residing in the care home, many of who will have complex needs with high levels of multimorbidity. However, there is a lack of consistency in the provision of primary care and specialist services to this population and a known gap in knowledge and skills of dementia care in care home staff and primary care teams. Methods This article considers the current health policy drivers to enhance integrated health and social care provision to care homes and proposes a model of care that would support the aims of the NHS Long Term Plan for care to be delivered closer to home and improve out of hospital care which includes people who live in care homes by introducing Enhanced Health in Care Homes. It is crucial that such a model includes the correct skill mix to meet the needs of the care home population. Conclusions There are currently gaps in service provision to many care homes. Admiral nurse case managers and specialists in dementia care, are well placed to support the delivery of Enhanced Health in Care Homes and improve access to specialist support to care home residents, their families, care home staff and the wider health and social care system.

New relationships and intimacy in long-term care: The views of relatives of residents with dementia and care home staff

Dementia ◽  
2016 ◽  
Vol 17 (4) ◽  
pp. 405-422 ◽  
Author(s):  
Esther Wiskerke ◽  
Jill Manthorpe
Keyword(s):  
Qualitative Interviews ◽  
Care Home ◽  
Care Homes ◽  
Sexual Intimacy ◽  
Term Care ◽  
Care Home Staff ◽  
General Terms ◽  
People With Dementia ◽  
The Moment ◽  
Person With Dementia

Background There is limited research on what family members and frontline care home staff consider to be the best responses to the sexual expression of a person with dementia, whilst at the same time respecting relatives’ feelings, managing their possible distress and conflict. Methods This exploratory study investigated the views of relatives and care workers of new relationships or sexual intimacy between care home residents with dementia, whilst still married to another person. It reports the themes that emerged in qualitative interviews with eight relatives of people with dementia and with 12 frontline care home staff working in two English care homes. Interviews took place in 2015 using a hypothetical vignette that unfolded in four stages. Thematic analysis was used to analyse the data. Findings The views of care home staff and relatives had similarities in general terms regarding the problems arising around expressions of sexuality in care homes: indicting that a light-hearted or non-physical connection between residents is deemed acceptable, but the moment it becomes a sexual relationship then decision making becomes more complicated. Staff were inclined to turn to managers for advice and to consider separating residents. They expressed familiarity with distracting residents from situations that were of concern. Relatives were considerate of the difficulties and dilemmas faced by care home staff. Conclusion The use of a vignette facilitated discussion of a potentially sensitive topic. Areas for further research are identified.

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

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.

scholarly journals A qualitative study exploring therapists’ experiences of implementing a complex intervention promoting meaningful activity for residents in care homes

2018 ◽  
Vol 33 (3) ◽  
pp. 575-583 ◽  
Author(s):  
Raymond Smith ◽  
Julia Wood ◽  
Fiona Jones ◽  
Sue Turner ◽  
Michael Hurley
Keyword(s):  
Care Home ◽  
Complex Interventions ◽  
Occupational Therapists ◽  
Care Staff ◽  
Care Homes ◽  
Complex Care ◽  
Meaningful Activity ◽  
Qualitative Interview Study ◽  
Home Intervention ◽  
Trusting Relationships

Objectives: To explore the experiences of occupational therapists and physiotherapists and to reveal any factors that can facilitate delivering a complex care home intervention promoting meaningful activity. Design: Qualitative interview study using data from three focus groups conducted longitudinally post intervention implementation. Data were analysed thematically. Setting: Three residential care homes in South London, UK. Subjects: All therapists involved in the implementation of the intervention: three occupational therapists and three physiotherapists. Results: Three interconnected themes emerged from the analysis: (1) developing trusting relationships, (2) empowering staff and (3) remaining flexible. Therapists described how successfully implementing a complex care home intervention was dependant on developing trusting relationships with care staff. This enabled the therapists to empower care staff to take ownership of the intervention and help embed it in care home culture, facilitating long-term change. The therapists described how remaining flexible in their approach helped keep care staff engaged for the duration of implementation. Conclusion: This study has revealed several important factors that can help facilitate therapists delivering complex interventions in care homes.

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