Systematic review of the effective components of psychosocial interventions delivered by care home staff to people with dementia

Rapaport, Penny; Livingston, Gill; Murray, Joanna; Mulla, Aasiya; Cooper, Claudia

doi:10.1136/bmjopen-2016-014177

Cited by 59 publications

(92 citation statements)

References 78 publications

(388 reference statements)

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“…companionship). Appropriate support reduces unmet needs and enables the person to remain connected to family and community for longer by delaying or preventing a transition into residential care (Rapaport, Livingston, Murray, Mulla, & Cooper, ; Samus et al, ). In addition, being in a familiar home environment and neighbourhood can help the person with dementia to cope better with their everyday lives, particularly as the home gradually becomes the locus for everyday activities (Sixsmith et al, ).…”

Section: Introductionmentioning

confidence: 99%

‘I know they are not trained in dementia’: Addressing the need for specialist dementia training for home care workers

Polacsek

Goh

Malta

et al. 2019

Health Soc Care Community

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Global population ageing has meant a rapid increase in the numbers of older people with dementia, most of whom live in their own homes. Staying at home is an important determinant of health and well-being. As care needs increase, the quality of community support which older people receive directly influences their capacity to remain in their own homes. While many are supported informally by family carers, formal support provided by home care workers often enables them to remain at home for longer period. However, providing community-based care for people with dementia can be challenging. Workers often lack training in dementia-specific care for clients with increasingly complex needs, and typically work without direct supervision.As the demand for person-centred home care for people with dementia increases, specialist dementia training for home care workers is urgently needed. In this qualitative study, we used in-depth interviews of a purposive sample, comprising 15 family carers and four older people with dementia, to understand the experience of receiving community care. Data analysis was guided by Braun and Clarke's approach to thematic analysis and revealed the following five overlapping themes, relating to home care workers' understanding of dementia, person-centred care, communication and rapport, mutual collaboration, and the influence of organisational constraints on continuity of care. Although participants acknowledged that service providers operated under challenging circumstances, they were frustrated with home care workers' lack of dementia knowledge and inconsistent staff rostering. Conversely, an understanding of the lived experience of dementia, effective communication and rapport, and continuity of care contributed significantly to a positive experience of receiving care.The findings of this study will be used to inform the essential elements of a training

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Section: Introductionmentioning

confidence: 99%

‘I know they are not trained in dementia’: Addressing the need for specialist dementia training for home care workers

Polacsek

Goh

Malta

et al. 2019

Health Soc Care Community

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“…In people with dementia, language impairment can impede functioning and effective communication, resulting in disruptive behaviour, due to unmet needs or frustration . Residents with dementia may become agitated if people use language beyond their comprehension or they are not understood when communicating .…”

Section: Introductionmentioning

confidence: 99%

“…In people with dementia, language impairment can impede functioning and effective communication, resulting in disruptive behaviour, 8 due to unmet needs or frustration. 9 Residents with dementia may become agitated if people use language beyond their comprehension or they are not understood when communicating. 10 Language impairment may be especially challenging for people whose first language is not the local language, in whom cognitive decline can cause regression to the primary language, and loss of second language abilities.…”

Section: Introductionmentioning

confidence: 99%

Relationship between speaking English as a second language and agitation in people with dementia living in care homes: Results from the MARQUE (Managing Agitation and Raising Quality of life) English national care home survey

Cooper

Rapaport

Robertson

et al. 2017

Int J Geriat Psychiatry

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ObjectiveAs not speaking English as a first language may lead to increased difficulties in communication with staff and other residents, we (1) tested our primary hypotheses that care home residents with dementia speaking English as a second language experience more agitation and overall neuropsychiatric symptoms, and (2) explored qualitatively how staff consider that residents' language, ethnicity, and culture might impact on how they manage agitation.MethodsWe interviewed staff, residents with dementia, and their family carers from 86 care homes (2014–2015) about resident's neuropsychiatric symptoms, agitation, life quality, and dementia severity. We qualitatively interviewed 25 staff.ResultsSeventy‐one out of 1420 (5%) of care home residents with dementia interviewed spoke English as a second language. After controlling for dementia severity, age, and sex, and accounting for care home and staff proxy clustering, speaking English as a second language compared with as a first language was associated with significantly higher Cohen‐Mansfield Agitation Inventory (adjusted difference in means 8.3, 95% confidence interval 4.1 to 12.5) and Neuropsychiatric inventory scores (4.1, 0.65 to 7.5). Staff narratives described how linguistic and culturally isolating being in a care home where no residents or staff share your culture or language could be for people with dementia, and how this sometimes caused or worsened agitation.ConclusionsConsidering a person with dementia's need to be understood when selecting a care home and developing technology resources to enable dementia‐friendly translation services could be important strategies for reducing distress of people with dementia from minority ethnic groups who live in care homes.

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“…We developed MARQUE, a six-session manual-based intervention, followed by an implementation and supervision period (panel), based on our systematic review of strategies to reduce or prevent agitation for people with dementia in care homes, 11 qualitative interviews with care home staff about their understanding of agitation and what facilitated use of successful strategies, 23 cross-sectional and longitudinal data on determinants of agitation in care homes, 6,24 a systematic review of components and strategies for successful implementation of psychosocial interventions in care homes, 17 and coproduction with stakeholders. We ran three focus groups with family carers of people with dementia who had experienced agitation and or lived in a care home, two before developing the intervention and one after, about what should be in the intervention.…”

Section: Methodsmentioning

confidence: 99%

“…and what enables interventions to become integrated into care practice long term. 17,18 This trial aimed to assess whether the MARQUE intervention reduced agitation in residents with dementia after 8 months compared with treatment as usual (TAU).…”

Section: Implications Of All the Available Evidencementioning

confidence: 99%

Clinical and cost-effectiveness of the Managing Agitation and Raising Quality of Life (MARQUE) intervention for agitation in people with dementia in care homes: a single-blind, cluster-randomised controlled trial

Livingston

Barber

Marston

et al. 2019

The Lancet Psychiatry

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Background Many people with dementia living in care homes have distressing and costly agitation symptoms. Interventions should be efficacious, scalable, and feasible. Methods We did a parallel-group, cluster-randomised controlled trial in 20 care homes across England. Care homes were eligible if they had 17 residents or more with dementia, agreed to mandatory training for all eligible staff and the implementation of plans, and more than 60% of eligible staff agreed to participate. Staff were eligible if they worked during the day providing face-to-face care for residents with dementia. Residents were eligible if they had a known dementia diagnosis or scored positive on screening with the Noticeable Problems Checklist. A statistician independent of the study randomised care homes (1:1) to the Managing Agitation and Raising Quality of Life (MARQUE) intervention or treatment as usual (TAU) using computer-generated randomisation in blocks of two, stratified by type of home (residential or nursing). Care home staff were not masked to the intervention but were asked not to inform assessors. Residents with dementia, family carers, outcome assessors, statisticians, and health economists were masked to allocation until the data were analysed. MARQUE is an evidence-based manualised intervention, delivered by supervised graduate psychologists to staff in six interactive sessions. The primary outcome was agitation score at 8 months, measured using the Cohen-Mansfield Agitation Inventory (CMAI). Analysis of the primary outcome was done in the modified intention-to-treat population, which included all randomly assigned residents for whom CMAI data was available at 8 months. Mortality was assessed in all randomly assigned residents. This study is registered with the ISRCTN registry, number ISRCTN96745365.

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Systematic review of the effective components of psychosocial interventions delivered by care home staff to people with dementia

Cited by 59 publications

References 78 publications

‘I know they are not trained in dementia’: Addressing the need for specialist dementia training for home care workers

‘I know they are not trained in dementia’: Addressing the need for specialist dementia training for home care workers

Relationship between speaking English as a second language and agitation in people with dementia living in care homes: Results from the MARQUE (Managing Agitation and Raising Quality of life) English national care home survey

Clinical and cost-effectiveness of the Managing Agitation and Raising Quality of Life (MARQUE) intervention for agitation in people with dementia in care homes: a single-blind, cluster-randomised controlled trial

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