Claire Craig

What should be in a self-management programme for people with early dementia?

Objectives: First, to use participative research methods to obtain views from people with dementia and carers about their experiences and the interventions that they consider can assist in facilitating independence and quality of life post diagnosis. Second, to use these views to identify priority topics for a potential self-management programme. Third, to explore the relevance of the identified topics with a consultation group of people with dementia and their carers, thus informing the creation of a draft self-management programme. Method: A series of individual and dyad interviews were conducted with people with dementia and family carers to explore their experiences post diagnosis and obtain views of how quality life can be maintained while living with dementia. A further group of people with dementia and carers then met over six successive weeks to explore and provide feedback on the topic areas generated out of the initial interviews and add to the content. Results: Data generated from the individual interviews identified a number of themes for a potential self-management group which were then validated through consultation. Optimum modes of delivery of a self-management programme were also indicated. Conclusions: A draft programme has been constructed building upon the framework of identified priorities. The process and outputs from the consultation also indicated the significant ramifications of such a programme for services.

The lived experience of redesigning lifestyle post retirement in the UK

The purpose of this study was to examine the feasibility of introducing and delivering an occupation-based lifestyle intervention, inspired by the US Lifestyle Redesign® into a UK context and to test requirements for a future robust clinical evaluation. The intervention involves a weekly facilitated group session to assist participants to engage with new and neglected occupations supplemented by an individual monthly meeting with one of the facilitators. A range of quantitative and qualitative methods were employed for the entire research programme. An in-depth interview was conducted with all participants before and after the 8-month programme and their progress was documented in reflective diaries maintained by the programme facilitators. The four participants whose narratives are described in this paper were experiencing eroded lifestyle as a result of diminished health combined with other challenges of later life. However, results of post-intervention interviews revealed that all had been able to engage with new and re-engage with neglected occupations despite continuing compromises. None of the participants reported experiencing improved physical health but all talked about the improvements to their confidence, self-efficacy and overall well-being which they attributed to the programme. Therefore, the intervention appears to warrants the investment necessary for population-based evaluation.

Lifestyle Matters for maintenance of health and wellbeing in people aged 65 years and over: study protocol for a randomised controlled trial

BackgroundHealthy, active ageing is strongly associated with good mental wellbeing which in turn helps to prevent mental illness. However, more investment has been made into research into interventions to prevent mental illness than into those designed to improve mental wellbeing. This applied research programme will provide high quality evidence for an intervention designed to improve and sustain mental wellbeing in older adults.Methods/DesignThis study was a multi-centre, pragmatic, two-arm, parallel group, individually randomised controlled trial to determine the population benefit of an occupational therapy based intervention for community living people aged 65 years or older. Participants (n = 268) will be identified in one city in the North of England and in North Wales through GP mail-outs, signposting by local authority, primary care staff and voluntary sector organisations and through community engagement. Participants will be randomised to one of two treatment arms: an intervention (Lifestyle Matters programme); or control (routine access to health and social care). All participants will be assessed at baseline, 6 and 24 months post-randomisation. The primary outcome, which is a person reported outcome, is the SF-36 Mental Health dimension at six months post randomisation. Secondary outcome measures have been selected to measure psychosocial, physical and mental health outcomes. They include other dimensions of the SF36, EQ-5D-3L, Brief Resilience Scale, General Perceived Self Efficacy Scale, PHQ-9, de Jong Gierveld Loneliness Scale, Health and Social Care Resource Use and the wellbeing question of the Integrated Household Survey 2011. A cost effectiveness analysis will investigate the incremental cost per Quality Adjusted Life Years (QALYs) of the Lifestyle Matters intervention compared with treatment as usual.DiscussionThe questions being posed through this research are important given the increasing numbers of older people, pressure on the public purse and the associated need to support good health in the extended lifespan. The proposed trial will determine the clinical and cost effectiveness of the intervention delivered in a UK context. The results will support commissioners and providers with decisions about implementation.Trial registrationCurrent Controlled Trials ISRCTN67209155

A preventative lifestyle intervention for older adults (Lifestyle Matters): a randomised controlled trial

Abstract Objectives to test whether an occupation-based lifestyle intervention can sustain and improve the mental well-being of adults aged 65 years or over compared to usual care, using an individually randomised controlled trial. Participants 288 independently living adults aged 65 years or over, with normal cognition, were recruited from two UK sites between December 2011 and November 2015. Interventions lifestyle Matters is a National Institute for Health and Care Excellence recommended multi-component preventive intervention designed to improve the mental well-being of community living older people at risk of decline. It involves weekly group sessions over 4 months and one to one sessions. Main outcome measures the primary outcome was mental well-being at 6 months (mental health (MH) dimension of the SF-36). Secondary outcomes included physical health dimensions of the SF-36, extent of depression (PHQ-9), quality of life (EQ-5D) and loneliness (de Jong Gierveld Loneliness Scale), assessed at 6 and 24 months. Results data on 262 (intervention = 136; usual care = 126) participants were analysed using intention to treat analysis. Mean SF-36 MH scores at 6 months differed by 2.3 points (95 CI: −1.3 to 5.9; P = 0.209) after adjustments. Conclusions analysis shows little evidence of clinical or cost-effectiveness in the recruited population with analysis of the primary outcome revealing that the study participants were mentally well at baseline. The results pose questions regarding how preventive interventions to promote well-being in older adults can be effectively targeted in the absence of proactive mechanisms to identify those who at risk of decline. Trial Registration ISRCTN67209155.

Student perspectives on the development and evaluation of a joint international education to promote employability in Europe

OBJECTIVE This article presents a student evaluation of a joint international education developed as part of a European project which sought to equip health care practitioners with the skills to support employability of individuals furthest removed from the labour market, disadvantaged on account of age, gender, migration or ethnicity. PARTICIPANTS Thirty eight students out of the forty one students that participated in the pilot of four modules (NL, UK, SE, DE) returned completed digital questionnaires (92.6% response rate). METHODS The study is descriptive by nature. A questionnaire was used to collect the data from students. Additionally students attending the module in the UK also took part in a series of qualitative interviews which sought to explore their experiences in more detail. These were recorded, transcribed and analyzed. RESULTS Students reported that joint education facilitates competence development. The competencies they identified (Information Communications Technology) were recognised as being key to enhancing employability of disadvantaged groups. CONCLUSIONS The joint international education exemplified by EEE4all offers one model of how to build a responsive international curriculum to ensure that the workforce of the future is well placed to meet the needs of this changing world.

The long-term (24-month) effect on health and well-being of the Lifestyle Matters community-based intervention in people aged 65 years and over: a qualitative study

Objectives To assess the long-term effect on health and well-being of the Lifestyle Matters programme. Design Qualitative study of a subset of intervention arm participants who participated in the Lifestyle Matters randomised controlled trial (RCT). Setting The intervention took place at community venues within two sites in the UK. Participants A purposeful sample of 13 participants aged between 66 and 88 years from the intervention arm of the RCT were interviewed at 24 months post randomisation. Interviews aimed to understand how participants had used their time in the preceding 2 years and whether the intervention had any impact on their lifestyle choices, participation in meaningful activities and well-being. Intervention Lifestyle Matters is a 4-month occupational therapy intervention, consisting of group and individual sessions, designed to enable community living older people to make positive lifestyle choices and participate in new or neglected activities through increasing self-efficacy. Results Interviews revealed that the majority of interviewed participants were reportedly active at 24 months, with daily routines and lifestyles not changing significantly over time. All participants raised some form of benefit from attending Lifestyle Matters, including an improved perspective on life, trying new hobbies and meeting new friends. A number of intervention participants spoke of adapting to their changing circumstances, but there were significant and lasting benefits for 2 of 13 intervention participants interviewed. Conclusion The majority of those who experienced the Lifestyle Matters intervention reported minor benefits and increases in self-efficacy, but they did not perceive that it significantly improved their health and well-being. The two participants who had experienced major benefits also reported having had life-changing events, suggesting that this intervention is most effective at the time when lifestyle has to be reconsidered if mental well-being is to be sustained. Trial registration ISRCTN, ISRCTN67209155, post results.

Designing Health Technology: The Ethical Dimension

Global demographics and the rising number of people living with long-term conditions have placed increasing pressure on existing healthcare delivery. Technological innovation in the form of telehealth and telecare has been posited as one possible solution, offering individuals with chronic conditions a set of tools to monitor and better manage their health, reducing pressure on existing services and making possible cost savings through fewer admissions to hospital [30]. These advances are challenging and reshaping existing models of care, revolutionizing how and where healthcare is provided.

Behaviours: Design and behaviour change in health

The purpose of this chapter is to discuss the design of acute care settings with a focus on the evolution of design practice over the last decade. In particular, ideas around healing environments describe how design is contributing to enhanced health and wellbeing and how recent developments are helping to create better designs. The chapter covers aspects of the theoretical hypothesis explaining the relationship between people, the environment and healing with a focus on three elements: how people perceive the environment, social interaction as part of healing and the influence of peoples sociocultural background. The chapter looks at evidence-informed design in the context of acute healthcare settings whilst also covering trends, challenges and opportunities in healthcare design, and how this field is developing. A case study demonstrates elements of a real project on a before and after basis. The chapter concludes with the message that design of acute care settings involves much more than simply providing a space for care services to take place.This chapter explores the role of design in the context of behaviour change for people living with long-term conditions. A series of short case studies illustrates how design can facilitate the development of products and interventions that better support the needs of individuals and how these can lead to positive coping behaviours. The chapter concludes with a broader discussion of the complexities and ethical issues that design in the context of behaviour change promotes.

Book review: Design for care: innovating healthcare experience by Peter Jones

The last decade has witnessed an exponential growth in the number of designers work- ing in healthcare contexts. In part, this has occurred as a consequence of population demographics, of rapid changes occurring in healthcare technologies and also at a point where the need for new ways of thinking and working to meet the changing contexts of where and how health care is delivered is being recognized. Design for Care is one of the first books solely dedicated to exploring the role of designers in this arena.

Design for care: innovating healthcare experience, by Peter Jones

The last decade has witnessed an exponential growth in the number of designers work- ing in healthcare contexts. In part, this has occurred as a consequence of population demographics, of rapid changes occurring in healthcare technologies and also at a point where the need for new ways of thinking and working to meet the changing contexts of where and how health care is delivered is being recognized. Design for Care is one of the first books solely dedicated to exploring the role of designers in this arena.