Elaine Argyle

The enriched opportunities programme for people with dementia: a cluster-randomised controlled trial in 10 extra care housing schemes.

Objectives: The Enriched Opportunities Programme (EOP) is a multi-level intervention focussing on improved quality of life for people with dementia. This study compared the experience of people living with dementia and other mental health problems in extra care housing schemes that utilised EOP with schemes that employed an active control intervention. Method: Ten extra care housing schemes were cluster randomised to receive either the EOP intervention or an active control intervention for an 18-month period. Residents with dementia or other significant mental health problems (20–30 per scheme) were assessed on a number of outcome measures at baseline, six months, one year and 18 months. The primary outcome measure was quality of life. Self-reported depression was an important secondary outcome. Results: The EOP-participating residents rated their quality of life more positively over time (4.0 (SE 0.6) units; 14% p < 0.001) than the active control (1.3 (SE 0.6) units; 4% p = 0.003). There was also a significant group–time interaction for depressive symptoms (p = 0.003). The EOP-participating residents reported a reduction of 25% at both six and 12 months and a 37% reduction at 18 months (all ps < 0.001). EOP residents were less likely than residents in the active control sites to move to a care home or to be admitted to a hospital inpatient bed. They were more likely to be seen by a range of community health professionals. Conclusion: The EOP had a positive impact on the quality of life of people with dementia in well-staffed extra care housing schemes.

Person centred dementia care: problems and possibilities

Purpose Dementia care is an issue of increasing policy focus, with person centred approaches becoming synonymous with quality provision in this area. However, the implementation and efficacy of this approach is difficult to measure and there are still huge variations in working practices, with task centred approaches traditionally predominating over more holistic forms of care. In order to address these issues the procedure of dementia care mapping has been developed, which aims to assess the wellbeing of people with dementia and other vulnerable groups through the observation of communal activities. This article aims to critically assess the implementation of a person centred approach. Design/methodology/approach – With the use of dementia care mapping, this article assesses the implementation of a person centred approach with a group of care home residents. All were female, their ages ranged from 77 to 92. Findings – It is shown that while participants potentially experienced many benefits from person centred approaches and the social engagement and integration that derived from this, its efficacy and impact was undermined by contextual factors such as staff shortages. Originality/value – In order that contextual factors are recognised and addressed, practice should transcend its focus on the promotion of individual wellbeing and address the wider group and social contexts which can facilitate or prevent its fulfilment.

Space, the final frontier: outdoor access for people living with dementia

Studies have consistently found that access to outdoor space has a positive impact on the mental and physical well-being of people with dementia (Mapes, 2010; Rappe & Topo, 2007). Benefits are often linked to an affinity with nature (Hendriks, van Vliet, Gerritsen, & Dr€ oes, 2016) and outdoor settings (Olsson, Lampic, Skovdahl, & Engstr€ om, 2013) with a government White Paper expressing the commitment to reconnect people with this natural environment (HM Government, 2011). The benefits of outdoor access can also arise from engagement in specific activities, helping to promote inclusion and occupation, with the Joseph Rowntree Foundation (2005) finding that older people regarded the ability to get out and keep active as being an important aspect of their life. Specific benefits of going outside expressed by people with dementia include interaction with others, aesthetic appreciation, exercise and a sense of freedom (Duggan, Blackman, Martyr, & Van Schaik, 2008). For those living in care homes, where privacy tends to be lacking, additional benefits of outdoor access can also potentially include the experience of being alone and in a peaceful place. Of course, these benefits are unlikely to be unique to people with dementia who just want to maintain an ordinary way of life (Fukushima, Nagahata, Ishibashi, Takahashi, & Moriyama, 2005). Nor are benefits confined to the promotion of individual well-being. As such, this editorial will suggest that access to the outdoors is central to the promotion of the human rights and social inclusion of people with dementia. It will also explore the barriers and facilitators to the achievement of this access.

Research based theatre in dementia knowledge transfer: views from the front line

Purpose - Formal ties between the theatre and research dissemination have only recently developed and its general efficacy is largely unknown. Here we aim to redress this neglect by examining the effectiveness of a research based theatrical event in promoting dementia knowledge transfer with a group of front line care workers. The event ran over eight days and consisted of an original theatrical production followed by a chaired audience discussion and workshops. Design/methodology/approach-Questionnaires which had been developed specifically for this evaluation were completed by 863 front line workers on the day of the event, eliciting their profiles and immediate reactions. Three months after the event, thirty completed a follow-up questionnaire and eight were interviewed. Findings-Attendance was well received with high degrees of both cognitive and emotional engagement being expressed in the initial questionnaire. The follow-up evaluation suggested that these positive reactions were sustained over time. However, many taking part in this follow-up thought that their practice had not changed as a result of event attendance. This apparent discrepancy between knowledge transfer and utilisation appeared to be partly the result of the influence of contextual factors in impeding this utilisation within work settings. Originality/value-Evidence is provided on the positive impact of theatre on dementia carers’ working lives. This is sufficient to warrant further applications of this method, provided there is careful attention to embedding the messages in the workplace context and evaluating their efficacy.

Implementing person centred dementia care: a musical intervention

Purpose - Recent years have seen the advocacy of person centred approaches to dementia care. An important component of this approach has been the use of arts in the promotion of health and wellbeing. However, relatively little attention has been given to the barriers and facilitators experienced in trying to implement these types of interventions in a dementia care setting. It is therefore the purpose of this article to help to redress this neglect by examining the process of implementing a personalized musical intervention for clients of a specialist dementia home care service. Design/methodology/approach - Drawing on interviews with five project stakeholders, the paper examines, not only the potential benefits to be gained from the musical intervention but also identifies the barriers experienced in its implementation and ways in which they could be overcome. Findings - It was found that although the musical intervention had a potentially positive impact, there were multi-leveled barriers to its implementation including issues of training, leadership as well as contextual issues such as commissioning and resourcing more generally. Originality/value - The key role played by these issues in the process of implementation suggests that practice should transcend its focus on individual well-being and address the wider factors that can facilitate or prevent its fulfillment. While the multi-leveled nature of the obstacles identified suggest that the implementation of innovative interventions within health and social care settings should adopt a similarly eclectic approach.

Creative practice in a group setting

Purpose – Involvement in creative practice is commonly regarded as “therapeutic” but what is actually meant by this and how does this work promote social inclusion and mental well-being, particularly when performed in a group setting? Drawing on the findings of a research project called Clay Transformations (AHRC), the purpose of this paper is to consider these questions. The project involved running a series of clay workshops aimed at people with experience of mental health service use and those who work with them. Design/methodology/approach – In order to explore the significance of art involvement to people who use mental health services, qualitative research findings are presented. These are then linked to relevant literature in order to consider the way in which workshop participation helped to promote social inclusion and mental well-being. Findings – Many benefits were gained from workshop attendance deriving from involvement in the process and the outcome of art creation. These benefits were enhanced by the group context in which the work took place and the mutual support and interaction arising from this group membership. Originality/value – The recognition of the therapeutic value of creative practice has been accompanied by the emergence of the notion of “mutual recovery” which extends the concept of recovery beyond an individualised focus. The positive findings of this project uphold these developments and suggest that mental health practice should address the wider social contexts that can facilitate the promotion of mental well-being.

The effective ingredients of social support at home for people with dementia: a literature review

Purpose Recent years have seen an increasing reliance on social support at home for people with dementia and the advocacy of a person centred and integrated approach in its provision. However, little is known about the effective ingredients of this support and how they differ from more generic or health-based services. The purpose of this paper is to explore the existing evidence base. Design/methodology/approach A review of relevant literature was carried out, combining a systematic search and selection of articles with a narrative analysis. Findings The review identified 14 relevant studies of varying research designs which yielded conflicting findings with regard to the optimal timing of interventions and their overall impact. This highlights the problems of review and generalisability when attempting to compare findings of research in this area. This was exacerbated by the blurred divide between health and social care and ambiguities in the meaning of the latter. Research limitations/implications This methodological heterogeneity demonstrates the need for consistency in research approaches if comparisons are to be made. Further questions include the precise components that distinguish social care from health care, the optimal timing for the introduction of this care and whether adherence to good practice in this area can be linked to cost effectiveness. Originality/value The review identifies relevant issues in need of further investigation and tentative themes emerging from the literature which suggest the utility of an adequately resourced, integrated and responsive approach to intervention.

Introducing the Care Certificate Evaluation: Innovative practice

Although investment in staff development is a prerequisite for high-quality and innovative care, the training needs of front line care staff involved in direct care have often been neglected, particularly within dementia care provision. The Care Certificate, which was fully launched in England in April 2015, has aimed to redress this neglect by providing a consistent and transferable approach to the training of the front line health and social care workforce. This article describes the early stages of an 18-month evaluation of the Care Certificate and its implementation funded by the Department of Health Policy Research Programme.