Having one hour a week of social interaction, combined with a just a small amount of personalized care, can improve the quality of life of people with dementia who live in care homes, according to a recent study in the United Kingdom.
These findings came from the Improving Wellbeing and Health for People with Dementia (WHELD) trial, the largest non-pharmacological randomized control trial in people with dementia living in care homes to date. The study was conducted by researchers from the University of Exeter, King’s College London and Oxford Health NHS Foundation Trust and included the collaboration of the Alzheimer’s Society.
Findings from the trial were published in the journal PLOS Medicine, under the title “Impact of person-centred care training and person-centred activities on quality of life, agitation, and antipsychotic use in people with dementia living in nursing homes: A cluster-randomised controlled trial.”
Previous research had shown that in many care homes residents have as little as two minutes of social interaction per day. In addition, dementia patients often experience agitation and other symptoms that are difficult to treat and distressing for the individual, and may greatly impact quality of life.
“While many care homes are excellent, standards still vary hugely. We have previously found that the average amount of social interaction for people with dementia was just two minutes a day. It’s hardly surprising when that has a knock-on effect on quality of life and agitation,” Clive Ballard, who led the research, said in a press release. Ballard is a professor at the University of Exeter Medical School.
“Our approach improves care and saves money. We must roll out approaches that work to do justice to some of the most vulnerable people in society. Incredibly, of 170 career training manuals available on the market, only four are based on evidence that they really work. That is simply not good enough — it has to change,” he said.
The WHELD study aimed to evaluate the effectiveness of person-centred care and psychosocial intervention, incorporating an antipsychotic review on quality of life, agitation, and antipsychotic use in people with dementia living in nursing homes. It also examined costs.
The primary goal was to measure quality of life, and secondary goals included measuring agitation, neuropsychiatric symptoms, antipsychotic use, global deterioration, mood, unmet needs, mortality, pain and cost.
The randomized trial was conducted from January 2013 to September 2015 and compared the WHELD approach with treatment as usual (TAU) in people with dementia living in 69 care homes in the U.K. All care homes staff receiving the WHELD intervention received training in person-centered care and social interaction, and education regarding antipsychotic medications.
A total of 847 people were randomized to WHELD or TAU; of those, 553 completed the nine-month trial.
The WHELD intervention conferred benefits in terms of quality of life, agitation, and neuropsychiatric symptoms (albeit with relatively small effect sizes), as well as cost savings. Benefits were greatest in people with moderately severe dementia.
According to researchers, the WHELD intervention is a model that can be implemented readily in nursing homes.
“Taking a person-centred approach is about getting to know each resident as an individual their interests and preferences — and reflecting these in all aspects of care. It can improve the lives of the person themselves and it can be rewarding for carers, too. We’ve shown that this approach significantly reduces agitation and saves money. Rolling out the training nationwide could benefit many other people,” said Jane Fossey, from the Oxford Health NHS Foundation Trust.
The next challenge is to take the program to the 28,000 care homes in the U.K. to help improve the quality of life of the 300,000 dementia patients estimated to live in these facilities.
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