ENRICHEnabling Research in Care Homes
“Many older people in care homes report feeling lonely and socially isolated. Loneliness can have a negative impact on health outcomes and can lead to depression and increased confusion and memory loss (cognitive decline).
The internet, and video technologies such as Skype, FaceTime, or Zoom, can connect people to loved ones, or allow new social ties. But older people in care homes may be unfamiliar with the technology.
Many care homes run quizzes as a form of entertainment and mental stimulation. This research looked at virtual quizzes involving several care homes to improve socialisation. It explored whether the quizzes were feasible and beneficial.
This NIHR study is the first study to trial connecting care homes virtually via quiz sessions. Interviews revealed that residents felt more connected with each other, and with other care homes. They re-gained a sense of self and purpose and felt less lonely. Care home staff were eager to continue with the sessions, but they outlined barriers such as lack of staff support or time.
Unlike previous research into virtual socialising, this study included residents with dementia. It found that they benefited and remembered faces and conversations.
Four themes emerged from interviews with staff and residents:
- Residents with moderate-advanced dementia remembered faces and conversations but could not recall having seen the technology before. They expressed happiness when remembering conversations with people ‘outside’ of their care home, and answering questions in a ‘game’. They could recall details such as the gender or clothing of people who had spoken.
- Residents felt more connected with others. Within the same care home, residents learnt more about each other’s backgrounds and interests, and spoke fondly about their ‘teammates’. Across care homes, residents enjoyed comparing features of their environments.
- Residents re-gained a sense of self by sharing their stories and remembering their pasts with people of a similar age. One resident said the sessions were encouraging her to regain an interest in technology, but two expressed some insecurities, worrying that others may not like their image, and that ‘just anyone’ could see. However, the residents acknowledged that everyone on the calls had been friendly, and that they could move away from the screen if they wished.
- The virtual quizzes provided relief from loneliness or boredom. Most residents said the video calls helped them to ‘pass the time’ and gave them ‘something to do’. Residents said the quizzes encouraged them to get to know others within the same home more than passive activities, such as watching TV. Across care homes, residents were surprised that there were so many people with similar interests or professions, or who had grown up in the same area as they had.
Staff were keen to run virtual quizzes following the end of the study but said a lack of available staff and support could be a barrier. They saw positive effects on residents and enjoyed the competitive nature of the quiz themselves. They liked being able to get to know staff from other homes, and felt that the quizzes could help care homes connect with each other.”
For more information this study click here
“New research by the Health Foundation shows that the amount of hospital care received by those living in care homes in England rapidly declined in the first three months of the pandemic in 2020 and was substantially lower than in the same period in 2019.
The research, which is due to be peer reviewed, provides the first comprehensive and national analysis of all hospital care provided to care home residents during the first wave of the pandemic.
It appears to substantiate concerns that care home residents (including those in nursing homes and residential care) may have faced barriers to accessing hospital treatment as the NHS rapidly reorganised to free up hospital capacity to care for critically ill COVID-19 patients.”
If you would like to read more click on this link
“We are team of researchers based at the University of Surrey and University College London are interested in improving sleep in care home residents. We would like to develop an intervention that is feasible to deliver in care homes and helpful for improving residents’ sleep. However, before we can do this, we need to better understand current sleep practises in care homes. Consequently, we are asking adults aged 18+ who work in care homes in the UK to complete a short survey about this.
This survey will take approximately 5-10 mins to complete and will ask you 12 questions about your experiences with residents’ bedtimes, napping and monitoring residents at night. The survey is anonymous and no personal details will be collected. The information we collect will be used to design an intervention aimed at improving sleep in care home residents. We will then apply for funding to test out this intervention in care homes in the UK.”
If you would like to take part, please click on this link
“Most countries have restricted visits to care homes to prevent COVID-19 infections, however, concern is increasing about the negative impact of these restrictions on the health and wellbeing of care home residents and their families.
We carried out a rapid review of evidence to address three questions:
- What is the evidence on the impact of visitors in terms of infections in care homes?
- We found no scientific evidence that visitors to care homes introduced COVID-19 infections, however during the peak of the pandemic most countries did not allow visiting and there are some anecdotal reports attributing infections to visitors before restrictions.
- What is the evidence on the impact of closing care homes to visitors on the wellbeing of residents?
- There is increasing evidence that care home residents experienced greater depression and loneliness and demonstrated more behavioural disturbance during the period that included visitor bans.
- What has been the impact of restricting visits on quality of care?
- There is evidence of substantial care provision by unpaid carers and volunteers in care homes prior to the pandemic, hence visiting restrictions may have resulted in reductions in quality of care or additional tasks for care home staff.
Given that there were already low rates of social interactions among residents and loneliness before the COVID-19 pandemic, the evidence reviewed suggests that visiting restrictions are likely to have exacerbated this further. While there is no scientific evidence identifying visitors as the source of infections this is likely to reflect that most care homes did not allow visitors during the initial peaks of the pandemic. A pilot re-opening homes to visits under strict guidelines did not result in any infections.
Allowing visitors in facilities where there are no COVID-19 cases is important to support resident wellbeing. Safeguards to reduce risk of COVID-19 infection have been described, including visits through windows/glass, outdoor visits, and well-ventilated indoor spaces, screening of visitors, use of masks and other PPE and hand hygiene and cleaning.
In addition, it is important to recognize and support the provision of unpaid care, particularly for people who pre-COVID had a history of regular visiting to provide care (e.g. feeding, grooming, emotional support). They should be classified as essential workers, provided training and PPE, and be allowed to visit regularly and provide care, interacting as closely with residents as staff.”
More more information click here for the LTC Covid website
“When you woke this morning the clothes you planned to wear were gone. The shower gel smelt weird – it wasn’t your usual. There was no hairdryer to dry your hair. You wanted to make a hot drink but you had no access to a kettle … How is your day going? How do you feel? Welcome to the lives of many people with dementia living in care homes.”
This is the opening of a new training programme for care home staff developed by Dr Kellyn Lee, chartered psychologist and research fellow in ageing and dementia at the University of Southampton. Called material citizenship, it aims to get staff thinking about the importance of mundane, functional objects to our lives and identities, and how giving their residents agency over these things can significantly improve their wellbeing.
Charlotte Gilbert the general manager and the care home’s senior care assistant, Becci Fletcher, were among five staff from Brendoncare Knightwood who participated in the first one-day material citizenship course (moved online due to Covid). They credit the training with improving their practice as well as making them feel good about their work and the difference they can make – a welcome morale boost, mid-pandemic. Crucially, they say, it has “definitely” made life better for people in their care.
“One of our residents really wanted to polish her own room with a particular polish,” says Gilbert. Initially this was seen as unnecessary: the cleaning staff were there to clean. “But now we’ve got her the polish she wanted. She polishes her room and it makes it smell like home.”
“Another resident goes around collecting up all the trays after breakfast,” adds Fletcher. “Before the training we would say, ‘don’t worry, we’ll do that’ but now we let her do it. She enjoys it. She feels she’s looking after people and it gives her more sense of worth.”
Lee has now secured another year of funding, from the National Institute for Health Research’s Applied Research Collaboration Wessex, to roll out the training to more care homes. Sessions for other Brendoncare homes and Hallmark Care Homes will begin in February with more to follow.
Fletcher and Gilbert are in no doubt about the value of the rollout: “We feel passionately that everybody should have this training. If you take people’s everyday things away they lose independence and who they are. It may only mean changing 10 minutes of the day but it can make a massive difference.”
To access the full article click here
“An evidence-based programme for care home residents living with dementia improved their quality of life and reduced agitation and other symptoms of dementia. A major study across the UK found that the Well-being and Health for People Living with Dementia (WHELD) programme was effective and cost less to deliver than usual care.
The WHELD programme supports care home staff to deliver patient-centred interventions for residents with dementia. It seeks to reduce reliance on antipsychotic drugs and uses social interaction, personalised activities and exercise to improve care.
Most person-centred interventions used in care homes are not based on scientific evidence. WHELD was tested in a large clinical trial, which showed that it improved quality of life for people with dementia. The programme also reduced agitation and the overall burden of neuropsychiatric symptoms such as depression or aggression. A reduction in the number of hospital and GP visits made the approach less expensive to deliver than usual care.
What’s the issue?
A third of people with dementia in the UK (288,000) live in care homes. Those in care homes tend to have more severe dementia than those living in the community. Agitation and a range of other behavioural and psychological symptoms make it challenging to care for these people.
Person-centred care is the gold standard of care for people with dementia. Yet previous research has found that many care home residents have as little as two minutes of social interaction each day. There is currently no effective, evidence-based intervention to help staff care for these patients without using drugs.
In the first stages of this programme, researchers reviewed 40 studies on psychosocial interventions for people with dementia in care homes. These studies supported the use of person-centred approaches such as reminiscence therapy, in which photographs or other mementoes are used to help someone recall life events and memories. Walking, seated exercise, circle dance or other pleasant activities of the person’s choice were also found to help.
The researchers then looked at training manuals for person-centred care in dementia. Only four out of 170 manuals described interventions with proven benefits.
The team developed the first version of the WHELD programme based on the most practical and effective therapies. It combined person-centred care, management of agitation and non-drug approaches. A first randomised controlled trial tested this version of WHELD in 16 care homes over a period of nine months. It found that reviews of antipsychotic medication halved the use of these drugs. This increased the behavioural and psychological symptoms of dementia unless the medication review was combined with personalised activities. The combination of review plus social interaction significantly improved quality of life and reduced the risk of dying among people with dementia by 30%. Exercise reduced symptoms of agitation.”
For more details on this programme click here
The British Society of Gerontology Autumn Symposium Care Homes Research Special Interest group
“The prevalence of dementia is predicted to increase as our population ages. As the dementia progresses, many older adults with dementia will require advanced care – typically offered from within a residential care setting. Given this is the case for millions of people worldwide, it is important to explore ways in which these settings can support residents’ independence and wellbeing for as long as possible. In this symposium, supporting independence and wellbeing will be explored from two distinct, but related, perspectives.
24 November 12:30pm-2:00pm (UK Time)
Material Citizenship: Functional objects for meaningful lives (Dr Kellyn Lee).
Materiality has become an increasingly important topic in sociological studies of healthcare. How objects support the identity of people with a dementia in care homes is an emerging area. Whilst previous research had tended to focus on sentimental or cherished items (such as photographs and keepsakes) often considered for their comforting and ‘homely’ affordances, less attention has been given to functional objects (such as a pair of curling tongs or a vacuum cleaner) as a mechanism to maintain identity and encourage activity.
It is widely believed that older people moving into a care home are encouraged to bring items in from home however, only certain items are encouraged and these often carry caveats. Once in a care home people may often find themselves having to adjust their day-to-day activities to fit the task-orientated routine of care home life. The lack of personal possessions and access to functional objects can amplify barriers for residents to reach their optimal performance, reduce agency and increase dependency on care home staff.
This session introduces Material Citizenship as a conceptual framework which aims to encourage care home staff to consider the importance of functional objects in care practices.
The role of exercise in preventing falls and fractures for long-term care residents with dementia (Dr Caitlin McArthur).
Current evidence for the effectiveness and role of exercise in fall and fracture prevention is mixed. Recent systematic reviews have identified that exercise as a single intervention does not prevent falls in long-term care, but exercise as part of a multifactorial intervention (e.g., medication review, environmental assessment) does. The evidence for exercise as a fracture prevention strategy in long-term care is limited. Most studies to date do not include residents with significant cognitive impairment making the generalizability of the evidence limited to residents with good cognition. Further, few studies have examined the ethical decisions around encouraging independent mobility which may increase the risk for falls and fractures.
This session will provide an in-depth discussion of exercise as a fall and fracture prevention strategy in long-term care, including the evidence about its effectiveness and common barriers to implementing strategies. Content will focus on recent research findings about fall and fracture prevalence, risk factors, prevention, injury minimization, and how dementia contributes to risk.
Dr Kellyn Lee (firstname.lastname@example.org)
Kellyn is a Chartered Psychologist and Research Fellow in Ageing and Dementia, and Co-Director of the Alzheimer’s Society funded Doctoral Training Centre for Dementia Care – University of Southampton, UK.
Kellyn is responsible for the development and management of the Enabling Research in Care Homes (ENRICH) toolkit website and has experience of working on many ageing and dementia research projects. She currently leads on an impact project working with a care organisation to develop Material Citizenship as an online training programme for care home staff.
Dr Caitlin McArthur (email@example.com)
Caitlin is an Assistant Professor in the School of Physiotherapy at Dalhousie University in Halifax, Nova Scotia, Canada. Dr McArthur’s research focuses on improving the effectiveness of and access to rehabilitation for people living with chronic health conditions across the continuum of care, particularly home and long-term care. She is interested in fall and fracture prevention and improving functional mobility.
The session will be moderated by Dr Chad Witcher, Senior Lecturer, School of Sport, Health and Exercise Science, University of Portsmouth (firstname.lastname@example.org). Chad is the Special Interest Group’s Care Home Sector Engagement Co-Lead. He has an interest in physical activity engagement and promotion within care home settings.
About the Special Interest Group (SIG):
Our SIG aims to strengthen research, policy, and practice in all areas of care homes research, including those related to staff, residents, family members and carers, as well as the home environment, and its links with external organisations. We also aim to develop complementary working relationships with the other SIGs, as well as other groups and organisations that support care homes research.
If you would like to be part of the Care Homes Research SIG, please contact the SIG at BSGcarehomes@gmail.com
Please also follow us on Twitter @BSGcarehomes
“A 2-year study is being carried out by researchers at King’s College London university investigating the use of ‘residential respite’ services (e.g. a short stay in a care home) which provide a break for both people with dementia and their carers. The research focuses on short stays in care homes (known as residential respite).
We want to hear about the arrangements, expectations and experiences. What do people get out of them, and why do some people decide it is not for them? We would value your help so we can better understand what works well and what could be better.
We would talk to you via phone or Zoom/Skype and offer you £10 to thank you for your time. Please email Laura Cole if you would like more information or might want to take part: Laura.email@example.com
For more details on this study click here
The study is funded by an Alzheimer’s Society grant
The webinar takes place on Tuesday 13th October from 1.00 – 2.00pm and includes two presentations focusing on care homes:
Investigating “optimal time”: Multiple perspectives on the timing of moving into care homes for people living with dementia
Kritika Samsi (King’s College London)
Regulator quality ratings and care home residents quality of life
Ann-Marie Towers (University of Kent)
Time for questions and discussions
NIHR SSCR’s Webinars are free to attend with pre-registration.
To register click here