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INTRODUCTION: iWHELD is a digital person‐centered care program for people with dementia in nursing homes adapted for remote delivery during the COVID‐19 pandemic. METHODS: A 16‐week two‐arm cluster‐randomized controlled trial in 149 UK nursing homes compared iWHELD with treatment as usual (TAU). Primary outcome was the overall quality of life with secondary outcomes of agitation and psychotropic use. RESULTS: iWHELD conferred benefit to quality of life on the primary (F = 4.3, p = 0.04) and secondary measures of quality of life (F = 6.45, p = 0.01) and reduced psychotropic medication use (χ2 = 4.08, p = 0.04) with no worsening of agitation. Benefit was seen in participants who contracted COVID‐19, those with agitation at baseline, and those taking psychotropic medications. DISCUSSION: iWHELD confers benefits to quality of life and key measures of well‐being, can be delivered during the challenging conditions of a pandemic, and should be considered for use alongside any emerging pharmacological treatment for neuropsychiatric symptoms. Highlights: iWHELD is the only remote, digital delivery nursing home training programme for dementia careiWHELD improved quality of life in people with dementia and reduced antipsychotic use without worsening of agitationResidents who contracted Covid‐19 during the study also experienced benefits from iWHELDiWHELD offers a valuable, pandemic‐safe tool for improving dementia care [ABSTRACT FROM AUTHOR]

Background: Personalised risk reduction is a key driver for the nascent UK Brain Health Clinic (BHC) network, with increasing evidence that modifying dementia risk could delay or prevent disease progression. Livingston et al. (2020) demonstrated a number of risk factors for dementia, including less formal education (identified as no secondary education), excessive alcohol consumption (>21 units/week), obesity (BMI >30), depression and presence of an ApoE Ɛ4 allele; whilst increased physical activity has been associated with reduced risk and sleep duration is suggested to have a U‐shaped association with dementia risk. The aim of this study was to understand the prevalence of these risk factors within a typical UK memory clinic population. Method: The Oxford BHC is a joint clinical and research assessment service for Oxford Health NHS Foundation Trust memory clinic patients (O'Donoghue et al., 2022). It aims to provide detailed clinical assessment and equal access to research opportunities. Between August 2020 and May 2022, 152 BHC patients (93.2%) consented to their clinical data, including subsequent diagnosis, being used for research purposes (mean age = 78.2 years, range 65‐101 years; 52.6% female). Self‐reported questionnaires collected education (N = 124), alcohol consumption (M SASQ, N = 150), depressive symptoms (PHQ9, N = 148), physical activity (IPAQ, N = 152) and sleep (PSQI, N = 152). BMI was calculated from height and weight measured at BHC appointment (N = 146) and ApoE Ɛ genotyping from saliva sampling (N = 76). Result: Preliminary results show 7% of patients reported no formal qualifications, 1% consumed 6 or more units of alcohol daily/almost daily, 15.7% had a BMI >30 and 45% showed mild‐severe symptoms of depression. Inappropriate sleep was reported by 13%, 71% engaged in less than 150 minutes of physical activity a week and 41% had an ApoE Ɛ4 allele (see Figure 1). Conclusion: In this population, we found a relatively small prevalence of low education and alcohol consumption, but a large proportion of patients could benefit from interventions focused on improving mood and physical activity. Ongoing analysis aims to create a weighted composite risk score for this population and explore relationships with primary diagnosis, cognition and measures of brain health including hippocampal volume and white matter hyperintensities. [ABSTRACT FROM AUTHOR]

Objectives: The study aims to understand the factors that care home staff felt enabled or hindered them in continuing to use the well-being and health for people with dementia (WHELD) psychosocial approach in their care home and investigate whether there was sustained activity 9 to 12 months after the study ended.Methods: This qualitative study is part of a wider clinical trial, which demonstrated effectiveness of a psychosocial intervention on quality of life outcomes and neuropsychiatric symptoms for residents. Forty-seven care home staff within nine care homes in the United Kingdom participated in focus groups, between 9 and 12 months after the intervention had finished. Inductive thematic analysis was used to identify themes and interpret the data.Results: The findings highlighted that staff continued to use a range of activities and processes acquired through the research intervention, after the study had ended. Three overarching themes were identified as influential: "recognising the value" of the approach for residents and staff, "being well practiced" with sufficient support and opportunity to consolidate skills prior to the withdrawal of the researchers, and "taking ownership of the approach" to incorporate it as usual care.Conclusions: The WHELD approach can be sustained where the value of the approach is recognised, and sufficient support is provided during initial implementation for staff to build skills and confidence for it to become routine care. Further follow-up is required to understand longer term use and the impact for residents. [ABSTRACT FROM AUTHOR]

Introduction: To examine whether an optimized intervention is a more cost‐effective option than treatment as usual (TAU) for improving agitation and quality of life in nursing home residents with clinically significant agitation and dementia. Methods: A cost‐effectiveness analysis within a cluster‐randomized factorial study in 69 care homes with 549 residents was conducted. Each cluster was randomized to receive either the Well‐being and Health for people with Dementia (WHELD) intervention or TAU for nine months. Health and social care costs, agitation, and quality of life outcomes were evaluated. Results: Improvements in agitation and quality of life were evident in residents allocated to the WHELD intervention group. The additional cost of the WHELD intervention was offset by the higher health and social care costs incurred by TAU group residents (mean difference, £2103; 95% confidence interval, −13 to 4219). Discussion: The WHELD intervention has clinical and economic benefits when used in residents with clinically significant agitation. [ABSTRACT FROM AUTHOR]

Objectives: To examine the cost of care for people with dementia in institutional care settings, to understand the major cost drivers and to highlight opportunities for service development.Methods: Data on 277 residents with dementia in 16 UK residential or nursing homes were collected. We estimated care and support costs and fitted models to the data. Sensitivity analyses were also conducted.Results: Care home residents cost £792 weekly: 95% of the costs accounted for by direct fees. Hospital contacts contributed the largest proportion of the additional costs. Having an established diagnosis of dementia (b = 0.070; p < 0.05) was associated with higher costs. No association was found between cost and needs (b = -0.002; p = 0.818).Conclusion: The absence of an association between cost and needs emphasizes the importance of a more needs-based costing system which could result in clinical and economic advantages. Copyright © 2016 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background: Very few interventional studies have directly examined the impact of treatment approaches on health-related quality of life (HRQL) in people with dementia. This is of particular importance in therapies to address behavioural symptoms, where HRQL is often severely affected.Methods: Analysis within the WHELD cluster randomised factorial study in 16 UK care homes examining the impact of person-centred care in combination with antipsychotic review, social interaction and exercise interventions. This study analysed impact on HRQL through the DEMQOL-Proxy.Results: Data on HRQL were available for 187 participants. People receiving antipsychotic review showed a significant worsening in two DEMQOL-Proxy domains (negative emotion: p = 0.02; appearance: p = 0.04). A best-case scenario analysis showed significant worsening for total DEMQOL-Proxy score. Social interaction intervention resulted in a significant benefit to HRQL (p = 0.04). There was no deterioration in HRQL in groups receiving both antipsychotic review and social interaction (p = 0.62).Conclusions: This demonstrates an important detrimental impact of discontinuation of antipsychotics in dementia on HRQL, highlighting the need for careful review of best practice guidelines regarding antipsychotic use and emphasising the importance of providing evidence-based non-pharmacological interventions in conjunction with antipsychotic review. Copyright © 2016 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objective: To contribute to an optimised training programme for care staff that supports the implementation of evidence-based psychosocial interventions in long-term care.Methods: Qualitative study that involved focus group discussions with 119 care home staff within 16 care homes in the UK. Part of wider clinical trial aimed at developing and evaluating an effective and practical psychosocial intervention and implementation approach for people with dementia in long-term care. Inductive thematic analysis was used to identify themes and interpret the data.Results: The findings highlighted that successful training and support interventions must acknowledge and respond to 'whole home' issues. Three overarching themes emerged as influential: the importance of contextual factors such as staff morale, interpersonal relationships within the home, and experience and perceived value of the proposed intervention.Conclusions: Priority must be given to obtain the commitment of all staff, management and relatives to the training programme and ensure that expectations regarding interaction with residents, participation in activities and the reduction of medication are shared across the care home. [ABSTRACT FROM AUTHOR]

Objective The overall objective is to determine the availability of person-centred intervention and training manuals for dementia care staff with clinical trial evidence of efficacy. Design Interventions were identified using a search of electronic databases, augmented by mainstream search engines, reference lists, hand searching for resources and consultation with an expert panel. The specific search for published manuals was complemented by a search for randomised control trials focussing on training and activity-based interventions for people with dementia in care homes. Manuals were screened for eligibility and rated to assess their quality, relevance and feasibility. Results A meta-analysis of randomised control trials indicated that person-centred training interventions conferred significant benefit in improving agitation and reducing the use of antipsychotics. Each of the efficacious packages included a sustained period of joint working and supervision with a trained mental health professional in addition to an educational element. However, of the 170 manuals that were identified, 30 met the quality criteria and only four had been evaluated in clinical trials. Conclusions Despite the availability of a small number of evidence-based training manuals, there is a widespread use of person-centred intervention and training manuals that are not evidence-based. Clearer guidance is needed to ensure that commissioned training and interventions are based on robust evidence. Copyright © 2014 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background There are a paucity of validated measures focusing on quality of life for people with dementia in care facilities. Method The current study evaluated the internal consistency of Dementia Care Mapping (DCM) in a group of 123 people with dementia residing in care facilities and further evaluated the test retest reliability and concurrent validity of key DCM constructs in an additional group of 54 residents. Results The results show good internal consistency. Well–ill being score was significantly correlated with an informant rated quality of life measure (r = 0.73, p < 0.0001) and showed good test retest reliability (r = 0.55, p < 0.0001). An abbreviated assessment period focusing on the hour before lunch showed significant correlation with the total assessment period (well–ill being score r = 0.5, p = 0.02). Conclusion The current study indicates that DCM is a valid tool for the longitudinal evaluation of quality of life in people with dementia in care settings and that some abbreviation of the method may facilitate its use more widely. Copyright © 2002 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Investigates the role of vision in the encoding and reproduction of movement. Comparison of kinesthetic reproductions of a kinesthetically presented two-dimensional movement with reproductions where vision was present either during the standard or at reproduction; Findings that the presence of vision during the standard resulted in poorer accuracy and greater underestimation of movement size that when it was absent.