Steps to better understanding resistant behaviours and the culture of bedside dementia care in hospitals
High levels of resistance to care by people with dementia can be exacerbated by responses by staff on the wards. This study sought to understand the interactions and culture underlying care by closely observing and documenting what was actually happening on ten wards in five UK hospitals, and through interviews with carers and families.
This in-depth study confirmed that people living with dementia are often resistant to care in acute hospital settings. Behaviour included wandering in wards, pu...
Goal-setting can help people with early-stage dementia improve function
Goal-setting as part of cognitive rehabilitation delivered by occupational therapists helped people with early dementia progress towards independence in daily tasks, with benefits lasting for nine months. This approach focuses on the everyday tasks needing concentration and memory and prioritising those that matter most to individuals, from using the cooker or answering the phone. The intervention was well-received, but the cost-effectiveness is not clear, because quality of life continued to de...
Training programme to improve communication between staff and patients with dementia in hospital shows promise
Communication with people with dementia can be challenging for healthcare professionals. A new two-day training programme shows potential to help professionals become more confident in managing difficult situations on the ward.
After analysis of 41 videoed exchanges between 26 healthcare professionals and 26 people with dementia in acute hospitals, researchers identified particular challenges. These included requests for action, such as asking them to take a drink or get out of bed, and at the ...
Antidepressants do not help treat depression in people living with dementia
Antidepressants do not reduce symptoms of depression in people with dementia compared with placebo (dummy pills). Measured 6 to 13 weeks after starting the treatment, there is little or no difference in participants’ symptoms, but an increased chance of unwanted side effects. The review did not identify enough data to determine if antidepressants have an effect in the longer-term.
This Cochrane review included randomised controlled trials of any antidepressant drugs compared to placebo. P...
Case managers improve outcomes for people with dementia and their carers
Using a case manager to coordinate health and social care improves the challenging behaviour of people with dementia and reduces the burden on caregivers. Quality of life of caregivers improves the most when case managers have a professional background in nursing.
This NIHR-funded review compared the effectiveness of standard community treatment and interventions with case managers overseeing the interventions for people living with dementia. It considered evidence from 14 trials in a number of...
Person-centred care improves quality of life for care home residents with dementia
A person-centred care intervention for people with dementia living in care homes improved their quality of life, reduced agitation and improved interactions with staff. It may also save costs compared with usual care.
The WHELD intervention involves training staff in person-centred care, with a focus on improving social interactions and appropriate use of antipsychotic medications. An early study suggested it could halve antipsychotic use.
This larger-scale NIHR trial conducted across 69 UK nu...
NIHR Themed Review
Advancing Care - Research with Care Homes
There are more than twice as many people living in care homes in England and Wales, than there are people staying in hospital. Yet we know far more about effective treatments in hospital and less about what works most effectively to improve care for older people in care homes. Research in care homes is a relatively new and emerging field.
Advancing Care provides an overview of recent NIHR research on improving the health and care of care home residents. It highlights current research taking pla...
A third of people with dementia have treatable vision problems
New data shows that around a third of people with dementia have serious vision problems, such as cataracts or short sightedness, more than the general population of that age. Levels are higher still for people with dementia in care homes – about half have vision problems.
Yet this study showed that many of the people with dementia and vision impairment had not received the right treatment. This often involves simple measures. For many, spectacles could have improved poor sight. A quarter ...
Coordinating care for people with long term conditions and dementia: room for improvement
New evidence shows that almost one fifth of people with dementia also have other serious conditions such as stroke, diabetes and visual impairment. Services are not currently designed to provide adequate integrated care for people with dementia plus other conditions. For instance, people with dementia are less likely to get diabetes checks or cataract surgery than those without dementia. Carers are not routinely contacted, and there is a lack of guidance for health professionals covering more th...
Supporting carers of people with dementia
Dementia is becoming more common as we live longer. Caring for people with dementia is demanding, with increased dependency as the disease progresses and behaviour which is often challenging. Around two thirds of people with dementia live at home and there may be as many as 670,000 people in the UK who are the main carers for people with dementia.
The new Care Act, which came into force in England from April 2015, now requires local authorities to assess the needs of carers for support and serv...