Preparing care home staff to manage challenging behaviours among residents living with dementia: A mixed-methods evaluation

We evaluated an intervention designed to manage challenging behaviours of people with dementia. Framework analysis of interviews (n = 21) showed the intervention modified practice and perceptions. The intervention (n = 58; power calculation proposed n = 160 for medium effect) had no significant effect on attitudes to dementia for time (p = .42) or care home (p = .15). The Maslach burnout scores did not change significantly for person-centredness for time (p = .83) or care home (p = .29). Hope scores showed a significant effect post-intervention (p = .004), but this was not maintained. No significant main effect was found for care home (p = .36). Experiential learning enabled staff to experience benefits of person-centred care firsthand

Walking football as sustainable exercise for older adults – A pilot investigation

The health benefits of playing football and the importance of exercise and social contact for healthy ageing are well established, but few older adults in the UK take enough exercise. Football is popular, flexible in format and draws players into engrossing, effortful and social exercise, but the physical demands of play at full speed may make it unsustainable for some older adults. Restricted to walking pace, will play still be engaging? Will health benefits be retained? Will physical demands remain manageable? This pilot study aims to investigate: (1) the experience of older adults playing walking football every week, is it sustainable and rewarding, (2) the intensity and locomotor pattern of walking football, (3) the scale and nature of walking football health benefits and (4) possible cognitive benefits of playing walking football through measures of processing speed, selective and divided attention and updating and inhibition components of executive function. ‘Walking football’ and ‘waiting list’ groups were compared before and after 12 weeks of one-hour per week football. Walking football was found to be engaging, sustainable for older adults and moderately intensive; however, selective health and cognitive benefits were not found from this brief intervention

Checklist for co-creating safe spaces with young people participating in research

Creating safe spaces in research As researchers, it is imperative that we provide safe spaces for young people to participate in research. This is particularly relevant to the field of mental health research, where participants may be asked to engage in activities that require them to discuss or reflect on experiences of poor mental health. Such activities can be upsetting for participants and so it is important to consider what actions can be taken to best reduce risks of negative experience for participants. This will also lead to improved research data quality. Currently, there is limited information to inform the creation of safe spaces for young people participating in research. We felt that there was a need to address this gap through the creation of a new checklist resource that was co-developed with young people. To facilitate this, we worked with the Institute for Mental Health’s Youth Advisory Group (IMH YAG), based at the University of Birmingham. The IMH YAG is made up of young people aged 18-25 with lived experience of mental health difficulty or experience of supporting a young person with lived experience of mental health difficulty. We identified three key themes: confidentiality and consent, fostering trust and feeling safe. Our checklist centres around how to best accommodate these needs and we have presented practical tips on how this can be addressed at three different stages of research participation: before, during and after.  We hope that this checklist will support researchers to consider what steps can be taken to ensure that children and young people participate in research that makes them feel safe and empowered.</p

MEDREV (pharmacy-health psychology intervention in people living with dementia with behaviour that challenges):the feasibility of measuring clinical outcomes and costs of the intervention

BACKGROUND: People living with dementia in care homes frequently exhibit "behaviour that challenges". Anti-psychotics are used to treat such behaviour, but are associated with significant morbidity. This study researched the feasibility of conducting a trial of a full clinical medication review for care home residents with behaviour that challenges, combined with staff training. This paper focusses on the feasibility of measuring clinical outcomes and intervention costs. METHODS: People living with moderate to severe dementia, receiving psychotropics for behaviour that challenges, in care homes were recruited for a medication review by a specialist pharmacist. Care home and primary care staff received training on the management of challenging behaviour. Data were collected at 8 weeks, and 3 and 6 months. Measures were Neuropsychiatric Inventory-Nursing Home version (NPI-NH), cognition (sMMSE), quality of life (EQ-5D-5 L/DEMQoL) and costs (Client Services Receipt Inventory). Response rates, for clinical, quality of life and health economic measures, including the levels of resource-use associated with the medication review and other non-intervention costs were calculated. RESULTS: Twenty-nine of 34 participants recruited received a medication review. It was feasible to measure the effects of the complex intervention on the management of behaviour that challenges with the NPI-NH. There was valid NPI-NH data at each time point (response rate = 100%). The sMMSE response rate was 18.2%. Levels of resource-use associated with the medication review were estimated for all 29 participants who received a medication review. Good response levels were achieved for other non-intervention costs (100% completion rate), and the EQ-5D-5 L and DEMQoL (≥88% at each of the time points where data was collected). CONCLUSIONS: It is feasible to measure the clinical and cost effectiveness of a complex intervention for behaviour that challenges using the NPI-NH and quality of life measures. TRIAL REGISTRATION: ISRCTN58330068. Retrospectively registered, 15 October 2017

Protocol for a cluster randomised waitlist-controlled trial of a goal-based behaviour change intervention for employees in workplaces enrolled in health and wellbeing initiatives.

Many workplaces offer health and wellbeing initiatives to their staff as recommended by international and national health organisations. Despite their potential, the influence of these initiatives on health behaviour appears limited and evaluations of their effectiveness are rare. In this research, we propose evaluating the effectiveness of an established behaviour change intervention in a new workplace context. The intervention, 'mental contrasting plus implementation intentions', supports staff in achieving their health and wellbeing goals by encouraging them to compare the future with the present and to develop a plan for overcoming anticipated obstacles. We conducted a systematic review that identified only three trials of this intervention in workplaces and all of them were conducted within healthcare organisations. Our research will be the first to evaluate the effectiveness of mental contrasting outside a solely healthcare context. We propose including staff from 60 organisations, 30 in the intervention and 30 in a waitlisted control group. The findings will contribute to a better understanding of how to empower and support staff to improve their health and wellbeing. Trial registration: ISRCTN17828539

Medication review plus person-centred care:a feasibility study of a pharmacy-health psychology dual intervention to improve care for people living with dementia

BACKGROUND: "Behaviour that Challenges" is common in people living with dementia, resident in care homes and historically has been treated with anti-psychotics. However, such usage is associated with 1800 potentially avoidable deaths annually in the UK. This study investigated the feasibility of a full clinical trial of a specialist dementia care pharmacist medication review combined with a health psychology intervention for care staff to limit the use of psychotropics. This paper focuses on feasibility; including recruitment and retention, implementation of medication change recommendations and the experiences and expectations of care staff. METHODS: West Midlands care homes and individuals meeting the inclusion criteria (dementia diagnosis; medication for behaviour that challenges), or their personal consultee, were approached for consent. A specialist pharmacist reviewed medication. Care home staff received an educational behaviour change intervention in a three-hour session promoting person-centred care. Primary healthcare staff received a modified version of the training. The primary outcome measure was the Neuropsychiatric Inventory-Nursing Home version at 3 months. Other outcomes included quality of life, cognition, health economics and prescribed medication. A qualitative evaluation explored expectations and experiences of care staff. RESULTS: Five care homes and 34 of 108 eligible residents (31.5%) were recruited, against an original target of 45 residents across 6 care homes. Medication reviews were conducted for 29 study participants (85.3%) and the pharmacist recommended stopping or reviewing medication in 21 cases (72.4%). Of the recommendations made, 57.1% (12 of 21) were implemented, and implementation (discontinuation) took a mean of 98.4 days. In total, 164 care staff received training and 21 were interviewed. Care staff reported a positive experience of the intervention and post intervention adopting a more holistic patient-centred approach. CONCLUSIONS: The intervention contained two elements; staff training and medication review. It was feasible to implement the staff training, and the training appeared to increase the ability and confidence of care staff to manage behaviour that challenges without the need for medication. The medication review would require significant modification for full trial partly related to the relatively limited uptake of the recommendations made, and delay in implementation. TRIAL REGISTRATION: ISRCTN58330068 . Registered 15 October 2017. Retrospectively registered