A Taxonomy of Arts Interventions for People With Dementia

Background and Objectives The current evidence base for the arts and dementia has several limitations relating to the description, explanation, communication, and simplification of arts interventions. Research addressing these challenges must be multidisciplinary, taking account of humanities and science perspectives. Consequently, this research aimed to produce a taxonomy, or classification, of arts interventions for people with dementia as a contribution to this growing field. Research Design and Methods This research was underpinned by taxonomy and realist methodology. Taxonomy, the science of classification, produces a common language to name, define, and describe the world around us. Realist theory explains how interventions “work” and produce their effects. The main findings in this paper were generated from a case study and a Delphi study. Results An arts and dementia taxonomy of 12 dimensions was developed: Art Form, Artistic elements, Artistic focus, Artistic materials, Arts activity, Arts approaches, Arts facilitators, Arts location, Competencies, Complementary arts, Intervention context, Principles. Discussion and Implications Arts interventions can be classified according to their contexts, mechanisms, and outcomes. A range of stakeholders could benefit from the taxonomy, including people with dementia, artists, practitioners, carers, care staff, funders, commissioners, researchers, and academics. Language relating to the arts and dementia can be adapted depending on the audience. This is a foundational model requiring further development within the arts and dementia community

Setting priorities to inform assessment of care homes’ readiness to participate in healthcare innovation: a systematic mapping review and consensus process

© 2020 The Author(s). This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly citedOrganisational context is known to impact on the successful implementation of healthcare initiatives in care homes. We undertook a systematic mapping review to examine whether researchers have considered organisational context when planning, conducting, and reporting the implementation of healthcare innovations in care homes. Review data were mapped against the Alberta Context Tool, which was designed to assess organizational context in care homes. The review included 56 papers. No studies involved a systematic assessment of organisational context prior to implementation, but many provided post hoc explanations of how organisational context affected the success or otherwise of the innovation. Factors identified to explain a lack of success included poor senior staff engagement, non-alignment with care home culture, limited staff capacity to engage, and low levels of participation from health professionals such as general practitioners (GPs). Thirty-five stakeholders participated in workshops to discuss findings and develop questions for assessing care home readiness to participate in innovations. Ten questions were developed to initiate conversations between innovators and care home staff to support research and implementation. This framework can help researchers initiate discussions about health-related innovation. This will begin to address the gap between implementation theory and practice.Peer reviewe

Ab-initio study of the relation between electric polarization and electric field gradients in ferroelectrics

The hyperfine interaction between the quadrupole moment of atomic nuclei and the electric field gradient (EFG) provides information on the electronic charge distribution close to a given atomic site. In ferroelectric materials, the loss of inversion symmetry of the electronic charge distribution is necessary for the appearance of the electric polarization. We present first-principles density functional theory calculations of ferroelectrics such as BaTiO3, KNbO3, PbTiO3 and other oxides with perovskite structures, by focusing on both EFG tensors and polarization. We analyze the EFG tensor properties such as orientation and correlation between components and their link with electric polarization. This work supports previous studies of ferroelectric materials where a relation between EFG tensors and polarization was observed, which may be exploited to study ferroelectric order when standard techniques to measure polarization are not easily applied.Comment: 9 pages, 6 figures, 5 tables, corrected typos, as published in Phys. Rev.

Effective health care for older people resident in care homes: the optimal study protocol for realist review

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.Background: Care homes in the UK rely on general practice for access to specialist medical and nursing care as well as referral to therapists and secondary care. Service delivery to care homes is highly variable in both quantity and quality. This variability is also evident in the commissioning and organisation of care home-specific services that range from the payment of incentives to general practitioners (GPs) to visit care homes, to the creation of care home specialist teams and outreach services run by geriatricians. No primary studies or systematic reviews have robustly evaluated the impact of these different approaches on organisation and resident-level outcomes. Our aim is to identify factors which may explain the perceived or demonstrated effectiveness of programmes to improve health-related outcomes in older people living in care homes. Methods/Design: A realist review approach will be used to develop a theoretical understanding of what works when, why and in what circumstances. Elements of service models of interest include those that focus on assessment and management of residents’ health, those that use strategies to encourage closer working between visiting health care providers and care home staff, and those that address system-wide issues about access to assessment and treatment. These will include studies on continence, dignity, and speech and language assessment as well as interventions to promote person centred dementia care, improve strength and mobility, and nutrition. The impact of these interventions and their different mechanisms will be considered in relation to five key outcomes: residents’ medication use, use of out of hours’ services, hospital admissions (including use of Accident and Emergency) and length of hospital stay, costs and user satisfaction. An iterative three-stage approach will be undertaken that is stakeholder-driven and optimises the knowledge and networks of the research team. Discussion: This realist review will explore why and for whom different approaches to providing health care to residents in care homes improves access to health care in the five areas of interest. It will inform commissioning decisions and be the basis for further research. This systematic review protocol is registered on the PROSPERO database reference number: CRD42014009112NIHR Health Services & Delivery Research Programme. Project number 11/1021/0

A synthesis: what works to deliver optimal health outcomes for uk care home residents

The detailed reviews, interviews and subsequent longitudinal case studies structured around a unifying realist analytical framework allowed us to establish a theory of commissioning for health care provision to care homes which proposes health services will work better when: staff are explicitly tasked to work with care homes at an institutional level as well as individual residents; healthcare and care home staff are empowered to co-design their working models; where explicit expertise in dementia care is available; the role of GP as a medical care provider is supported by access to a wider array of services; and they incorporate care management. There was no evidence from our study that a short term focus on avoiding admissions to acute hospitals from care homes added any value to service specification or care delivery

Anticholinergic Drug Exposure and the Risk of Dementia: A Nested Case-Control Study

IMPORTANCE Anticholinergic medicines have short-term cognitive adverse effects, but itis uncertain whether long-term use of these drugs is associated with an increased risk of dementia.OBJECTIVE To assess associations between anticholinergic drug treatments and risk of dementia in persons 55 years or older.DESIGN, SETTING, AND PARTICIPANTS This nested case-control study took place in general practices in England that contributed to the QResearch primary care database. The study evaluated whether exposure to anticholinergic drugs was associated with dementia risk in 58 769 patients with a diagnosis of dementia and 225 574 controls 55 years or older matched by age, sex, general practice, and calendar time. Information on prescriptions for 56 drugs with strong anticholinergic properties was used to calculate measures of cumulative anticholinergic drug exposure. Data were analyzed from May 2016 to June 2018.EXPOSURES The primary exposure was the total standardized daily doses (TSDDs) of anticholinergic drugs prescribed in the 1 to 11 years prior to the date of diagnosis of dementia or equivalent date in matched controls (index date).MAIN OUTCOMES AND MEASURES Odds ratios (ORs) for dementia associated with cumulative exposure to anticholinergic drugs, adjusted for confounding variables.RESULTS Of the entire study population (284 343 case patients and matched controls), 179 365 (63.1%) were women, and the mean (SD) age of the entire population was 82.2 (6.8) years. The adjusted OR for dementia increased from 1.06 (95%CI, 1.03-1.09) in the lowest overall anticholinergic exposure category (total exposure of 1-90 TSDDs) to 1.49 (95%CI, 1.44-1.54) in the highest category (>1095 TSDDs), compared with no anticholinergic drug prescriptions in the 1 to 11 years before the index date. There were significant increases in dementia risk for the anticholinergic antidepressants (adjusted OR [AOR], 1.29; 95%CI, 1.24-1.34), antiparkinson drugs (AOR, 1.52; 95%CI, 1.16-2.00), antipsychotics (AOR, 1.70; 95% CI, 1.53-1.90), bladder antimuscarinic drugs (AOR, 1.65; 95%CI, 1.56-1.75), and antiepileptic drugs (AOR, 1.39; 95%CI, 1.22-1.57) all for more than 1095 TSDDs. Results were similar when exposures were restricted to exposure windows of 3 to 13 years (AOR, 1.46; 95%CI, 1.41-1.52) and 5 to 20 years (AOR, 1.44; 95%CI, 1.32-1.57) before the index date for more than 1095 TSDDs. Associations were stronger in cases diagnosed before the age of 80 years. The population-attributable fraction associated with total anticholinergic drug exposure during the 1 to 11 years before diagnosis was 10.3%.CONCLUSIONS AND RELEVANCE Exposure to several types of strong anticholinergic drugs is associated with an increased risk of dementia. These findings highlight the importance of reducing exposure to anticholinergic drugs in middle-aged and older people

Care home readiness: a rapid review and consensus workshops on how organisational context affects care home engagement with health care innovation

Summary The NHS Five-Year Forward view recognises that the NHS needs to do more to support older people living with frailty in care homes. This paper presents the findings from a rapid review and consensus events that explored how organisational context affects uptake of healthcare innovation in long term care settings. Care home managers and front line staff, care home researchers, NHS commissioners and NHS practitioners participated in the workshops. The review found that uptake is likely to be better when contextual factors are addressed. Leadership and care home culture were important but there was a limited consensus about how to identify this or, for example, what kind of leadership made a difference. A few studies highlighted the importance of making sure that the priorities of care home and health care practitioners were aligned and establishing that care home staff had the resources and time to implement the change. Workshop participants agreed that the different contextual factors discussed in the literature were important and resonated with their experience. NHS services and practitioners had not however, structured their work with care homes to take these factors into account. Also discussed was the need to consider if NHS services understood how to work with care homes. In deciding how and when to allocate resources to care homes to support new initiatives, the NHS needs to consider carefully the organisational contexts and assess them appropriately. Based on the combined findings we suggest ten key questions for commissioners and service providers working with care home providers. Ideally these questions can be used prior to working with care homes. They can also help to structure reviews of uptake of innovations to enhance health in care homes. 1. Does this intervention align with care home priorities? Or are there other potential interventions that care homes identify as more pressing? 2. What evidence is there of senior management interest and enthusiasm for this intervention at organisation & unit level? Are they willing and able on a daily basis to take a leadership role in supporting the proposed change? 3. Do care home staff have enough “slack and flexibility” to accommodate the change into their current workload, is this recognised as core to their work? 4. How is change discussed (formally and informally) in the care home setting? Who needs to be involved in decision-making about what is being proposed and how it is implemented? 5. What are the recent changes or health related projects this care home has been involved with? 6. Is there a champion in both the care home and in the linked NHS service with protected time to help facilitate change? 7. What are the pre-existing working relationships between NHS services and care home staff and networks of care and support around the care home? ( e.g. GPs, visiting specialists, links with local hospital) 8. Could the intervention appear judgemental by signalling in a negative way that the care home needs to change? 9. How well do existing care home training programmes and work schedules fit with what is proposed? 10. Will care home staff have to collect and enter new data or is it held in existing systems? The report concludes by suggesting some strategies that might support how NHS practitioners and care home staff address their capacity and readiness to work together

Mementos from Boots multisensory boxes: qualitative evaluation of an intervention for people with dementia: innovative practice

This qualitative study explored a multisensory (including olfactory) intervention for people with dementia. Six themed boxes (e.g. Childhood) containing items chosen from the Boots archive designed to encourage conversation were used in weekly group sessions. Session participants were people with dementia and care staff from a local care home, a trained facilitator and archivists from Boots UK. Semi-structured interviews explored participants’ experiences of the sessions. Interviews were analysed using Thematic Analysis. The three major themes Engagement (subthemes: Inclusiveness; Emotional involvement; Factors that supported engagement), What’s in the box (subthemes: Contents stimulate memories; Mystery, variety and age of items; Value of olfactory stimuli), and A conversation starter (subtheme: Opportunity for self-expression) reveal the success of the intervention and the value of olfactory stimuli. Multisensory boxes including olfactory stimulation can be an engaging intervention with scope to refine it for people with dementia and their carers in the wider community

Relationships, expertise, incentives, and governance: Supporting care home residents' access to health care: An interview study from England

Objectives: To explore what commissioners of care, regulators, providers, and care home residents in England identify as the key mechanisms or components of different service delivery models that support the provision of National Health Service (NHS) provision to independent care homes. Methods: Qualitative, semistructured interviews with a purposive sample of people with direct experience of commissioning, providing, and regulating health care provision in care homes and care home residents. Data from interviews were augmented by a secondary analysis of previous interviews with care home residents on their personal experience of and priorities for access to health care. Analysis was framed by the assumptions of realist evaluation and drew on the constant comparative method to identify key themes about what is required to achieve quality health care provision to care homes and resident health. Results: Participants identified 3 overlapping approaches to the provision of NHS that they believed supported access to health care for older people in care homes: (1) Investment in relational working that fostered continuity and shared learning between visiting NHS staff and care home staff, (2) the provision of age-appropriate clinical services, and (3) governance arrangements that used contractual and financial incentives to specify a minimum service that care homes should receive. Conclusion: The 3 approaches, and how they were typified as working, provide a rich picture of the stakeholder perspectives and the underlying assumptions about how service delivery models should work with care homes. The findings inform how evidence on effective working in care homes will be interrogated to identify how different approaches, or specifically key elements of those approaches, achieve different health-related outcomes in different situations for residents and associated health and social care organizations.Open Access funded by Department of Health UK

INTERNATIONAL COLLABORATIONS TO SHAPE RESEARCH

The file attached to this record is the author's final peer reviewed version.The Brazilian care home sector is underdeveloped, and the limited available evidence suggests that care quality falls below international standards. Development of the Brazilian care home sector could be associated with better outcomes for those receiving care, and more efficient use of resources across health and social care. Research has an important role to play. This article summarises research priorities for Brazilian long-term care homes developed as part of an international workshop held in Brazil and the UK, and attended by 71 clinicians and researchers from 6 Brazilian Universities, supported by an international faculty of 8 Brazilian, 8 British, 2 Dutch and 1 Austrian academics. The research priorities identified were: understanding and supporting multidisciplinary working in care homes, with emphasis on describing availability of multidisciplinary teams and how they operate; dignity and sensitivity to cultural needs, with emphasis on collating accounts from Brazilian stakeholders about dignity in care and how it can be delivered; enriching the care home environment with art, music and gardens, with a focus on developing arts in the care home space in a way that is sensitive to Brazilian cultural identity; and benchmarking quality of care, with emphasis on exploring how international quality benchmarking tools can be adapted for use in Brazilian care homes, taking account of new initiatives to include person-centred outcomes as part of benchmarking. Instrumental to research in these priority areas will be establishing care home research capacity in Brazil