The Enriched Opportunities Programme: Maximising well-being of older people in extra care housing Dawn Brooker Elaine Argyle & David Clancy Bradford Dementia Group UK

Aims of presentation Describe the Enriched Opportunities Programme intervention Outline RCT research in extra care housing Share some baseline results, early gains & obstacles

Enriched Opportunities Programme 2002-2005: References

Brooker, D. & Woolley, R. (2007) Enriching Opportunities for People living with Dementia: The Development of a Blueprint for a Sustainable Activity-Based Model of Care.

Aging and Mental Health,

11(4): 371-383 Brooker, D., Woolley, R. & Lee, D. (2007) Enriching Opportunities for People living with Dementia in Nursing Homes: An evaluation of a multi-level activity-based model of care.

Aging and Mental Health

11(4): 361-370

Partnership

•

ExtraCare Charitable Trust

•

Bradford Dementia Group

•

External experts

www.bradford.ac.uk

External Experts •

Kate Allen

•

Clive Ballard

• • • • • • • • • • • •

Paul Batson Karen Bryan Errollyn Bruce Sheila Cheyney Ann Childs Richard Coaten Carole Dinshaw Jim Ellis Jane Fossey Tina Free Penny Garner Margaret Goodall

• • • • • • • • • • • • • •

Margaret Hardware John Keady John Killick David Lee Rebecca Leech James Lindsay Hazel May Esme Moniz-Cook Sally Nocker Kate Reid Pam Schweitzer Claire Surr Graham Stokes Denise Westwood

Essential elements of the Enriched Opportunities Programme Focus on those residents who are most at risk of exclusion

• Specialist expertise - The Locksmith • Individual assessment & case work • External networking and liaison • A skilled staff team • The provision of activities • Management & Leadership

ExtraCare Housing features

• Tenancy rights and your own front door • Dining room and community facilities • Government funding and promotion • Physical environment • Mixed age & dependency levels • Care and assistance programmes

People with dementia – a home for life?

Current Research Programme

Does the Enriched Opportunities Programme make any difference to the lives of residents with significant mental health problems living in extra care housing, over and above the impact of employing an extra staff member to help with activities?

www.bradford.ac.uk

Research design

Evaluation of the Enriched Opportunities Programme in extra care housing compared to an attention placebo intervention by means of a Randomized Cluster Controlled Trial (RCT) over a period of eighteen months.

Enriched Opportunities Programme Intervention

• Locksmith staff • Individualised assessment, case work & liaison for target residents • A skilled staff team – training & mentoring • Activities geared to the needs of the target group • Management & Leadership

Attention placebo

Employment of an extra senior member of staff (Project Support Worker Coach) to generally assist with promoting activities within the housing scheme.

Study sites & residents

10 extra care housing schemes & villages in the Midlands and North West of England ranging in size from 45 to 320 residents 35 residents per site selected according to their vulnerability to exclusion from the community.

5 schemes get Enriched Opportunities Programme for 18 months 5 schemes get attention placebo for 12 months followed by 6 months full Enriched Opportunities Programme

Inclusion criteria screen

• Dementia or confusion • Communication difficulties • Social isolation • Challenging behaviour • Depression or low mood

Time table May-Dec 2006 Preparation, recruitment, ethics Jan –May 2007 Baseline measures June-Dec2007 6 month measures Jan-May 2008 12 month measures June –Dec 2008 18 month measures Jan – Feb 2009 Data Analyses Mar – June 2009 Feedback & dissemination

Measures with participants

• QOLAD • EQ5D • SF12 • Duke DSSI • GDS • MMSE • Rating enjoyment of activities and goals • Dementia Care Mapping

Measures completed with key worker

• QOLAD proxy • Bartel inventory • Basoll mood scale • Bristol Activities of daily living (BADLS) • Activities over past 4 weeks • Goals identified

Measures of staff attitude and behaviour

• Staff perception of nursing older people • Attitude to Dementia Questionnaire • Opinion of intervention • Numbers of Personal Detractions and Personal Enhancers observed on DCM • Staff turnover

Cost effectiveness

• Use of services • Psychotropic medication • Hospitalisations • Relocations • Deaths

Qualitative enquiry

• Locksmith learning logs • Interviews with locksmiths, project support worker coaches, managers • Compliance with intervention checklist • Case studies • Focus groups with residents • Focus groups with staff

Participants: 1113 were screened 294 approached for consent Consent No’s Gender Age EOP N = 135 115 direct 20relative 8 30 m 105 f 81.2 (53-98) PSWC N=133 122 direct 11relative 18 35 m 98 f 82 (56-100)

Diagnoses per scheme for participating residents Dem’a diag Query dem’a other psych Psych med EOP n=135 20% 0-65% 26 % 4-44% 25% 11-48% 35% 4-52% PSWC n=133 13% 4-35% 20% 0-29% 21% 13-43% 41% 33-52%

Quality of life scores QOLAD staff 13- 52 QOLAD Residents 13-52 EQ5D 5-15 EOP N = 135 27.11 14 – 48 PSWC N=133 27.8

14-48 29.08 14-44 31.113

13-47 9.08

5-14 8.918

5-15

Depression & enjoyment of activity GDS 0-15 GDS < 6 Enjoy activity 0-20 EOP N = 135 PSWC N=133 6.17

0-15 5.28

0-14 N = 61 (40-58% per scheme) N=53 (12-58% per scheme) 8.988

0-20 10.83

0-20

DCM Mood & Engagement EOP n = 86 observed WIB score +1.28

+0.15 +3.0

PSWC n=106 observed +1.36

+0.5 +3.2

% negative ME 3.4% 0-16% % +3 ME % + 5 ME 19.26% 3-43% 0% 3.6% 0-18% 20% 8-38% 0.6% 0-1.8%

Staff attitudes and interaction EOP staff = 194 PSWC staff = 196 NOP 13-65 52.18

36-64 52.61

39-63 ADQ 19-95 74.66

56-91 73.34

28-92 Total PD’s Total PE’s 13 0-7 3 0-2 95 5-30 57 4-30

Early gains

• Research process is a positive experience for residents • Target residents joining in general activities • Medication side effects ameliorated • Infections diagnosed • People with longstanding MH problems getting better support. • Liaison with CMHT’s, GP’s and AS • Lifestyle changes

Early barriers

• Where have all these frail residents come from?

• Where have all these residents with dementia come from?

• Stigma • Locksmiths feeling overwhelmed • PSWC’s being used to cover vacant shifts

Thank you for listening!

Dawn Brooker, Bradford Dementia Group, Email [email protected]

Tel 01274 235726 Website www.bradford.ac.uk/health/dementia