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The Enriched Opportunities Programme: The Enriched Opportunities Programme: Maximising well-being of older people in Maximising well-being of older people in extra care housingextra care housing
Dawn Brooker Dawn Brooker Elaine Argyle & David ClancyElaine Argyle & David ClancyBradford Dementia GroupBradford Dementia GroupUKUK
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
www.bradford.ac.uk
Partnership
• ExtraCare Charitable Trust
• Bradford Dementia Group
• External experts
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
www.bradford.ac.uk
Current Research ProgrammeDoes 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?
Research designEvaluation 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 & residents10 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 measuresJune-Dec2007 6 month measuresJan-May 2008 12 month measures June–Dec 2008 18 month measuresJan– 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 screened294 approached for consent
Consent No’s Gender Age
EOP N = 135
115 direct20relative
8 30 m105 f
81.2 (53-98)
PSWCN=133
122 direct11relative
18 35 m98 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%
PSWCn=133
13% 4-35%
20% 0-29%
21% 13-43%
41% 33-52%
Quality of life scores
QOLAD staff13- 52
QOLAD Residents13-52
EQ5D5-15
EOP N = 135
27.11 14 – 48
29.08 14-44
9.085-14
PSWCN=133
27.814-48
31.11313-47
8.9185-15
Depression & enjoyment of activity
GDS0-15
GDS < 6 Enjoy activity0-20
EOP N = 135
6.170-15
N = 61(40-58% per scheme)
8.9880-20
PSWCN=133
5.280-14
N=53(12-58% per scheme)
10.830-20
DCM Mood & Engagement
WIB score
% negative ME
% +3 ME
% + 5 ME
EOPn = 86 observed
+1.28+0.15- +3.0
3.4% 0-16%
19.26% 3-43%
0%
PSWC n=106 observed
+1.36+0.5 - +3.2
3.6% 0-18%
20% 8-38%
0.6% 0-1.8%
Staff attitudes and interaction
NOP 13-65
ADQ19-95
Total PD’s
Total PE’s
EOPstaff = 194
52.1836-64
74.6656-91
130-7
955-30
PSWC staff = 196
52.6139-63
73.3428-92
30-2
574-30
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 d.j.brooker@Bradford.ac.ukTel 01274 235726Website www.bradford.ac.uk/health/dementia
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