1998-2009 eop research & development
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The Enriched Opportunities Programme for people with dementia living in extra care housing: A randomised cluster controlled trial of a complex psycho-social intervention Dawn Brooker, Association for Dementia Studies University of Worcester - PowerPoint PPT PresentationTRANSCRIPT
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The Enriched Opportunities Programme for people with dementia living in extra care housing: A randomised cluster controlled trial of a complex psycho-social intervention
Dawn Brooker, Association for Dementia Studies University of WorcesterElaine Argyle, David Clancy, Andy Scally, University of Bradford. Guy Page ExtraCare Charitable TrustHazel May Gloucester 2gether NHS Foundation Trust
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1998-2009 EOP Research & Development1998- 2000 Between group comparison of nursing home residents participating in an activity challenge holiday and a matched control group.
2001-2003 The development of the EOP programme using qualitative enquiry and within group quantitative evaluation in four study sites
2005- 2009 Random cluster controlled trial in ten extra care housing schemes
University of Worcester Association for Dementia Studies
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Bringing together expertise
University of Worcester Association for Dementia Studies
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Extra Care Housing features Tenancy rights and your own front
door Restaurant, bar, shop, library, IT,
gym, hair salon and community facilities
People empowerment, ambassadors, awards, user feedback
Physical environment high spec Mixed age & dependency levels Care and assistance programmes
University of Worcester Association for Dementia Studies
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People with dementia – a home for life?
University of Worcester Association for Dementia Studies
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Cluster randomised controlled trial 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) in 10 ExtraCare housing schemes over a period of eighteen months. Study focussed on the lives of the 20-30 most vulnerable people living in each scheme.
University of Worcester Association for Dementia Studies
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EOP: The 5 Components
1. Specialist Expertise – the Locksmith – unlocks potential, unpicks issues
2. Individual Assessment and case work -applies ‘Enriched Model’ - proactive liaison with community & resources
3. Activity, Occupation and interventions4. Training – enables whole team approach5. Management and Leadership – sustains over time
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Attention placebo
Employment of an extra senior member of staff (Project Support Worker Coach) to generally assist with promoting activities within the housing scheme.
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Study sites10 extra care housing schemes & villages in the
Midlands and North West of England ranging in size from 45 to 320 residents
Randomised at site level 5 schemes Enriched Opportunities Programme, 5 schemes attention placebo
35 residents per site selected according to their vulnerability to exclusion from the community
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Inclusion Criteria
• Dementia or confusion • Communication
difficulties• Social isolation• Challenging behaviour• Depression or low mood
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Total of participants over 18 months
Condition Number of participants at baseline
Number at 18 months
Total EOP 33 male
111 female
TOTAL = 144
23 male
79 female
TOTAL = 102Total Placebo 39 male
110 female
TOTAL = 149
26 male
71 female
TOTAL = 97
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Significant improvement EOP Rated Quality of Life more positively Reported decreased symptoms of depression
University of Worcester Association for Dementia Studies
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QOLAD self-rated; time x intervention interaction: p < 0.001
Figure ? QOLAD Residents
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Baseline 6 Month 12 month 18 month
Time period
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EOP
PSWC
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QOLAD staff-rated; time x intervention interaction: p = 0.004
Figure ? QOLAD Staff
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Baseline 6 Month 12 month 18 month
Time period
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EOP
PSWC
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Depression GDS; time x intervention interaction: p = 0.003
Figure ? Average Geriatric Depression Score
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Baseline 6 Month 12 month 18 month
Time period
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EOP
PSWC
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Significant improvement EOP Half as likely to have to move out into a care
home Spent significantly less time in hospital More likely to have a GP visit More likely to access community health
resources More likely to have a mental health diagnoses
University of Worcester Association for Dementia Studies
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Reasons for drop-out from programme
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GP visits, community OT, Physio and chiropody costs
• EOP rose from £26,643 (6 month costs) at baseline to £35,877 for the same time period at the end of the intervention.
• In comparison the Placebo costs fell from £30,269 to £24,702 for the same time period.
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In-patient hospital Costs
• Costs for the EOP residents fell from £58,794 (6 month costs) to £34, 177 over the course of the intervention.
• Costs for the Placebo residents rose from £56,646 to £117,589 for the same period of time.
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Changes observed over-time in EOP and PSWC sites Greater opportunity to be active Greater use of community facilities More fun Greater variety of things to do Improved well-being observed Dependency generally increased over time
University of Worcester Association for Dementia Studies
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Things that didn’t change in 18 months
People remained satisfied with their level of support
Staff attitudes were positive to begin with and remained so
University of Worcester Association for Dementia Studies
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References Brooker D., Argyle, E., Clancy, D. & Scally A. (2009) Enriched Opportunities Programme: A cluster randomised controlled trial of a new approach to living with dementia and other
mental health issues in ExtraCare housing schemes and villages. University of Bradford.May, H., Edwards, P. and Brooker, D. (2009). Enriched Care Planning for People with Dementia:
A Good Practice Guide to Delivering Person-Centred Care. London, Jessica Kingsley Publications
Brooker D., Argyle, E. & Clancy, D. (2009) Mental Health Needs of people living in extra care housing. Journal of Care Services Management, Vol 3.3 March/April
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
Brooker, D. (2001) Enriching Lives: evaluation of the ExtraCare Activity Challenge. Journal of Dementia Care. (Research Focus) 9 (3), 33-37.
University of Worcester Association for Dementia Studies
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Next steps
• Writing up for peer-review• Roll-out across ExtraCare Charitable Trust
villages and schemes• Dissemination plan for Dept of Health• Development of leadership, “Locksmith” and
general dementia awareness training and education materials
University of Worcester Association for Dementia Studies
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Thank you for listening!
Prof Dawn BrookerAssociation for Dementia [email protected]
http://ihsc.worc.ac.uk/dementia www.extracare.org.uk
Photographs of people living with dementia taking part in The Enriched Opportunities Programme