Hostname: page-component-78c5997874-m6dg7 Total loading time: 0 Render date: 2024-11-10T19:30:27.320Z Has data issue: false hasContentIssue false
  • English
  • Français

AwareCare: a pilot randomized controlled trial of an awareness-based staff training intervention to improve quality of life for residents with severe dementia in long-term care settings

Published online by Cambridge University Press:  30 July 2012

Linda Clare ,
Rhiannon Whitaker ,
Robert T Woods ,
Catherine Quinn ,
Hannah Jelley ,
Zoe Hoare ,
Joan Woods ,
Murna Downs  and
Barbara A. Wilson
Linda Clare*
Affiliation:
School of Psychology, Bangor University, Bangor, Gwynedd LL57 2AS, UK
Rhiannon Whitaker
Affiliation:
North Wales Organisation for Randomised Trials in Health (NWORTH), Bangor University, Y Wern, Normal Site, Holyhead Road, Bangor, Gwynedd LL57 2PZ, UK
Robert T Woods
Affiliation:
Dementia Services Development Centre, Bangor University, 45 College Road, Bangor, Gwynedd LL57 2AS, UK
Catherine Quinn
Affiliation:
School of Psychology, Bangor University, Bangor, Gwynedd LL57 2AS, UK
Hannah Jelley
Affiliation:
School of Psychology, Bangor University, Bangor, Gwynedd LL57 2AS, UK
Zoe Hoare
Affiliation:
North Wales Organisation for Randomised Trials in Health (NWORTH), Bangor University, Y Wern, Normal Site, Holyhead Road, Bangor, Gwynedd LL57 2PZ, UK
Joan Woods
Affiliation:
Dementia Services Development Centre, Bangor University, 45 College Road, Bangor, Gwynedd LL57 2AS, UK
Murna Downs
Affiliation:
Bradford Dementia Group, School of Health Studies, Bradford University, Horton A Building, Richmond Road, Bradford BD7 1DP, UK
Barbara A. Wilson
Affiliation:
Medical Research Council Cognition and Brain Sciences Unit, 15 Chaucer Road, Cambridge CB2 2EF, UK
*
Correspondence should be addressed to: Professor Linda Clare, School of Psychology, Bangor University, Bangor, Gwynedd LL57 2AS, UK. Phone: +44 1248 388178. Email: l.clare@bangor.ac.uk.
Get access Rights & Permissions [Opens in a new window]

Abstract

Background: The extent to which care home residents with severe dementia show awareness is influenced by the extent to which the environment provides opportunities for engagement and by the way in which care staff interact with them. We aimed to establish whether training care staff to observe and identify signs of awareness in residents with severe dementia resulted in improved quality of life for residents.

Methods: In this pilot cluster randomized trial, care staff in four homes (n = 32) received training and supervision and carried out structured observations of residents using the AwareCare measure (n = 32) over an eight-week period, while staff in four control homes (n = 33) had no training with regard to their residents (n = 33) and no contact with the research team. The primary outcome was resident quality of life. Secondary outcomes were resident well-being, behavior and cognition, staff attitudes and well-being, and care practices in the home.

Results: Following intervention, residents in the intervention group had significantly better quality of life as rated by family members than those in the control group, but care staff ratings of quality of life did not differ. There were no other significant between-group differences. Staff participating in the intervention identified benefits in terms of their understanding of residents’ needs.

Conclusions: Staff were able to use the observational measure effectively and relatives of residents in the intervention homes perceived an improvement in their quality of life.

Keywords

family caregiversobservationwell-beingbehaviorcognitionresponsivenessstaff attitudescare practices
Type
Research Article
Information
International Psychogeriatrics , Volume 25 , Issue 1 , January 2013 , pp. 128 - 139
Copyright
Copyright © International Psychogeriatric Association 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Asplund, K., Norberg, A., Adolfsson, R. and Waxman, H. M. (1991). Facial expressions in severely demented patients – a stimulus-response study of four patients with dementia of the Alzheimer type. International Journal of Geriatric Psychiatry, 6, 599–606. doi:10.1002/gps.930060809.CrossRefGoogle Scholar
Ballard, C.et al. (2001). Quality of care in private sector and NHS facilities for people with dementia: cross-sectional survey. BMJ, 323, 426–427. doi:10.1136/bmj.323.7310.426.CrossRefGoogle ScholarPubMed
Brooker, D. J. R., Sturmey, P., Gatherer, A. J. H. and Summerbell, C. (1993). The Behavioural Assessment Scale of Later Life (BASOLL): a description, factor analysis, scale development, reliability and validity data for a new scale for older adults. International Journal of Geriatric Psychiatry, 8, 747–754. doi:10.1002/gps.930080907.CrossRefGoogle Scholar
Clare, L., Rowlands, J., Bruce, E., Surr, C. and Downs, M. (2008). “I don't do like I used to do”: a grounded theory approach to conceptualising awareness in people with moderate to severe dementia living in long-term care. Social Science and Medicine, 66, 2366–2377. doi:10.1016/j.socscimed.2008.01.045.CrossRefGoogle ScholarPubMed
Clare, L., Woods, R. T., Whitaker, R., Wilson, B. A. and Downs, M. (2010). Development of an awareness-based intervention to enhance quality of life in severe dementia. Trials, 11, 73. doi:10.1186/1745-6215-11-73.CrossRefGoogle ScholarPubMed
Clare, L., Markova, I., Roth, I. and Morris, R. (2011). Awareness in Alzheimer's disease and associated dementias: theoretical framework and clinical implications. Aging and Mental Health, 15, 936–944. doi:10.1080/13607863.2011.583630.CrossRefGoogle ScholarPubMed
Clare, L.et al. (2012). AwareCare: development and validation of an observational measure of awareness in people with severe dementia. Neuropsychological Rehabilitation, 22, 113–133. doi:10.1080/09602011.2011.640467.CrossRefGoogle ScholarPubMed
Cohen, J. (1988). Statistical Power Analysis for the Behavioral Sciences, 2nd edn.Hillsdale, NJ: Lawrence Erlbaum Associates.Google Scholar
Crespo, M., de Quiros, M. B., Gomez, M. M. and Hornillos, C. (2012). Quality of life of nursing home residents with dementia: a comparison of perspectives of residents, family and staff. The Gerontologist, 52, 56–65. doi:10.1093/geront/gnr080.CrossRefGoogle ScholarPubMed
Donoghue, C. (2010). Nursing home staff turnover and retention: an analysis of national level data. Journal of Applied Gerontology, 29, 89–106. doi:10.1177/0733464809334899.CrossRefGoogle Scholar
Edelman, P., Fulton, B. R., Kuhn, D. and Chang, C.-H. (2005). A comparison of three methods of measuring dementia-specific quality of life: perspectives of residents, staff and observers. The Gerontologist, 45 (Special Issue 1), 27–36. doi:10.1093/geront/45.suppl_1.27.CrossRefGoogle ScholarPubMed
Goldberg, D. (1992). General Health Questionnaire (GHQ-12). Windsor, UK: NFER-Nelson.Google Scholar
Götell, E., Brown, S. and Ekman, S.-L. (2003). Influence of caregiver singing and background music on posture, movement, and sensory awareness in dementia care. International Psychogeriatrics, 15, 411–430. doi:10.1017/S1041610203009657.CrossRefGoogle ScholarPubMed
Hintze, J. (2004). NCSS and PASS. Kaysville, Utah. Available at: www.NCSS.com (Number Cruncher Statistical Systems); last accessed 1 October 2007.Google Scholar
Kuske, B., Hanns, S., Luck, T., Angermeyer, M. C., Behrens, J. and Riedel-Heller, S. G. (2007). Nursing home staff training in dementia care: a systematic review of evaluated programs. International Psychogeriatrics, 19, 818–841. doi:10.1017/S1041610206004352.CrossRefGoogle Scholar
Lintern, T., Woods, B. and Phair, L. (2000). Training is not enough to change care practice. Journal of Dementia Care, 8, 15–17.Google Scholar
Magai, C., Cohen, C., Gomberg, D., Malatesta, C. and Culver, C. (1996). Emotional expression during mid-to late-stage dementia. International Psychogeriatrics, 8, 383–395. doi:10.1017/S104161029600275X.CrossRefGoogle ScholarPubMed
Magai, C., Cohen, C. I. and Gomberg, D. (2002). Impact of training dementia caregivers in sensitivity to nonverbal emotion signals. International Psychogeriatrics, 14, 25–38. doi:10.1017/S1041610202008256.CrossRefGoogle ScholarPubMed
Maslach, C., Jackson, S. E. and Leiter, M. P. (1996). Maslach Burnout Inventory: Manual. Palo Alto, CA: Consulting Psychologists Press.Google Scholar
McCabe, M. P., Davidson, T. E. and George, K. (2007). Effectiveness of staff training programs for behavioural problems among older people with dementia. Aging and Mental Health, 11, 505–519. doi:10.1080/13607860601086405.CrossRefGoogle Scholar
Moniz-Cook, E.et al. (1998). Can staff training reduce behavioural problems in residential care for the elderly mentally ill? International Journal of Geriatric Psychiatry, 13, 149–158. doi:10.1002/(SICI)1099-1166(199803)13:3<149::AID-GPS746>3.0.CO;2-Q.3.0.CO;2-Q>CrossRefGoogle ScholarPubMed
Norberg, A., Melin, E. and Asplund, K. (1986). Reactions to music, touch and object presentation in the final stage of dementia: an exploratory study. International Journal of Nursing Studies, 23, 315–323. doi:10.1016/0020-7489(86)90054-4.CrossRefGoogle ScholarPubMed
Perrin, T. (1997). The positive response schedule for severe dementia. Aging and Mental Health, 1, 184–191. doi:10.1080/13607869757290.CrossRefGoogle Scholar
Reisberg, B. (1988). Functional assessment staging (FAST). Psychopharmacology Bulletin, 24, 653–659.Google ScholarPubMed
Visser, S., McCabe, M. P., Hodgson, C., Buchanan, G., Davison, T. E. and George, K. (2008). Managing behavioral symptoms of dementia: effectiveness of staff education and peer support. Aging and Mental Health, 12, 47–55. doi:10.1080/13607860701366012.CrossRefGoogle ScholarPubMed
Walter, S. D., Eliasziw, M. and Donner, A. (1998). Sample size and optimal designs for reliability studies. Statistics in Medicine, 17, 101–110. doi:10.1002/(SICI)1097-0258(19980115)17:1<101::AID-SIM727>3.0.CO;2-E.3.0.CO;2-E>CrossRefGoogle ScholarPubMed
Ward, T., Dawe, B., Procter, A., Murphy, E. and Weinman, J. (1993). Assessment in severe dementia: the Guy's Advanced Dementia Schedule. Age and Ageing, 22, 183–189. doi:10.1093/ageing/22.3.183.CrossRefGoogle ScholarPubMed
Weiner, M. F., Martin-Cook, K., Svetlik, D. A., Saine, K., Foster, B. and Fontaine, C. S. (2000). The quality of life in late-stage dementia (QUALID) scale. Journal of the American Medical Directors’ Association, 1, 114–116.Google ScholarPubMed
Zimmerman, S.et al. (2005a). Attitudes, stress and satisfaction of staff who care for residents with dementia. Gerontologist, 45 (Special Issue 1), 96–105. doi:10.1093/geront/45.suppl_1.96.CrossRefGoogle ScholarPubMed
Zimmerman, S.et al. (2005b). Dementia care and quality of life in assisted living and nursing homes. Gerontologist, 45 (Special Issue 1), 133–146. doi:10.1093/geront/45.suppl_1.133.CrossRefGoogle ScholarPubMed