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Development, feasibility, and acceptability of an intervention to improve care for agitation in people living in nursing homes with dementia nearing the end-of-life

Published online by Cambridge University Press:  15 September 2020

Elizabeth L. Sampson Open the ORCID record for Elizabeth L. Sampson [Opens in a new window] ,
Julie Barber ,
Juliet Gillam ,
Francesca La Frenais ,
Katie Lambe ,
Anne Laybourne ,
Monica Manela ,
Louise Marston ,
Kirsten Moore Open the ORCID record for Kirsten Moore [Opens in a new window]  and
Monica Panca
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Elizabeth L. Sampson*
Affiliation:
Marie Curie Palliative Care Research Unit, Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, LondonW1T 7NF, UK
Julie Barber
Affiliation:
Department of Statistical Science and Priment Clinical Trials Unit, University College, LondonWC1E 6BT, UK
Juliet Gillam
Affiliation:
Department of Old Age Psychiatry, Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, LondonW1T 7NF, UK
Francesca La Frenais
Affiliation:
Department of Old Age Psychiatry, Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, LondonW1T 7NF, UK
Katie Lambe
Affiliation:
Department of Old Age Psychiatry, Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, LondonW1T 7NF, UK
Anne Laybourne
Affiliation:
Department of Old Age Psychiatry, Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, LondonW1T 7NF, UK
Monica Manela
Affiliation:
Department of Primary Care and Population Health and Priment Clinical Trials Unit, University College London, Rowland Hill Street, LondonNW3 2PF, UK
Louise Marston
Affiliation:
Department of Primary Care and Population Health and Priment Clinical Trials Unit, University College London, Rowland Hill Street, LondonNW3 2PF, UK
Kirsten Moore
Affiliation:
Marie Curie Palliative Care Research Unit, Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, LondonW1T 7NF, UK
Monica Panca
Affiliation:
Department of Primary Care and Population Health and Priment Clinical Trials Unit, University College London, Rowland Hill Street, LondonNW3 2PF, UK
Aisling Stringer
Affiliation:
Department of Old Age Psychiatry, Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, LondonW1T 7NF, UK
Lucy Webster
Affiliation:
Department of Old Age Psychiatry, Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, LondonW1T 7NF, UK
Gill Livingston
Affiliation:
Department of Old Age Psychiatry, Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, LondonW1T 7NF, UK
*
Correspondence should be addressed to: Elizabeth L. Sampson, Marie Curie Palliative Care Research Unit, Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, LondonW1T 7NF, UK. Fax: 020 7679 9426, Telephone: 020 7679 9730. Email: e.sampson@ucl.ac.uk.
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Abstract

Objectives:

To develop a staff training intervention for agitation in people with severe dementia, reaching end-of-life, residing in nursing homes (NHs), test feasibility, acceptability, and whether a trial is warranted.

Design:

Feasibility study with pre- and post-intervention data collection, qualitative interviews, and focus groups.

Setting:

Three NHs in South East England with dementia units, diverse in terms of size, ownership status, and location.

Participants:

Residents with a dementia diagnosis or scoring ≥2 on the Noticeable Problems Checklist, rated as “severe” on Clinical Dementia Rating Scale, family carers, and staff (healthcare assistants and nurses).

Intervention:

Manualized training, delivered by nonclinical psychology graduates focusing on agitation in severe dementia, underpinned by a palliative care framework.

Measurements:

Main outcomes were feasibility of recruitment, data collection, follow-up, and intervention acceptability. We collected resident, family carer, and staff demographics. Staff provided data on resident’s agitation, pain, quality of life, and service receipt. Staff reported their sense of competence in dementia care. Family carers reported on satisfaction with end-of-life care. In qualitative interviews, we explored staff and family carers’ views on the intervention.

Results:

The target three NHs participated: 28 (49%) residents, 53 (74%) staff, and 11 (85%) family carers who were eligible to participate consented. Eight-four percent of staff attended ≥3 sessions, and we achieved 93% follow-up. We were able to complete quantitative interviews. Staff and family carers reported the intervention and delivery were acceptable and helpful.

Conclusions:

The intervention was feasible and acceptable indicating a larger trial for effectiveness may be warranted.

Keywords

dementiapalliative carenursing homefeasibility studyagitation
Type
Original Research Article
Information
International Psychogeriatrics , Volume 33 , Special Issue 10: Issue Theme: Non-cognitive Concerns in People with Dementia , October 2021 , pp. 1069 - 1081
Copyright
© International Psychogeriatric Association 2020

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