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Hoben M, Dymchuk E, Doupe MB, Keefe J, Aubrecht K, Kelly C, Stajduhar K, Banerjee S, O'Rourke HM, Chamberlain S, Beeber A, Salma J, Jarrett P, Arya A, Corbett K, Devkota R, Ristau M, Shrestha S, Estabrooks CA. Counting what counts: assessing quality of life and its social determinants among nursing home residents with dementia. BMC Geriatr 2024; 24:177. [PMID: 38383339 PMCID: PMC10880372 DOI: 10.1186/s12877-024-04710-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 01/15/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Maximizing quality of life (QoL) is a major goal of care for people with dementia in nursing homes (NHs). Social determinants are critical for residents' QoL. However, similar to the United States and other countries, most Canadian NHs routinely monitor and publicly report quality of care, but not resident QoL and its social determinants. Therefore, we lack robust, quantitative studies evaluating the association of multiple intersecting social determinants with NH residents' QoL. The goal of this study is to address this critical knowledge gap. METHODS We will recruit a random sample of 80 NHs from 5 Canadian provinces (Alberta, British Columbia, Manitoba, Nova Scotia, Ontario). We will stratify facilities by urban/rural location, for-profit/not-for-profit ownership, and size (above/below median number of beds among urban versus rural facilities in each province). In video-based structured interviews with care staff, we will complete QoL assessments for each of ~ 4,320 residents, using the DEMQOL-CH, a validated, feasible tool for this purpose. We will also assess resident's social determinants of QoL, using items from validated Canadian population surveys. Health and quality of care data will come from routinely collected Resident Assessment Instrument - Minimum Data Set 2.0 records. Knowledge users (health system decision makers, Alzheimer Societies, NH managers, care staff, people with dementia and their family/friend caregivers) have been involved in the design of this study, and we will partner with them throughout the study. We will share and discuss study findings with knowledge users in web-based summits with embedded focus groups. This will provide much needed data on knowledge users' interpretations, usefulness and intended use of data on NH residents' QoL and its health and social determinants. DISCUSSION This large-scale, robust, quantitative study will address a major knowledge gap by assessing QoL and multiple intersecting social determinants of QoL among NH residents with dementia. We will also generate evidence on clusters of intersecting social determinants of QoL. This study will be a prerequisite for future studies to investigate in depth the mechanisms leading to QoL inequities in LTC, longitudinal studies to identify trajectories in QoL, and robust intervention studies aiming to reduce these inequities.
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Affiliation(s)
- Matthias Hoben
- School of Health Policy and Management, Faculty of Health, York University, Room 301E Stong College, 4700 Keele StreetON, Toronto, M3J 1P3, Canada.
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB, Canada.
| | - Emily Dymchuk
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Malcolm B Doupe
- Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Janice Keefe
- Nova Scotia Centre on Aging, Mount Saint Vincent University, Halifax, Canada
| | - Katie Aubrecht
- Department of Sociology, Faculty of Arts, St. Francis Xavier University, Antigonish, NS, Canada
| | - Christine Kelly
- Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Kelli Stajduhar
- School of Nursing, Faculty of Human & Social Development, University of Victoria, Victoria, BC, Canada
| | - Sube Banerjee
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Hannah M O'Rourke
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Stephanie Chamberlain
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Anna Beeber
- School of Nursing, Johns Hopkins University, Baltimore, MD, USA
| | - Jordana Salma
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Pamela Jarrett
- Faculty of Medicine, Dalhousie University, Horizon Health Network, Saint John, New Brunswick, Canada
| | - Amit Arya
- Freeman Centre for the Advancement of Palliative Care, North York General Hospital, Toronto, ON, Canada
- Specialist Palliative Care in Long-Term Care Outreach Team, Kensington Gardens Long-Term Care, Kensington Health, Toronto, ON, Canada
- Division of Palliative Care, Department of Family & Community Medicine, University of Toronto, Toronto, ON, Canada
- Division of Palliative Care, Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Kyle Corbett
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Rashmi Devkota
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Melissa Ristau
- Dr. Gerald Zetter Care Centre, The Good Samaritan Society, Edmonton, AB, Canada
| | - Shovana Shrestha
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Carole A Estabrooks
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
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Corner J, Penhale B, Arthur A. A personhood and citizenship training workshop for care home staff to potentially increase wellbeing of residents with dementia: intervention development and feasibility testing of a cluster randomised controlled trial. Pilot Feasibility Stud 2023; 9:2. [PMID: 36624509 PMCID: PMC9827649 DOI: 10.1186/s40814-022-01222-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 12/01/2022] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND In the UK, one third of people with dementia live in residential care homes, a sector where high staff turnover negatively affects continuity of care. To examine the effect of including personhood and citizenship principles in training, interventions need to be robustly tested, with outcomes relevant to residents with dementia. METHODS Phase one intervention development: The training intervention (PERSONABLE) comprised five reflective exercises facilitated by a mental health nurse/researcher. PERSONABLE was informed by four focus groups, and one field exercise, consisting of care home staff and family members. Phase two feasibility testing: Participants were (i) care home residents with dementia and (ii) care home staff working in any role. After baseline measurements, care homes were randomly allocated to (i) staff receiving PERSONABLE training or (ii) training as usual. Feasibility outcomes were the recruitment and attrition of care homes, residents and staff members (measured ten weeks between randomisation and follow-up), the acceptability of the training intervention PERSONABLE, and acceptability of outcome measures. The care home environment was evaluated, at baseline, using the Therapeutic Environment Screening Survey for Residential Care Homes. Measurements conducted at baseline and follow-up were resident wellbeing (Dementia Care Mapping™), staff knowledge of and confidence with personhood and citizenship (Personhood in Dementia Questionnaire and a perceived ability to care visual analogue scale). Inter-rater agreement for Dementia Care Mapping™ was undertaken at follow-up in one intervention and one training as a usual care home. RESULTS Phase one: The developed reflective approach to the PERSONABLE exercises appeared to give staff a holistic understanding of residents living with dementia, seeing them as autonomous people rather than reductively as persons with a condition. Phase two: Six care homes, 40 residents and 118 staff were recruited. Four residents were lost to follow-up. Twenty-nine staff in the PERSONABLE arm of the study received the training intervention. In the PERSONABLE arm, 26 staff completed both baseline and follow-up measurements compared to 21 in the training as the usual arm. The most common reason for the loss to follow-up of staff was leaving employment. For the outcome measure Dementia Care Mapping™, the proportion of overall agreement between the two observers was 18.6%. High attrition of staff occurred in those homes undergoing leadership changes. CONCLUSION With the right approach, it is possible to achieve good engagement during trial recruitment and intervention delivery of care home managers, staff and residents. Organisational changes are a less controllable aspect of trials but having a visible researcher presence during data collection helps to capitalise the engagement of those staff remaining in employment. Tailored, brief and flexible training interventions encourage staff participation. Simplification of study methods helps promote and retain sufficient staff in a definitive randomised controlled trial. This study found that some components of Dementia Care Mapping™ work effectively as an outcome measure. However, inter-rater reliability was poor, and the practical implementation of the measurement would need a great deal of further refinement to accurately capture the effect of a training intervention if delivered across a large number of clusters. The Dementia Care Mapping™ measurement fidelity issue would be further complicated if using multiple different unacquainted observers. TRIAL REGISTRATION Registered with the ISRCTN under the title: Does a dementia workshop, delivered to residential care home staff, improve the wellbeing of residents with dementia? Trial identifier: ISRCTN13641553. Registered: 30/05/2017 http://www.isrctn.com/ISRCTN13641553 .
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Affiliation(s)
- Jason Corner
- grid.8273.e0000 0001 1092 7967University of East Anglia, School of Health Sciences, Norwich Research Park, Norwich, NR4 7TJ UK
| | - Bridget Penhale
- grid.8273.e0000 0001 1092 7967University of East Anglia, School of Health Sciences, Norwich Research Park, Norwich, NR4 7TJ UK
| | - Antony Arthur
- grid.8273.e0000 0001 1092 7967University of East Anglia, School of Health Sciences, Norwich Research Park, Norwich, NR4 7TJ UK
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Tsukii N, Nakamura K, Yamaguchi H. [Effectiveness in reducing BPSD of care intervention using the Himotoki Sheet from the perspective of individuals with dementia]. Nihon Ronen Igakkai Zasshi 2023; 60:424-433. [PMID: 38171760 DOI: 10.3143/geriatrics.60.424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
AIM This study aimed to examine the effect of intervention using the Himotoki Sheet versus conventional care on behavioral and psychological symptoms of dementia (BPSD) in residents of care facilities. METHODS This non-randomized controlled trial included 37 institutionalized individuals with dementia. During the four-week intervention period, the care workers in the intervention group, which consisted of 17 participants, were asked to 1) select one BPSD item for intervention from the items of the Behavioral and Psychological Symptoms of Dementia Plus Questionnaire (BPSD+Q), 2) complete the Himotoki Sheet and share information about the BPSD focused on by the team led by the Himotoki Sheet manager, and 3) provide care according to the contents of the Himotoki Sheet. The 18 patients in the control group received conventional care for four weeks. A two-way analysis of variance was used to compare changes in scores between groups and the BPSD+Q. RESULTS A total of 32 participants (intervention group, n=16; control group, n=16) were analyzed. There were no significant differences in basic attributes between the groups. There was a significant interaction between the group and the BPSD+Q distress score (F=4.704, p=0.038) and Hyperactive domain distress score (F=4.946, p=0.034). The BPSD+Q (p=0.002) and Hyperactive domain (p=0.001) distress scores were significantly reduced in the intervention group but not the control group. CONCLUSIONS In comparison to conventional care, care using the Himotoki Sheet was associated with a significant reduction in the BPSD+Q and Hyperactive domain distress scores.
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Affiliation(s)
- Naoya Tsukii
- Tokyo Center for Dementia Care Research and Practices
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Tahami Monfared AA, Stern Y, Doogan S, Irizarry M, Zhang Q. Stakeholder Insights in Alzheimer's Disease: Natural Language Processing of Social Media Conversations. J Alzheimers Dis 2022; 89:695-708. [PMID: 35938254 DOI: 10.3233/jad-220422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Social media data may be especially effective for studying diseases associated with high stigma, such as Alzheimer's disease (AD). OBJECTIVE We primarily aimed to identify issues/challenges experienced by patients with AD using natural language processing (NLP) of social media posts. METHODS We searched 130 public social media sources between January 1998 and December 2021 for AD stakeholder social media posts using NLP to identify issues/challenges experienced by patients with AD. Issues/challenges identified by ≥10% of any AD stakeholder type were described. Illustrative posts were selected for qualitative review. Secondarily, issues/challenges were organized into a conceptual AD identification framework (ADIF) and representation of ADIF categories within clinical instruments was assessed. RESULTS We analyzed 1,859,077 social media posts from 30,341 AD stakeholders (21,011 caregivers; 7,440 clinicians; 1,890 patients). The most common issues/challenges were Worry/anxiety (34.2%), Pain (33%), Malaise (28.7%), Confusional state (27.1%), and Falls (23.9%). Patients reported a markedly higher volume of issues/challenges than other stakeholders. Patient posts reflected the broader scope of patient burden, caregiver posts captured both patient and caregiver burden, and clinician posts tended to be targeted. Less than 5% of the high frequency issues/challenges were in the "function and independence" and "social and relational well-being" categories of the ADIF, suggesting these issues/challenges may be difficult to capture. No single clinical instrument covered all ADIF categories; "social and relational well-being" was least represented. CONCLUSION NLP of AD stakeholder social media data revealed a broad spectrum of real-world insights regarding patient burden.
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Affiliation(s)
- Amir Abbas Tahami Monfared
- Eisai, Inc., Nutley, NJ, USA.,McGill University, Epidemiology, Biostatistics and Occupational Health, Montreal (QC), Canada
| | - Yaakov Stern
- Cognitive Neuroscience Division, Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
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Koch J, Amos JG, Beattie E, Lautenschlager NT, Doyle C, Anstey KJ, Mortby ME. Non-pharmacological interventions for neuropsychiatric symptoms of dementia in residential aged care settings: An umbrella review. Int J Nurs Stud 2022; 128:104187. [DOI: 10.1016/j.ijnurstu.2022.104187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 01/23/2022] [Accepted: 01/24/2022] [Indexed: 10/19/2022]
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Feasibility of Routine Quality of Life Measurement for People Living With Dementia in Long-Term Care. J Am Med Dir Assoc 2021; 23:1221-1226. [PMID: 34411540 DOI: 10.1016/j.jamda.2021.07.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 06/22/2021] [Accepted: 07/17/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Maximizing quality of life (QoL) is the ultimate goal of long-term dementia care. However, routine QoL measurement is rare in nursing home (NH) and assisted living (AL) facilities. Routine QoL measurement might lead to improvements in resident QoL. Our objective was to assess the feasibility of using DEMQOL-CH, completed by long-term care staff in video calls with researchers, to assess health-related quality of life (HrQoL) of NH and AL residents with dementia or other cognitive impairment. DESIGN Cross-sectional study. SETTING AND PARTICIPANTS We included a convenience sample of 5 NHs and 5 AL facilities in the Canadian province of Alberta. Forty-two care staff who had worked in the facility for ≥3 months completed DEMQOL-CH assessments of 183 residents who had lived in the facility for 3 months or more and were aged ≥65 years. Sixteen residents were assessed independently by 2 care staff to assess inter-rater reliability. METHODS We assessed HrQoL in people with dementia or other cognitive impairment using DEMQOL-CH, and assessed time to complete, inter-rater reliability, internal consistency reliability, and care staff ratings of feasibility of completing the DEMQOL-CH. RESULTS Average time to complete DEMQOL-CH was <5 minutes. Staff characteristics were not associated with time to complete or DEMQOL-CH scores. Inter-rater reliability [0.735, 95% confidence interval (CI): 0.712-0.780] and internal consistency reliability (0.834, 95% CI: 0.779-0.864) were high. The DEMQOL-CH score varied across residents (mean = 84.8, standard deviation = 11.20, 95% CI: 83.2-86.4). Care aides and managers rated use of the DEMQOL-CH as highly feasible, acceptable, and valuable. CONCLUSIONS AND IMPLICATIONS This study provides a proof of concept that DEMQOL-CH can be used to assess HrQoL in NH and AL residents and provides initial indications of feasibility and resources required. DEMQOL-CH may be used to support actions to improve the QoL of residents.
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Surr CA, Holloway I, Walwyn REA, Griffiths AW, Meads D, Martin A, Kelley R, Ballard C, Fossey J, Burnley N, Chenoweth L, Creese B, Downs M, Garrod L, Graham EH, Lilley-Kelly A, McDermid J, McLellan V, Millard H, Perfect D, Robinson L, Robinson O, Shoesmith E, Siddiqi N, Stokes G, Wallace D, Farrin AJ. Effectiveness of Dementia Care Mapping™ to reduce agitation in care home residents with dementia: an open-cohort cluster randomised controlled trial. Aging Ment Health 2021; 25:1410-1423. [PMID: 32279541 DOI: 10.1080/13607863.2020.1745144] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Agitation is common and problematic in care home residents with dementia. This study investigated the (cost)effectiveness of Dementia Care Mapping™ (DCM) for reducing agitation in this population. METHOD Pragmatic, cluster randomised controlled trial with cost-effectiveness analysis in 50 care homes, follow-up at 6 and 16 months and stratified randomisation to intervention (n = 31) and control (n = 19). Residents with dementia were recruited at baseline (n = 726) and 16 months (n = 261). Clusters were not blinded to allocation. Three DCM cycles were scheduled, delivered by two trained staff per home. Cycle one was supported by an external DCM expert. Agitation (Cohen-Mansfield Agitation Inventory (CMAI)) at 16 months was the primary outcome. RESULTS DCM was not superior to control on any outcomes (cross-sectional sample n = 675: 287 control, 388 intervention). The adjusted mean CMAI score difference was -2.11 points (95% CI -4.66 to 0.44, p = 0.104, adjusted ICC control = 0, intervention 0.001). Sensitivity analyses supported the primary analysis. Incremental cost per unit improvement in CMAI and QALYs (intervention vs control) on closed-cohort baseline recruited sample (n = 726, 418 intervention, 308 control) was £289 and £60,627 respectively. Loss to follow-up at 16 months in the original cohort was 312/726 (43·0%) mainly (87·2%) due to deaths. Intervention dose was low with only a quarter of homes completing more than one DCM cycle. CONCLUSION No benefits of DCM were evidenced. Low intervention dose indicates standard care homes may be insufficiently resourced to implement DCM. Alternative models of implementation, or other approaches to reducing agitation should be considered.
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Affiliation(s)
- Claire A Surr
- Centre for Dementia Research, School of Health and Community Studies, Leeds Beckett University, Leeds, UK
| | - Ivana Holloway
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Rebecca E A Walwyn
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Alys W Griffiths
- Centre for Dementia Research, School of Health and Community Studies, Leeds Beckett University, Leeds, UK
| | - David Meads
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Adam Martin
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Rachael Kelley
- Centre for Dementia Research, School of Health and Community Studies, Leeds Beckett University, Leeds, UK
| | | | - Jane Fossey
- Psychological Services, Oxford Health NHS Foundation Trust, Oxford, UK
| | - Natasha Burnley
- Centre for Dementia Research, School of Health and Community Studies, Leeds Beckett University, Leeds, UK
| | - Lynn Chenoweth
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, Australia
| | - Byron Creese
- Medical School, University of Exeter, Exeter, UK
| | - Murna Downs
- Centre for Applied Dementia Studies, University of Bradford, Bradford, UK
| | - Lucy Garrod
- Psychological Services, Oxford Health NHS Foundation Trust, Oxford, UK
| | - Elizabeth H Graham
- Academic Unit of Elderly Care and Rehabilitation, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Amanda Lilley-Kelly
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Joanne McDermid
- Liaison Psychiatry Services, Wolfson Centre for Age Related Diseases, Kings College London, London, UK
| | - Vicki McLellan
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Holly Millard
- Psychological Services, Oxford Health NHS Foundation Trust, Oxford, UK
| | - Devon Perfect
- Psychological Services, Oxford Health NHS Foundation Trust, Oxford, UK
| | - Louise Robinson
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Olivia Robinson
- Centre for Dementia Research, School of Health and Community Studies, Leeds Beckett University, Leeds, UK
| | - Emily Shoesmith
- Centre for Dementia Research, School of Health and Community Studies, Leeds Beckett University, Leeds, UK
| | - Najma Siddiqi
- Department of Health Sciences, Hull York Medical School, University of York, York, UK.,Bradford District Care NHS Foundation Trust, Bradford, UK
| | | | - Daphne Wallace
- Centre for Applied Dementia Studies, University of Bradford, Bradford, UK
| | - Amanda J Farrin
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
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8
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Griffiths AW, Robinson OC, Shoesmith E, Kelley R, Surr CA. Staff experiences of implementing Dementia Care Mapping to improve the quality of dementia care in care homes: a qualitative process evaluation. BMC Health Serv Res 2021; 21:138. [PMID: 33579279 PMCID: PMC7881580 DOI: 10.1186/s12913-021-06152-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 02/03/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dementia Care Mapping™ (DCM) is a widely used, staff-led, psychosocial intervention to support the implementation of person-centred care. Efficacy evaluations in care homes have produced mixed outcomes, with implementation problems identified. Understanding the experiences of staff trained to lead DCM implementation is crucial to understanding implementation challenges, yet this has rarely been formally explored. This study aimed to examine the experiences of care home staff trained to lead DCM implementation, within a large cluster randomised controlled trial. METHODS Process evaluation including, semi-structured interviews with 27 trained mappers from 16 intervention allocated care homes. Data were analysed using template variant of thematic analysis. RESULTS Three main themes were identified 1) Preparedness to lead - While mappers overwhelmingly enjoyed DCM training, many did not have the personal attributes required to lead practice change and felt DCM training did not adequately equip them to implement it in practice. For many their expectations of the mapper role at recruitment contrasted with the reality once they began to attempt implementation; 2) Transferring knowledge into practice - Due to the complex nature of DCM, developing mastery required regular practice of DCM skills, which was difficult to achieve within available time and resources. Gaining engagement of and transferring learning to the wider staff team was challenging, with benefits of DCM largely limited to the mappers themselves, rather than realised at a care home level; and 3) Sustaining DCM - This required a perception of DCM as beneficial, allocation of adequate resources and support for the process which was often not able to be provided, for the mapper role to fit with the staff member's usual duties and for DCM to fit with the home's ethos and future plans for care. CONCLUSIONS Many care homes may not have staff with the requisite skills to lead practice change using DCM, or the requisite staffing, resources or leadership support required for sustainable implementation. Adaptations to the DCM tool, process and training may be required to reduce its complexity and burden and increase chances of implementation success. Alternatively, models of implementation not reliant on care home staff may be required.
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Affiliation(s)
- Alys Wyn Griffiths
- Centre for Dementia Research, Leeds Beckett University, City Campus, Leeds, LS1 3HE, UK
| | - Olivia C Robinson
- Centre for Dementia Research, Leeds Beckett University, City Campus, Leeds, LS1 3HE, UK
| | - Emily Shoesmith
- Centre for Dementia Research, Leeds Beckett University, City Campus, Leeds, LS1 3HE, UK
| | - Rachael Kelley
- Centre for Dementia Research, Leeds Beckett University, City Campus, Leeds, LS1 3HE, UK
| | - Claire A Surr
- Centre for Dementia Research, Leeds Beckett University, City Campus, Leeds, LS1 3HE, UK.
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9
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Kelley R, Griffiths AW, Shoesmith E, McDermid J, Couch E, Robinson O, Perfect D, Surr CA. The influence of care home managers on the implementation of a complex intervention: findings from the process evaluation of a randomised controlled trial of dementia care mapping. BMC Geriatr 2020; 20:303. [PMID: 32842965 PMCID: PMC7446218 DOI: 10.1186/s12877-020-01706-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 08/13/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many people with dementia live in care homes, where staff can struggle to meet their complex needs. Successful practice improvement interventions in these settings require strong managerial support, but little is known about how managers can support implementation in practice, or what factors support or hinder care home managers in providing this support. Using Dementia Care Mapping™ (DCM) as an example, this study explored how care home managers can support the implementation of complex interventions, and identified factors affecting their ability to provide this support. METHODS We undertook interviews with 48 staff members (managers and intervention leads) from care homes participating in the intervention arm of the DCM EPIC trial of DCM implementation. RESULTS Managerial support played a key role in facilitating the implementation of a complex intervention in care home settings. Managers could provide practical and financial support in many forms. However, managerial support and leadership approaches towards implementation were highly variable in practice, and implementation was easily de-stabilised by management changes or competing managerial priorities. How well managers understood, valued and engaged with the intervention, alongside the leadership style they adopted to support implementation, were key influences on implementation success. CONCLUSIONS For care home managers to effectively support interventions they must fully understand the proposed intervention and its potential value. This is especially important during times of managerial or practice changes, when managers lack the skills required to effectively support implementation, or when the intervention is complex. It may be unfeasible to successfully implement new interventions during times of managerial or practice instability. TRIAL REGISTRATION Current Controlled Trials ISRCTN82288852 , registered 16/01/2014.
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Affiliation(s)
- R Kelley
- Centre for Dementia Research, Leeds Beckett University, Leeds, LS1 3HE, UK.
| | - A W Griffiths
- Centre for Dementia Research, Leeds Beckett University, Leeds, LS1 3HE, UK
| | - E Shoesmith
- Centre for Dementia Research, Leeds Beckett University, Leeds, LS1 3HE, UK
| | - J McDermid
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - E Couch
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - O Robinson
- Centre for Dementia Research, Leeds Beckett University, Leeds, LS1 3HE, UK
| | - D Perfect
- Oxfordshire NHS Trust, Oxfordshire, UK
| | - C A Surr
- Centre for Dementia Research, Leeds Beckett University, Leeds, LS1 3HE, UK
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10
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Schaap FD, Dijkstra GJ, Reijneveld SA, Finnema EJ. Use of dementia care mapping in the care for older people with intellectual disabilities: A mixed-method study. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2020; 34:149-163. [PMID: 32812319 PMCID: PMC7818226 DOI: 10.1111/jar.12794] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 06/26/2020] [Accepted: 07/23/2020] [Indexed: 01/10/2023]
Abstract
Background The ageing of people with intellectual disabilities, with associated morbidity like dementia, calls for new types of care. Person‐centred methods may support care staff in providing this, an example being Dementia Care Mapping (DCM). DCM has been shown to be feasible in ID‐care. We examined the experiences of ID‐professionals in using DCM. Methods We performed a mixed‐methods study, using quantitative data from care staff (N = 136) and qualitative data (focus‐groups, individual interviews) from care staff, group home managers and DCM‐in‐intellectual disabilities mappers (N = 53). Results DCM provided new insights into the behaviours of clients, enabled professional reflection and gave new knowledge and skills regarding dementia and person‐centred care. Appreciation of DCM further increased after the second cycle of application. Conclusion DCM is perceived as valuable in ID‐care. Further assessment is needed of its effectiveness in ID‐care with respect to quality of care, staff‐client interactions and job performance.
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Affiliation(s)
- Feija D Schaap
- Research Group Living, Wellbeing and Care for Older People, NHL Stenden University of Applied Sciences, Leeuwarden, The Netherlands.,Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Geke J Dijkstra
- Research Group Living, Wellbeing and Care for Older People, NHL Stenden University of Applied Sciences, Leeuwarden, The Netherlands.,Department of Health Sciences, Applied Health Research, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Sijmen A Reijneveld
- Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Evelyn J Finnema
- Research Group Living, Wellbeing and Care for Older People, NHL Stenden University of Applied Sciences, Leeuwarden, The Netherlands.,Department of Health Sciences, Nursing Research, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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11
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Holt Clemmensen T, Hein Lauridsen H, Andersen-Ranberg K, Kaae Kristensen H. Informal carers' support needs when caring for a person with dementia - A scoping literature review. Scand J Caring Sci 2020; 35:685-700. [PMID: 32781496 DOI: 10.1111/scs.12898] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 06/26/2020] [Accepted: 07/14/2020] [Indexed: 01/24/2023]
Abstract
BACKGROUND Informal carers of people with dementia report having unmet needs for support and few supportive interventions have been shown to be effective. There is a need to develop needs assessment instruments and supportive interventions with a holistic and person-centred approach to meet the various and complex needs of carers. The aim of this study was to provide an overview of carers' support needs when caring for people with dementia with the objectives to map and synthesise knowledge on key concepts of carers' support needs. METHODS A scoping review methodology was used. A literature search was conducted in PsycINFO, CINAHL, PubMed and EMBASE between January 2007 and October 2019. Three authors independently selected articles meeting the inclusion criteria, and data were extracted using a matrix developed for that purpose. Inductive content analysis was used to synthesise key concepts of carers' support needs. RESULTS The search identified 2748 articles after removing duplicates, and 122 articles were included in the mapping of carers' support needs. Synthesising carers' support needs indicated that the full extent of support needs emerges in the interaction between the carer and the person cared for and that it is possible to categorise support needs into four key concepts related to: 1) the carer as a person, 2) managing being a carer, 3) providing care, and 4) knowledge of dementia. CONCLUSION The findings of this study help to map a framework describing carers' support needs that may guide the development of future needs assessment instruments and supportive interventions.
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Affiliation(s)
- Trine Holt Clemmensen
- Health Sciences Research Centre, UCL University College, Odense, Denmark.,Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Henrik Hein Lauridsen
- Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Karen Andersen-Ranberg
- Department of Public Health, University of Southern Denmark, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Hanne Kaae Kristensen
- Health Sciences Research Centre, UCL University College, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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12
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Meads DM, Martin A, Griffiths A, Kelley R, Creese B, Robinson L, McDermid J, Walwyn R, Ballard C, Surr CA. Cost-Effectiveness of Dementia Care Mapping in Care-Home Settings: Evaluation of a Randomised Controlled Trial. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2020; 18:237-247. [PMID: 31701483 PMCID: PMC7085468 DOI: 10.1007/s40258-019-00531-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND Behaviours such as agitation impact on the quality of life of care-home residents with dementia and increase healthcare use. Interventions to prevent these behaviours have little evidence supporting their effectiveness or cost-effectiveness. We conducted an economic evaluation alongside a trial assessing Dementia Care Mapping™ (DCM) versus usual care for reducing agitation, and highlight methodological challenges of conducting evaluations in this population and setting. METHODS RCT data over 16 months from English care-home residents with dementia (intervention n = 418; control n = 308) were analysed. We conducted a cost-utility analysis from the healthcare provider perspective. We gathered resource use and utility (EQ-5D-5L and DEMQoL-Proxy-U) from people living with dementia and proxy informants (staff and relatives). Data were analysed using seemingly unrelated regression, accounting for care-home clustering and bootstrapping used to capture sampling uncertainty. RESULTS Costs were higher in the intervention arm than in the control arm (incremental = £1479) due in part to high cost outliers. There were small QALY gains (incremental = 0.024) in favour of DCM. The base-case ICER (£64,380 per QALY) suggests DCM is not cost-effective versus usual care. With the exception of analyses excluding high cost outliers, which suggested a potential for DCM to be cost-effective, sensitivity analyses corroborated the base-case findings. Bootstrapped estimates suggested DCM had a low probability (< 0.20 where λ = £20,000) of being cost-effective versus control. CONCLUSION DCM does not appear to be a cost-effective intervention versus usual care in this group and setting. The evaluation highlighted several methodological challenges relating to validity of utility assessments, loss to follow-up and compliance. Further research is needed on handling high-cost individuals and capturing utility in this group. ISRCTN reference 82288852.
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Affiliation(s)
- David M Meads
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, Worsley Building, Clarendon Way, University of Leeds, Leeds, UK.
| | - Adam Martin
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, Worsley Building, Clarendon Way, University of Leeds, Leeds, UK
| | - Alys Griffiths
- Centre for Dementia Research, School of Health and Community Studies, Leeds Beckett University, Leeds, UK
| | - Rachael Kelley
- Centre for Dementia Research, School of Health and Community Studies, Leeds Beckett University, Leeds, UK
| | - Byron Creese
- College of Medicine and Health, University of Exeter, Exeter, UK
| | | | - Joanne McDermid
- Wolfson Centre for Age Related Diseases, King's College London, London, UK
| | - Rebecca Walwyn
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - Clive Ballard
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Claire A Surr
- Centre for Dementia Research, School of Health and Community Studies, Leeds Beckett University, Leeds, UK
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13
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Surr CA, Holloway I, Walwyn RE, Griffiths AW, Meads D, Kelley R, Martin A, McLellan V, Ballard C, Fossey J, Burnley N, Chenoweth L, Creese B, Downs M, Garrod L, Graham EH, Lilley-Kelley A, McDermid J, Millard H, Perfect D, Robinson L, Robinson O, Shoesmith E, Siddiqi N, Stokes G, Wallace D, Farrin AJ. Dementia Care Mapping™ to reduce agitation in care home residents with dementia: the EPIC cluster RCT. Health Technol Assess 2020; 24:1-172. [PMID: 32216870 PMCID: PMC7132533 DOI: 10.3310/hta24160] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The quality of care for people with dementia in care homes is of concern. Interventions that can improve care outcomes are required. OBJECTIVE To investigate the clinical effectiveness and cost-effectiveness of Dementia Care Mapping™ (DCM) for reducing agitation and improving care outcomes for people living with dementia in care homes, versus usual care. DESIGN A pragmatic, cluster randomised controlled trial with an open-cohort design, follow-up at 6 and 16 months, integrated cost-effectiveness analysis and process evaluation. Clusters were not blinded to allocation. The primary end point was completed by staff proxy and independent assessors. SETTING Stratified randomisation of 50 care homes to the intervention and control groups on a 3 : 2 ratio by type, size, staff exposure to dementia training and recruiting hub. PARTICIPANTS Fifty care homes were randomised (intervention, n = 31; control, n = 19), with 726 residents recruited at baseline and a further 261 recruited after 16 months. Care homes were eligible if they recruited a minimum of 10 residents, were not subject to improvement notices, had not used DCM in the previous 18 months and were not participating in conflicting research. Residents were eligible if they lived there permanently, had a formal diagnosis of dementia or a score of 4+ on the Functional Assessment Staging Test of Alzheimer's Disease, were proficient in English and were not terminally ill or permanently cared for in bed. All homes were audited on the delivery of dementia and person-centred care awareness training. Those not reaching a minimum standard were provided training ahead of randomisation. Eighteen homes took part in the process evaluation. INTERVENTION Two staff members from each intervention home were trained to use DCM and were asked to carry out three DCM cycles; the first was supported by an external expert. MAIN OUTCOME MEASURES The primary outcome was agitation (Cohen-Mansfield Agitation Inventory), measured at 16 months. Secondary outcomes included resident behaviours and quality of life. RESULTS There were 675 residents in the final analysis (intervention, n = 388; control, n = 287). There was no evidence of a difference in agitation levels between the treatment arms. The adjusted mean difference in Cohen-Mansfield Agitation Inventory score was -2.11 points, being lower in the intervention group than in the control (95% confidence interval -4.66 to 0.44; p = 0.104; adjusted intracluster correlation coefficient: control = 0, intervention = 0.001). The sensitivity analyses results supported the primary analysis. No differences were detected in any of the secondary outcomes. The health economic analyses indicated that DCM was not cost-effective. Intervention adherence was problematic; only 26% of homes completed more than their first DCM cycle. Impacts, barriers to and facilitators of DCM implementation were identified. LIMITATIONS The primary completion of resident outcomes was by staff proxy, owing to self-report difficulties for residents with advanced dementia. Clusters were not blinded to allocation, although supportive analyses suggested that any reporting bias was not clinically important. CONCLUSIONS There was no benefit of DCM over control for any outcomes. The implementation of DCM by care home staff was suboptimal compared with the protocol in the majority of homes. FUTURE WORK Alternative models of DCM implementation should be considered that do not rely solely on leadership by care home staff. TRIAL REGISTRATION Current Controlled Trials ISRCTN82288852. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 16. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Claire A Surr
- Centre for Dementia Research, School of Health and Community Studies, Leeds Beckett University, Leeds, UK
| | - Ivana Holloway
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | | | - Alys W Griffiths
- Centre for Dementia Research, School of Health and Community Studies, Leeds Beckett University, Leeds, UK
| | - David Meads
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Rachael Kelley
- Centre for Dementia Research, School of Health and Community Studies, Leeds Beckett University, Leeds, UK
| | - Adam Martin
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Vicki McLellan
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | | | - Jane Fossey
- Psychological Services, Oxford Health NHS Foundation Trust, Oxford, UK
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Natasha Burnley
- Centre for Dementia Research, School of Health and Community Studies, Leeds Beckett University, Leeds, UK
| | | | | | - Murna Downs
- Centre for Applied Dementia Studies, University of Bradford, Bradford, UK
| | - Lucy Garrod
- Psychological Services, Oxford Health NHS Foundation Trust, Oxford, UK
| | - Elizabeth H Graham
- Academic Unit of Elderly Care and Rehabilitation, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | | | - Joanne McDermid
- Wolfson Centre for Age-Related Diseases, King's College London, London, UK
| | - Holly Millard
- Psychological Services, Oxford Health NHS Foundation Trust, Oxford, UK
| | - Devon Perfect
- Psychological Services, Oxford Health NHS Foundation Trust, Oxford, UK
| | - Louise Robinson
- Institute for Ageing and Health, Newcastle University, Newcastle upon Tyne, UK
| | - Olivia Robinson
- Centre for Dementia Research, School of Health and Community Studies, Leeds Beckett University, Leeds, UK
| | - Emily Shoesmith
- Centre for Dementia Research, School of Health and Community Studies, Leeds Beckett University, Leeds, UK
| | - Najma Siddiqi
- Department of Health Sciences, Hull York Medical School, University of York, York, UK
- Bradford District Care NHS Foundation Trust, Bradford, UK
| | | | - Daphne Wallace
- Centre for Dementia Research, School of Health and Community Studies, Leeds Beckett University, Leeds, UK
| | - Amanda J Farrin
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
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14
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Yamamoto H, Yokokohji Y. Development of an ICT-Based Dementia Care Mapping Support System and Its Usefulness Assessment. Am J Alzheimers Dis Other Demen 2020. [DOI: 10.1177/1533317519880422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: Dementia Care Mapping (DCM) is an established practice method to implement Person-centred Care in dementia care settings. However, it is not easy to carry out DCM because of its high complexity. The aim of this study is to solve DCM complexity by adopting technology. Methods: Authors developed (1) a new information-communication technology (ICT) based DCM support system based on the investigation of difficulties and/or burden encountered during mapping (n = 33) and (2) a new evaluation test method, using role-play videos, for assessing the usefulness and reliability of the system. Mapping data, collected using the support system or the conventional paper-based DCM (n = 22), were compared. Results: We obtained users’ positive ratings of the system for burden reduction and its usability. Moreover, the developed prototype system indicated to have already reached the level of conventional paper-based DCM in terms of mapping accuracy. Conclusion: Usefulness of the ICT-based support system was confirmed to help overcome DCM complexity.
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Affiliation(s)
- Hirotoshi Yamamoto
- Department of Mechanical Engineering, Graduate School of Engineering, Kobe University, Kobe, Japan
| | - Yasuyoshi Yokokohji
- Department of Mechanical Engineering, Graduate School of Engineering, Kobe University, Kobe, Japan
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15
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Yamamoto H, Yokokohji Y, Ishihara T. Practicality Assessment of the Improved ICT-Based Dementia Care Mapping Support System. Am J Alzheimers Dis Other Demen 2020; 35:1533317520935716. [PMID: 32648472 PMCID: PMC10623911 DOI: 10.1177/1533317520935716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Authors have developed an ICT (Information-Communication Technology)-based Dementia Care Mapping (DCM™) support system and assessed its usefulness previously using videos. The aim of this study is to evaluate practicality of the improved support system by actual mapping. METHODS We obtained highly reliable mapping data by a team of 3 mappers (M1, M2, and M3), who mapped 5 elderly people with dementia continuously over 4 hours in 2 sites. M1 mapped by conventional paper-based DCM™, while M2 and M3 mapped using the support system. Collected mapping data (n = 8, total of 232.5 hours = 2790 time frames) were compared. RESULTS The concordance rates between M1 and M2/M3 were over 70%; the required level for DCM™ evaluation purposes, with 1 exception. We also obtained users' positive ratings regarding the system usability. CONCLUSION Practicality of the ICT-based DCM™ support system was confirmed for evaluation purposes, demonstrating the system is ready for practical use.
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Affiliation(s)
- Hirotoshi Yamamoto
- Department of Mechanical Engineering, Graduate School of Engineering, Kobe University, Kobe, Japan
| | - Yasuyoshi Yokokohji
- Department of Mechanical Engineering, Graduate School of Engineering, Kobe University, Kobe, Japan
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16
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Surr CA, Shoesmith E, Griffiths AW, Kelley R, McDermid J, Fossey J. Exploring the role of external experts in supporting staff to implement psychosocial interventions in care home settings: results from the process evaluation of a randomized controlled trial. BMC Health Serv Res 2019; 19:790. [PMID: 31684943 PMCID: PMC6829988 DOI: 10.1186/s12913-019-4662-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 10/21/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Psychosocial interventions offer opportunities to improve care for people with dementia in care homes. However, implementation is often led by staff who are not well prepared for the role. Some interventions use external experts to support staff. However little is known about external expert, care home staff and manager perceptions of such support. This paper addresses this gap. METHODS Multi-methods study within a process evaluation of a cluster randomised controlled trial of Dementia Care Mapping™ (DCM). Interviews were conducted with six external experts who also completed questionnaires, 17 care home managers and 25 care home staff responsible for DCM implementation. Data were analysed using descriptive statistics and template analysis. RESULTS Three themes were identified: the need for expert support, practicalities of support and broader impacts of providing support. Expert support was vital for successful DCM implementation, although the five-days provided was felt to be insufficient. Some homes felt the support was inflexible and did not consider their individual needs. Practical challenges of experts being located at a geographical distance from the care homes, limited when and how support was available. Experts gained knowledge they were able to then apply in delivering DCM training. Experts were not able to accurately predict which homes would be able to implement DCM independently in future cycles. CONCLUSIONS An external expert may form a key component of successful implementation of psychosocial interventions in care home settings. Future research should explore optimal use of the expert role.
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Affiliation(s)
- Claire A. Surr
- Centre for Dementia Research, School of Health and Community Studies, Leeds Beckett University, Leeds, LS1 3HE UK
| | - Emily Shoesmith
- Centre for Dementia Research, School of Health and Community Studies, Leeds Beckett University, Leeds, LS1 3HE UK
| | - Alys W. Griffiths
- Centre for Dementia Research, School of Health and Community Studies, Leeds Beckett University, Leeds, LS1 3HE UK
| | - Rachael Kelley
- Centre for Dementia Research, School of Health and Community Studies, Leeds Beckett University, Leeds, LS1 3HE UK
| | | | - Jane Fossey
- Oxford Health NHS Foundation Trust, Oxford, UK
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17
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Surr CA, Griffiths AW, Kelley R, Holloway I, Walwyn REA, Martin A, McDermid J, Chenoweth L, Farrin AJ. The Implementation of Dementia Care Mapping in a Randomized Controlled Trial in Long-Term Care: Results of a Process Evaluation. Am J Alzheimers Dis Other Demen 2019; 34:390-398. [PMID: 31056923 PMCID: PMC6676338 DOI: 10.1177/1533317519845725] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study explored intervention implementation within a pragmatic, cluster randomized controlled trial of Dementia Care Mapping™ (DCM) in UK care homes. DCM is a practice development tool comprised of a 5 component cycle (staff briefing, mapping observations, data analysis and reporting, staff feedback, and action planning) that supports delivery of person-centered care. Two staff from the 31 intervention care homes were trained in DCM and asked to deliver 3 cycles over a 15-month period, supported by a DCM expert during cycle 1. Implementation data were collected after each mapping cycle. There was considerable variability in DCM implementation fidelity, dose, and reach. Not all homes trained 2 mappers on schedule, and some found it difficult to retain mappers. Only 26% of homes completed more than 1 cycle. Future DCM trials in care home settings should consider additional methods to support intervention completion including intervention delivery being conducted with ongoing external support.
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Affiliation(s)
- Claire A. Surr
- Centre for Dementia Research, Leeds Beckett University, Leeds, United Kingdom
| | - Alys W. Griffiths
- Centre for Dementia Research, Leeds Beckett University, Leeds, United Kingdom
| | - Rachael Kelley
- Centre for Dementia Research, Leeds Beckett University, Leeds, United Kingdom
| | - Ivana Holloway
- Clinical Trials Research Unit, University of Leeds, Leeds, United Kingdom
| | | | - Adam Martin
- Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | - Joanne McDermid
- Wolfson Centre for Age Related Diseases, Kings College London, London, United Kingdom
| | - Lynn Chenoweth
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, New South Wales, Australia
| | - Amanda J. Farrin
- Clinical Trials Research Unit, University of Leeds, Leeds, United Kingdom
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18
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Schaap FD, Finnema EJ, Stewart RE, Dijkstra GJ, Reijneveld SA. Effects of Dementia Care Mapping on job satisfaction and caring skills of staff caring for older people with intellectual disabilities: A quasi-experimental study. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2019; 32:1228-1240. [PMID: 31087472 PMCID: PMC6851587 DOI: 10.1111/jar.12615] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 03/27/2019] [Accepted: 04/02/2019] [Indexed: 11/27/2022]
Abstract
Background The ageing of people with intellectual disabilities, involving consequences like dementia, creates a need for methods to support care staff. One promising method is Dementia Care Mapping (DCM). This study examined the effect of DCM on job satisfaction and care skills of ID‐care staff. Methods We performed a quasi‐experimental study in 23 group homes for older people with intellectual disabilities in the Netherlands. Among staff, we assessed job satisfaction and care skills as primary outcomes and work experience measures as secondary outcomes (N = 227). Results Dementia Care Mapping achieved no significantly better effect than care as usual (CAU) for primary outcomes on job satisfaction (MWSS‐HC) and working skills (P‐CAT). Effect sizes varied from −0.18 to −0.66. We also found no differences for any of the secondary outcomes. Conclusion Dementia Care Mapping does not increase job satisfaction and care skills of staff caring for older people with intellectual disabilities. This result differs from previous findings and deserves further study.
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Affiliation(s)
- Feija D Schaap
- Research Group Living, Wellbeing and Care for Older People, NHL University of Applied Sciences, Leeuwarden, The Netherlands.,Department of Health Sciences, Community & Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Evelyn J Finnema
- Research Group Living, Wellbeing and Care for Older People, NHL University of Applied Sciences, Leeuwarden, The Netherlands
| | - Roy E Stewart
- Department of Health Sciences, Community & Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Geke J Dijkstra
- Department of Health Sciences, Applied Health Research, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Sijmen A Reijneveld
- Department of Health Sciences, Community & Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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19
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Schaap FD, Dijkstra GJ, Stewart RE, Finnema EJ, Reijneveld SA. Effects of Dementia Care Mapping on well-being and quality of life of older people with intellectual disability: A quasi-experimental study. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2019; 32:849-860. [PMID: 30868692 PMCID: PMC6849613 DOI: 10.1111/jar.12576] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 11/15/2018] [Accepted: 01/23/2019] [Indexed: 12/31/2022]
Abstract
Background The ageing of people with intellectual disability, accompanied with consequences like dementia, challenges intellectual disability‐care staff and creates a need for supporting methods, with Dementia Care Mapping (DCM) as a promising possibility. This study examined the effect of DCM on the quality of life of older people with intellectual disability. Methods We performed a quasi‐experimental study in 23 group homes for older people with intellectual disability in the Netherlands, comparing DCM (n = 113) with care‐as‐usual (CAU; n = 111). Using three measures, we assessed the staff‐reported quality of life of older people with intellectual disability. Results DCM achieved no significantly better or worse quality of life than CAU. Effect sizes varied from 0.01 to −0.22. Adjustments for covariates and restriction of analyses to people with dementia yielded similar results. Conclusion The finding that DCM does not increase quality of life of older people with intellectual disability contradicts previous findings and deserves further study.
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Affiliation(s)
- Feija D Schaap
- Research Group Living, Wellbeing and Care for Older People, NHL University of Applied Sciences, Leeuwarden, The Netherlands.,Department of Health Sciences, Community & Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Geke J Dijkstra
- Department of Health Sciences, Applied Health Research, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Roy E Stewart
- Department of Health Sciences, Community & Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Evelyn J Finnema
- Research Group Living, Wellbeing and Care for Older People, NHL University of Applied Sciences, Leeuwarden, The Netherlands
| | - Sijmen A Reijneveld
- Department of Health Sciences, Community & Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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20
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Griffiths AW, Kelley R, Garrod L, Perfect D, Robinson O, Shoesmith E, McDermid J, Burnley N, Surr CA. Barriers and facilitators to implementing dementia care mapping in care homes: results from the DCM™ EPIC trial process evaluation. BMC Geriatr 2019; 19:37. [PMID: 30736748 PMCID: PMC6368774 DOI: 10.1186/s12877-019-1045-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 01/23/2019] [Indexed: 11/25/2022] Open
Abstract
Background Psychosocial person-centred interventions are considered best practice for addressing complex behaviours and care needs such as agitation and anxiety, and for improving the quality of life of people with dementia in care homes. Dementia Care Mapping (DCM™) is an established practice development tool and process aimed to help care home staff deliver more person-centred care. To date, few studies have evaluated the efficacy of DCM™ and have found mixed results. These results are suggested to be the outcome of intervention implementation, which may be impacted by a range of factors. This study reports the barriers and facilitators to DCM™ implementation in care homes found during the process evaluation conducted as part of a randomized controlled trial. Methods Eighteen of the 31 DCM™ intervention care homes were recruited to participate in the embedded process evaluation. Semi-structured interviews were conducted with 83 participants, comprising care home managers, trained DCM™ users (mappers), expert external mappers, staff members, relatives, and residents. Results Barriers and facilitators to DCM™ implementation were found at the mapper level (e.g. motivation and confidence), the DCM™ intervention level (e.g. understanding of DCM™) and the care home level (e.g. staffing issues, manager support). Further barriers caused by the burden of trial participation were also identified (e.g. additional paperwork). Conclusions Implementing DCM™ is complex and a greater consideration of potential barriers and facilitators in planning future studies and in practice could help improve implementation. Trial registration Current Controlled Trials ISRCTN82288852, registered 16/01/2014.
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Affiliation(s)
- Alys W Griffiths
- Centre for Dementia Research, School of Health and Community Studies, Leeds Beckett University, Leeds, LS1 3HE, UK.
| | - Rachael Kelley
- Centre for Dementia Research, School of Health and Community Studies, Leeds Beckett University, Leeds, LS1 3HE, UK
| | - Lucy Garrod
- Oxford Health NHS Foundation Trust, Oxford, UK
| | | | - Olivia Robinson
- Centre for Dementia Research, School of Health and Community Studies, Leeds Beckett University, Leeds, LS1 3HE, UK
| | - Emily Shoesmith
- Centre for Dementia Research, School of Health and Community Studies, Leeds Beckett University, Leeds, LS1 3HE, UK
| | - Joanne McDermid
- Wolfson Centre for Aged Related Diseases, King's College London, London, UK
| | - Natasha Burnley
- Centre for Dementia Research, School of Health and Community Studies, Leeds Beckett University, Leeds, LS1 3HE, UK
| | - Claire A Surr
- Centre for Dementia Research, School of Health and Community Studies, Leeds Beckett University, Leeds, LS1 3HE, UK
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21
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Holst G, Johansson M, Ahlström G. Signs in People with Intellectual Disabilities: Interviews with Managers and Staff on the Identification Process of Dementia. Healthcare (Basel) 2018; 6:healthcare6030103. [PMID: 30149606 PMCID: PMC6164955 DOI: 10.3390/healthcare6030103] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Revised: 08/20/2018] [Accepted: 08/23/2018] [Indexed: 11/24/2022] Open
Abstract
The life expectancy of people with intellectual disabilities (ID) has steadily increased, which has been accompanied by an increased risk of dementia. Staff and managers are key resources for safety diagnosis since they deliver information about people with ID behavior every day. The aim of the present study was to explore the identification process employed by staff and managers to detect signs of suspected dementia in people with an ID within intellectual disability services (ID-services). Twenty managers and 24 staff within an ID-service were interviewed and qualitative latent content analysis was applied. A model consisting of three themes on three levels of resources for the identification process of signs of suspected dementia emerged from the analysis. On the first level was the time and continuity in the care relationship, which is crucial for identifying and responding to changes in cognitive ability that indicate dementia. On the second level, the staff identify deficiencies in their own knowledge, seek support from colleagues and managers within their workplace and, on the third level, outside their workplace. Staff and managers expressed a need for early and continuous guidance and education from specialists in dementia and primary healthcare. This finding indicates an urgent need for intervention research and digital support for staff in dementia care.
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Affiliation(s)
- Göran Holst
- The Swedish Red Cross University College, Box 1059, SE-141 21 Stockholm, Sweden.
| | - Maria Johansson
- Department of Health Sciences, Faculty of Medicine, Lund University, Box 157, SE-221 00 Lund, Sweden.
| | - Gerd Ahlström
- Department of Health Sciences, Faculty of Medicine, Lund University, Box 157, SE-221 00 Lund, Sweden.
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Schaap FD, Dijkstra GJ, Finnema EJ, Reijneveld SA. The first use of dementia care mapping in the care for older people with intellectual disability: a process analysis according to the RE-AIM framework. Aging Ment Health 2018; 22:912-919. [PMID: 29171286 DOI: 10.1080/13607863.2017.1401582] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION The aging of the population with intellectual disability (ID), with associated conseqences as dementia, creates a need for evidence-based methods to support staff. Dementia Care Mapping (DCM) is perceived to be valuable in dementia care and promising in ID-care. The aim of this study was to evaluate the process of the first use of DCM in ID-care. METHODS DCM was used among older people with ID and care-staff in 12 group homes of six organisations. We obtained data on the first use of DCM in ID-care via focus-group discussions and face-to-face interviews with: care-staff (N = 24), managers (N = 10), behavioural specialists (N = 7), DCM-ID mappers (N = 12), and DCM-trainers (N = 2). We used the RE-AIM framework for a thematic process-analysis. RESULTS All available staff (94%) participated in DCM (reach). Regarding its efficacy, staff considered DCM valuable; it provided them new knowledge and skills. Participants intended to adopt DCM, by continuing and expanding its use in their organisations. DCM was implemented as intended, and strictly monitored and supported by DCM-trainers. As for maintenance, DCM was further tailored to ID-care and a version for individual ID-care settings was developed, both as standards for international use. To sustain the use of DCM in ID-care, a multidisciplinary, interorganisational learning network was established. CONCLUSION DCM tailored to ID-care proved to be an appropriate and valuable method to support staff in their work with aging clients, and it allows for further implementation. This is a first step to obtain an evidence-based method in ID-care for older clients.
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Affiliation(s)
- Feija D Schaap
- a Research Group Living, Wellbeing and Care for Older People , NHL University of Applied Sciences , Leeuwarden , The Netherlands.,c Department of Health Sciences, Community & Occupational Medicine , University Medical Center Groningen, University of Groningen , Groningen , The Netherlands
| | - Geke J Dijkstra
- b Department of Health Sciences, Applied Health Research , University Medical Center Groningen, University of Groningen , Groningen , The Netherlands
| | - Evelyn J Finnema
- a Research Group Living, Wellbeing and Care for Older People , NHL University of Applied Sciences , Leeuwarden , The Netherlands
| | - Sijmen A Reijneveld
- c Department of Health Sciences, Community & Occupational Medicine , University Medical Center Groningen, University of Groningen , Groningen , The Netherlands
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Schaap FD, Fokkens AS, Dijkstra GJ, Reijneveld SA, Finnema EJ. Dementia care mapping to support staff in the care of people with intellectual disability and dementia: a feasibility study. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2018; 31:1071-1082. [PMID: 29691956 DOI: 10.1111/jar.12464] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND The number of people with intellectual disability and dementia increases; this combination causes behavioural changes. Dementia Care Mapping (DCM) supports staff in dementia care in nursing homes and may be useful in intellectual disability-care. This qualitative study examines the feasibility of DCM for older people with intellectual disability and dementia. METHODS The present authors obtained data in focus groups and interviews with professional users and analysed using a framework for feasibility studies. With experts in dementia and intellectual disability researches, the present authors determined the overall feasibility. RESULTS DCM was found to be feasible in intellectual disability-care, regarding five domains of feasibility. Staff reported DCM to be useful and valuable and addresses to their demand for skills and knowledge. All professional users found DCM feasible in intellectual disability-care, which was confirmed by experts. CONCLUSIONS DCM is feasible in intellectual disability-care. When fully tailored to intellectual disability-care, DCM is useful and provides opportunities to assess its effectiveness.
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Affiliation(s)
- Feija D Schaap
- Research Group Living, Wellbeing and Care for Older People, NHL University of Applied Sciences, Leeuwarden, The Netherlands.,Department of Health Sciences, Community & Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Andrea S Fokkens
- Department of Health Sciences, Applied Health Research, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Geke J Dijkstra
- Department of Health Sciences, Applied Health Research, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Sijmen A Reijneveld
- Department of Health Sciences, Community & Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Evelyn J Finnema
- Research Group Living, Wellbeing and Care for Older People, NHL University of Applied Sciences, Leeuwarden, The Netherlands
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Surr CA, Griffiths AW, Kelley R. Implementing Dementia Care Mapping as a practice development tool in dementia care services: a systematic review. Clin Interv Aging 2018; 13:165-177. [PMID: 29416325 PMCID: PMC5790091 DOI: 10.2147/cia.s138836] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Dementia Care Mapping (DCM) is an observational tool set within a practice development process. Following training in the method, DCM is implemented via a cyclic process of briefing staff, conducting mapping observations, data analysis and report preparation, feedback to staff and action planning. Recent controlled studies of DCM's efficacy have found heterogeneous results, and variability in DCM implementation has been indicated as a potential contributing factor. This review aimed to examine the primary research evidence on the processes and the barriers and facilitators to implementing DCM as a practice development method within formal dementia care settings. PUBMED, PsycINFO, CINAHL, The Cochrane Library-Cochrane reviews, HMIC (Ovid), Web of Science and Social Care Online were searched using the term "Dementia Care Mapping". Inclusion criterion was primary research studies in any formal dementia care settings where DCM was used as a practice development tool and which included discussion/critique of the implementation processes. Assessment of study quality was conducted using the Mixed Methods Appraisal Tool. Twelve papers were included in the review, representing nine research studies. The papers included discussion of various components of the DCM process, including mapper selection and preparation; mapping observations; data analysis, report writing and feedback; and action planning. However, robust evidence on requirements for successful implementation of these components was limited. Barriers and facilitators to mapping were also discussed. The review found some consensus that DCM is more likely to be successfully implemented if the right people are selected to be trained as mappers, with appropriate mapper preparation and ongoing support and with effective leadership for DCM within the implementing organization/unit and in organizations that already have a person-centered culture or ethos. Future development of the DCM tool should consider ways to save on time taken to conduct DCM cycles. More research to understand the ingredients for effective DCM implementation is needed.
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Affiliation(s)
- Claire A Surr
- Centre for Dementia Research, School of Health and Community Studies, Leeds Beckett University, Leeds, UK
| | - Alys W Griffiths
- Centre for Dementia Research, School of Health and Community Studies, Leeds Beckett University, Leeds, UK
| | - Rachael Kelley
- Centre for Dementia Research, School of Health and Community Studies, Leeds Beckett University, Leeds, UK
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