Experiences of participant and public involvement in an international randomized controlled trial for people living with dementia and their informal caregivers

BACKGROUND

This study was initiated and co-designed by a Participant and Public Involvement (PPI) group attached to HOMESIDE, a randomized controlled trial that investigated music and reading interventions for people living with dementia and their family caregivers across five countries: Australia, Germany, Norway, Poland, and the UK. The aim was to capture experiences of PPI across the five countries, explore the benefits and challenges of PPI in dementia research, and identify contributions made to the study.

METHODS

We surveyed PPI members and academic researchers who collaborated on the HOMESIDE study. The survey was co-designed through consultation with PPI members and academics, alongside a small scoping literature review. Survey questions covered four topics: (1) expectations for PPI, (2) perceived contributions of PPI to the research study, (3) benefits and challenges of PPI, and (4) recommendations for future PPI in dementia research.

RESULTS

There were 23 responses, representing 50% of the PPI members (n = 16) and 29% of academics (n = 7). PPI was found to be beneficial to the research and individuals involved. Contributions to the research included supporting recruitment and publicity, advising on the design of participant-facing materials, guiding the design and delivery of the interventions, and identifying cultural differences affecting research delivery. PPI members benefited from building connections, sharing experiences and receiving support, learning about dementia and research, and gaining new unexpected experiences. Academics learned about the realities of living with dementia, which they felt informed and grounded their work. Several challenges were identified, including the need for clear expectations and objectives, inconsistency of PPI members across research stages, limitations of meeting online versus in-person, scheduling difficulties, and language barriers.

CONCLUSIONS

This study identifies important considerations for implementing PPI within dementia studies and international healthcare research more broadly. Our findings guided the development of five recommendations: (1) involve PPI members as early as possible and throughout the research process; (2) create a space for constructive criticism and feedback; (3) have clear tasks, roles, and expectations for PPI members; (4) involve PPI members with a diverse range of experiences and backgrounds; and (5) embed infrastructure and planning to support PPI.

The HOMESIDE Study-A Research Project to Support People Living With Dementia and Their Family Caregivers: Preliminary Report on Reading Intervention

The behavioral and psychological symptoms of dementia (BPSD) can be challenging for family caregivers to cope with, leading to distress and fatigue. It is therefore important to offer effective strategies to reduce the impact of BPSD. The HOMESIDE randomized controlled trial (RCT) was testing purposefully developed interventions to improve the quality of life and wellbeing of dyads of people with dementia and family caregivers as a result of reduction of BPSD. HOMESIDE RCT was conducted in Australia, Germany, Norway, Poland and the United Kingdom between 2019 and 2022. The study design was a three-arm parallel-group single-blinded, pragmatic RCT with a sample size of 432 dyads. Dyads were randomly allocated to one of three treatment conditions: Music Intervention plus Standard Care; or Reading Intervention plus Standard Care; or Standard Care only. The Reading Intervention (RI) within the HOMESIDE RCT aimed to evoke shared discussion, reminiscence, meaningful shared experiences and consequently enrich everyday life, interaction and the emotional connection between the caregiver (CG) and carereceiver (CR); as well as to enhance activities of daily living and to promote relaxation or stimulation as appropriate. This paper describes the underlying conceptual framework, the content, and delivery of the Reading Intervention within the HOMESIDE RCT.

Home-based family caregiver-delivered music and reading interventions for people living with dementia (HOMESIDE trial): an international randomised controlled trial

Background

Music interventions provided by qualified therapists within residential aged care are effective at attenuating behavioural and psychological symptoms (BPSD) of people with dementia (PwD). The impact of music interventions on dementia symptom management when provided by family caregivers is unclear.

Methods

We implemented a community-based, large, pragmatic, international, superiority, single-masked randomised controlled trial to evaluate if caregiver-delivered music was superior to usual care alone (UC) on reducing BPSD of PwD measured by the Neuropsychiatric Inventory-Questionnaire (NPI-Q). The study included an active control (reading). People with dementia (NPI-Q score ≥6) and their caregiver (dyads) from one of five countries were randomly allocated to caregiver-delivered music, reading, or UC with a 1:1:1 allocation stratified by site. Caregivers received three online protocolised music or reading training sessions delivered by therapists and were recommended to provide five 30-min reading or music activities per week (minimum twice weekly) over 90-days. The NPI-Q severity assessment of PwD was completed online by masked assessors at baseline, 90- (primary) and 180-days post-randomisation and analysed on an intention-to-treat basis using a likelihood-based longitudinal data analysis model. ACTRN12618001799246; ClinicalTrials.govNCT03907748.

Findings

Between 27th November 2019 and 7th July 2022, we randomised 432 eligible of 805 screened dyads (music n = 143, reading n = 144, UC n = 145). There was no statistical or clinically important difference in the change from baseline BPSD between caregiver-delivered music (-0.15, 95% CI -1.41 to 1.10, p = 0.81) or reading (-1.12, 95% CI -2.38 to 0.14, p = 0.082) and UC alone at 90-days. No related adverse events occurred.

Interpretation

Our findings suggested that music interventions and reading interventions delivered by trained caregivers in community contexts do not decrease enduring BPSD symptoms.

Funding

Our funding was provided by National Health and Medical Research Council, Australia; The Research Council of Norway; Federal Ministry of Education and Research, Germany; National Centre for Research and Development, Poland; Alzheimer's Society, UK, as part of the Joint Programme for Neurodegenerative Diseases consortia scheme.

Relish / Active Minds as a Tool Recommended for Occupational Therapists Working with Seniors Having Dementia. A Preliminary Report

Introduction: Dementia is a neurodegenerative disease that, among others, reduces the level of a patient’s functioning. Supporting patients should be comprehensive, also involving non-pharmacological interventions which include occupational therapy strategies based on the use of specific tools. The Relish / Active Minds sets, which have not yet been described in Polish scientific reports, can be found among available tools. The aim of the study was to preliminary assess the possibility of using these sensory, sensorimotor and cognitively stimulating sets dedicated to people with dementia in occupational therapy. Material and methods: The study involved 30 people with dementia attending the Day Care Home in Oświęcim, who participated in specially-designed activities using Relish / Active Minds sets. The participants were divided into 2 equinumerous groups: patients with moderate and mild dementia. In each group, activities were carried out using 3 Relish / Active Minds products with various degrees of difficulty. All participants used each of the 3 products under the supervision of a therapist 3 times in the period from Sept. to Oct. 2020. The activities were conducted by occupational therapists trained by the authors of the study. To monitor the course of the study, original observation tables and interviews with occupational therapists were used. Results: The markings for the difficulty level proposed by the designer in the products "Maze" and " Matching picture pairs " was shown to be inadequate with regard to the abilities of seniors with moderate and mild dementia. The use of Relish / Active Minds products by seniors with dementia had a positive effect on their communication skills, emotional state, cognitive condition and the sensorimotor area. Conclusions: It has been shown that, despite certain limitations, the Relish / Active Minds sets, with properly monitored application, contribute to the improvement of rehabilitation quality among elderly people with dementia and are a valuable tool in the work of an occupational therapist.

The HOMESIDE Music Intervention: A Training Protocol for Family Carers of People Living with Dementia

Background: The number of people living with dementia (PwD) worldwide is expected to double every 20 years. Many continue living at home, receiving support from family caregivers who may experience significant stress, simultaneously to that of the PwD. Meaningful and effective home-based interventions to support PwD and their caregivers are needed. The development of a theory- and practice-driven online home-based music intervention (MI) is delivered by credentialed music therapists, nested within the HOMESIDE RCT trial. Methods: Dyads including the PwD and their family carer are randomised to MI, reading (RI) or standard care (SC). MI aims to support health wellbeing and quality of life by training caregivers to intentionally use music (singing, instrument playing, movement/dancing, and music listening) with their family member (PwD) in daily routines. MI is underpinned by cognitive, relational, social, and psychological theories of mechanisms of change. Results: Preliminary sub-cohort results analyses show MI can be delivered and is accepted well by participants and music-therapist interventionists across five countries. Conclusions: The specialist skills of a music therapist through MI enable carers to access music when music therapists are not present, to meet carer and PwD needs. Music therapists embrace this changing professional role, observing therapeutic change for members of the dyads.

Validation of the Polish version of the Quality of the Carer-Patient Relationship (QCPR) in the population of seniors with dementia and their caregivers

Introduction: Quality of the Carer-Patient Relationship (QCPR) is a specific scale for testing the quality of relationships between the caregiver and the care recipient. Aims: The aim of the study was to translate, culturally adapt and validate the Polish language version of the QCPR questionnaire. Material and methods: The study was conducted in a group of 102 people who agreed to participate in this study. The group included 43 seniors with early and intermediate dementia and 59 carers of people with dementia. The snowball method was used in the selection of the sample. All respondents lived in the following provinces: Małopolskie and Śląskie. Respondents completed the paper version of the QCPR questionnaire once. The research was carried out in January 2020. Results: Cronbach's alpha reliability coefficients (α) for the Polish language version was α = 0.93α, which means that a very high level of internal compliance was noted. Conclusions: The proposed Polish language version of the Quality of the Carer-Patient Relationship (QCPR) questionnaire allow to assess the quality of relationships between people creates dyads. It should be noted that the analysis concerns a single-factor variant. The level of reliability of the top-down scales is admittedly high (warmth: α = 0.93; criticism: α = 0.75), nevertheless the analyzes show that it is a purely arbitrary, content division, and the responses of the respondents do not combine in the scales highlighted in the original version of the questionnaire.

HOMESIDE: home-based family caregiver-delivered music and reading interventions for people living with dementia: protocol of a randomised controlled trial

INTRODUCTION

Pharmacological interventions to address behavioural and psychological symptoms of dementia (BPSD) can have undesirable side effects, therefore non-pharmacological approaches to managing symptoms may be preferable. Past studies show that music therapy can reduce BPSD, and other studies have explored how formal caregivers use music in their caring roles. However, no randomised study has examined the effects on BPSD of music interventions delivered by informal caregivers (CGs) in the home setting. Our project aims to address the need for improved informal care by training cohabiting family CGs to implement music interventions that target BPSD, and the quality of life (QoL) and well-being of people with dementia (PwD) and CGs.

METHODS AND ANALYSIS

A large international three-arm parallel-group randomised controlled trial will recruit a sample of 495 dyads from Australia, Germany, UK, Poland and Norway. Dyads will be randomised equally to standard care (SC), a home-based music programme plus SC, or a home-based reading programme plus SC for 12 weeks. The primary outcome is BPSD of PwD (measured using the Neuropsychiatric Inventory-Questionnaire). Secondary outcomes will examine relationship quality between CG and PwD, depression, resilience, competence, QoL for CG and QoL for PwD. Outcomes will be collected at baseline, at the end of the 12-week intervention and at 6 months post randomisation. Resource Utilisation in Dementia will be used to collect economic data across the life of the intervention and at 6-month follow-up. We hypothesise that the music programme plus SC will generate better results than SC alone (primary comparison) and the reading programme plus SC (secondary comparison).

ETHICS AND DISSEMINATION

Ethical approval has been obtained for all countries. Results will be presented at national and international conferences and published in scientific journals and disseminated to consumer and caregiver representatives and the community.

TRIAL REGISTRATION NUMBERS

ACTRN12618001799246p; NCT03907748.

Level of happiness and happiness-determining factors perceived by women aged over 60 years

The aim of this article is to present the level of happiness perceived by women aged over 60 years (N = 100), to indicate the factors that determine the perception of happiness, and to determine the possibilities for strengthening the feeling of happiness. For the purposes of this article and the analysis of the obtained empirical data, the authors of this article assumed the structural theory of happiness, which allows for study participants to be viewed as biological, psychological, social, and spiritual beings.