Providing activity for people with dementia in care homes: a cluster randomised controlled trial

Abstract

The results may be related to the following: wide variability in how the intervention was implemented, such as low staff attendance at the education and coaching sessions, and patchy provision of additional activities to residents; or the residents' severity of dementia or the choice of outcome measures. Future studies need to pay more attention to process measures such as implementation and fidelity strategies, and outcome measures that better capture the focus of the intervention such as level of engagement and activity.

Do occupational therapy interventions improve quality of life in persons with dementia? A meta‐analysis with implications for future directions

“…Key information about the 10 selected trials of OT interventions for QoL in PwD is summarized in Table . The diagnosis of dementia was based on standard clinical criteria according to the Diagnostic and Statistical Manual of Mental Disorders , fourth edition, in four studies, and the International Classification of Diseases, tenth revision, in one study . The other studies either relied on ‘clinician best judgment’ of dementia or a Mini‐Mental State Examination score <24 .…”

“…The other studies either relied on ‘clinician best judgment’ of dementia or a Mini‐Mental State Examination score <24 . Dementia was broadly defined in seven studies, while two studies focused specifically on patients with Alzheimer's‐type dementia . In the study by Politis et al ., 64% of participants had Alzheimer's‐type dementia, 19% had probable vascular dementia, and the remaining participants had other types of dementia.…”

“…The study by Wenborn et al . had two different QoL ratings: one by the PwD and the other by the carer . The rating with the better post‐intervention QoL outcome was considered for the purpose of the overall meta‐analysis.…”

Raising the standard of applied dementia care research: addressing the implementation error

“…For example, recent pragmatic trials of support programmes (Kurz et al, 2012;Low et al, 2013;Van de Ven et al, 2013;Waldorff et al, 2012), telecare (Bardsley, Steventon, & Doll, 2013), training interventions (Beer et al, 2011;Spijker et al, 2011) and system enhancements or novel methods of delivering services (Goldberg et al, 2013;Meeuwsen et al, 2012;Nourhashemi et al, 2010;Van Houdt & De Lepeleire, 2010) all report no positive effects compared with the control 'usual care' condition. One study nonetheless demonstrated improvements in the patient experience and family carer satisfaction (Goldberg et al, 2013) whilst others point to problems with delivery of the intervention by practitioners such as poor adherence and variation in practice (Low et al, 2013;Spijker et al, 2013;Wenborn et al, 2013). Thus, failure to report positive outcomes may reflect genuine ineffectiveness where the intervention has failed to address basic human values such as dignity and autonomy (Vernooij-Dassen, Leatherman, & Rikkert, 2011) or may be a consequence of practical difficulties in conducting applied research in routine care settings (Iliffe et al, 2008).…”

How family members manage risk around functional decline: The autonomy management process in households facing dementia

“…Yet there are still important gaps in understanding how dementia is reshaping the social order of millions of households. While research has highlighted the importance of autonomy and meaningful activity to the wellbeing of cognitively-declining elders (Everard, Lach, Fisher, & Baum, 2000; Moyle et al, 2011; Phinney, Chaudhury, & O'Connor, 2007; Popham & Orrell, 2012; Wenborn et al, 2013), it has not yet explained how family members manage functional decline in the elder’s daily activities over time. This is an important gap in dementia research because 1) functional decline is associated with increased stress and burden for caregivers (Vitaliano, Zhang & Scanlan, 2003) and 2) responses to dementia by family members can influence long-term prognosis (Tschanz et al, 2013).…”