The Care Home Activity Project: Does introducing an occupational therapy programme reduce depression in care homes?

Abstract

The primary aim of the study was to test the hypothesis that depression severity in care homes for older people would be reduced by an occupational therapy programme. This was a feasibility study for a cluster randomised controlled trial and involved four intervention and four control homes in northern England. In each intervention home a registered occupational therapist worked full-time for one year delivering an individualised programme to participants. Pre- and post-intervention data for the Geriatric Mental State-Depression Scale (primary outcome measure) were obtained for 143 participants. Secondary outcomes included dependency and quality of life. No significant intervention effects were found in any of the quantitative outcome measures, though qualitative interviews showed the intervention was valued by many participants, staff and relatives. Therapist ratings and qualitative interviews suggested that the intervention was beneficial to some participants but no distinctive characteristics were found that might enable prediction of likely benefit on initial assessment. This exploratory study provides no evidence that this intervention produced benefits in terms of depression, dependency or quality of life. Lack of prior power calculations means these are not definitive findings; but numbers were sufficient to perform the required analyses and data did not suggest effects that would have reached statistical significance with a larger sample. This study highlights issues for consideration in providing such services in care homes.

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

“…Mozley et al . () evaluated the effects of an occupational therapy programme on residents with depression. There was no significant difference found using quantitative outcomes between the groups who did and did not receive the programme, but there was qualitative evidence of benefit.…”

Challenge Demcare: management of challenging behaviour in dementia at home and in care homes – development, evaluation and implementation of an online individualised intervention for care homes; and a cohort study of specialist community mental health care for families

“…This was higher than the original estimate of 15%, which was based on previous local studies. 63,131 The ICCs from the NPI and CMAI data were between 0.03 and 0.06 (except for the NPI distress subscale; see Table 25), and so were higher than the value of 0.03 used in the original sample size estimation. The dropout rate in the other residents group, consisting of residents with dementia or with CB but not both, was 17% and, therefore, closer to our original estimate of 15%.…”

“…Mozley et al, 131 in a study carried out in the same locality as the ResCare trial, reported a 39% loss of care home participants over 12 months because of death, moving elsewhere or illness too severe for follow-up. So we expected to lose two recruited CB residents (15%) per home over 4 months, yielding a completed sample of 48 × 11 = 528 participants.…”

“…Re-analysis of data from previous studies suggested that intracluster correlation coefficients (ICCs) rarely exceed 0.03. 131 We therefore judged that the ICC would not exceed 0.03, and calculated that 528 CB completers would provide the same power as a simple random sample of 528/[1 + 0.03 × (11 -1)] = 406. Our original design had > 80% (85%) power using a significance level of 5% to detect a difference in NPI scores equal to 0.3 of their population SD.…”

An Occupational Therapy intervention for residents with stroke-related disabilities in UK Care Homes (OTCH): cluster randomised controlled trial with economic evaluation

“…58 A previous study, assessing the feasibility of a trial evaluating the effectiveness of an OT programme at reducing levels of depression in a care home population, found no significant effects. 60 However, the trial was not powered to evaluate the efficacy of OT in alleviating in symptoms of depression. The OTCH trial sought to assess the influence of OT on levels of depression as a secondary outcome measure to the performance of personal ADL.…”