What is meaningful activity for people with dementia living in care homes? A comparison of the views of older people with dementia, staff and family carers

Harmer, Barbara J; Orrell, Martin

doi:10.1080/13607860802343019

Cited by 214 publications

(283 citation statements)

References 35 publications

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“…Torrington (2006) points to the importance for wellbeing of a physical environment that is designed to support activity of different types, provides opportunities for such activities to happen and provides settings that are recognisable at a multi-sensory level and are appropriate for their function. Harmer and Orrell (2008) reach similar conclusions in their study on meaningful activity for people with dementia living in care homes. Of importance here, is the interrelationship between the physical and psycho-social environment in contributing, or detracting from, residents' well-being.…”

Section: Introductionsupporting

confidence: 65%

“…Talking to people with dementia about what they like about a care home, when it happens, tends to focus on the quality of care experienced or the perceived quality of life that care home living provides (Harmer & Orrell, 2008;Orrell et al, 2008;Train, Nurock, Kitchen, Manela, & Livingston, 2005). Asking people with dementia their views on the building where they live is a new area our study set out to explore.…”

Section: What People With Dementia and Their Families Had To Say Aboumentioning

confidence: 99%

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Care home design for people with dementia: What do people with dementia and their family carers value?

Innes

Kelly

Dincarslan

2011

Aging & Mental Health

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Objectives: To report on the views of people with dementia who live in care homes and their family carers on aspects of design that are important to them, and discuss these in relation to developing physical care environments that respond to the wishes of people with dementia and their family carers. Method: Six focus groups were held: two in Northern Ireland and four in Scotland. A total of 40 people participated in the focus groups. Twenty nine people were with dementia (24 female and five male), and 11 were family carers (10 female and one male). Results: Carers discussed the features of a building they took into account when selecting a care home, and discussed this in relation to 'bricks and mortar versus people'. Key themes reported by people with dementia and their family carers included how the space in the environment is used, for example, what happens in the building and the presence or absence of certain design features. Outside space and wayfinding aids were identified as positive features of the home, along with a general lack of concern about ensuite provision. Conclusion:The results demonstrate the complexity of building design as it must provide living space acceptable to people with dementia living there and family members who visit, as well as provide a workable environment for staff. The findings highlight areas that should be considered by care home teams involved in the build of a new home or the redevelopment of an existing care home.

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Section: Introductionsupporting

confidence: 65%

Section: What People With Dementia and Their Families Had To Say Aboumentioning

confidence: 99%

Care home design for people with dementia: What do people with dementia and their family carers value?

Innes

Kelly

Dincarslan

2011

Aging & Mental Health

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“…The experience of enjoyment in life was obtained through engagement with varieties of meaningful activities as planned in 3LP. Previous studies show that engagement in activities facilitates positive affect, such as feelings of happiness (Elavsky et al 2005;Meeks, et al, 2007), fun and contentment with life (Harmer and Orrell, 2008) and reduction in depression (Resnick et al 2008;Shin et al 2009;Cheng, et al, 2012) and improved quality of life (Guallar-Castillón, 2014) and as stressed in many occupational therapy literatures (Egan and Mantes, 2010;Lee et al, 2010, Frandin, et, al. 2013.…”

Section: Resultsmentioning

confidence: 99%

“…For example, gardening, craft, cooking, indoor and outdoor activities. Engagement in activities related to life roles facilitate a sense of well-being and provide a sense of connection between past and present (Harmer & Orrell, 2008;Frandin, et.al, 2013).…”

Section: Resultsmentioning

confidence: 99%

An Activity Program for Older People

Dahlan

Ibrahim²

2017

AjQoL

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Older people in an institution live in a sedentary lifestyle. They lose their autonomy, seldom engage in activities and did not have a meaningful social relationship. These issues lead to decreased in quality of life (QoL). The aim of this randomised trial is to determine the effectiveness of a lifestyle redesign programme, i.e. the Lively Later Life Programme (3LP) on QoL. Eighty-two older people who fit the inclusion criteria were randomly assigned to the 3LP group and the control group. At the end of six months, there is a significant change in physical, psychological and social domains of QoL.

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“…This divergence of opinion reflects previous studies' findings that people with dementia and family carers do not always hold similar views on the provision of health-care services. 213,214 There is increased policy emphasis on involving people with dementia and family carers in planning the care that they receive, as nearly half report little or no involvement in the decisions and choices made about the support services they receive. 215 The results of this study suggest the need to listen more closely to the views of people with dementia and their families about their needs and choices when planning care interventions, particularly at times of crisis, as these may not reflect the priorities as assessed by health-care professionals.…”

Section: Discussionmentioning

confidence: 99%

Support at Home: Interventions to Enhance Life in Dementia (SHIELD) – evidence, development and evaluation of complex interventions

Orrell

Hoe

Charlesworth

et al. 2017

Programme Grants Appl Res

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BackgroundDementia is a national priority and this research addresses the Prime Minister’s commitment to dementia research as demonstrated by his 2020 challenge and the new UK Dementia Research Institute. In the UK > 800,000 older people have dementia. It has a major impact on the lives of people with dementia themselves, on the lives of their family carers and on services, and costs the nation £26B per year. Pharmacological cures for dementias such as Alzheimer’s disease are not expected before 2025. If no cure can be found, the ageing demographic will result in 2 million people living with dementia by 2050. People with dementia lose much more than just their memory and their daily living skills; they can also lose their independence, their dignity and status, their confidence and morale, and their roles both within the family and beyond. They can be seen as a burden by society, by their families and even by themselves, and may feel unable to contribute to society. This programme of research aims to find useful interventions to improve the quality of life of people with dementia and their carers, and to better understand how people with dementia can be supported at home and avoid being admitted to hospital.Objectives(1) To develop and evaluate the maintenance cognitive stimulation therapy (MCST) for people with dementia; (2) to develop the Carer Supporter Programme (CSP), and to evaluate the CSP and Remembering Yesterday, Caring Today (RYCT) for people with dementia both separately and together in comparison with usual care; and (3) to develop a home treatment package (HTP) for dementia, to field test the HTP in practice and to conduct an exploratory trial.Methods(1) The MCST programme was developed for people with dementia based on evidence and qualitative work. A randomised controlled trial (RCT) [with a pilot study of MCST plus acetylcholinesterase inhibitors (AChEIs)] compared MCST with cognitive stimulation therapy (CST) only. The MCST implementation study conducted a trial of outreach compared with usual care, and assessed implementation in practice. (2) The CSP was developed based on existing evidence and the engagement of carers of people with dementia. The RCT (with internal pilot) compared the CSP and reminiscence (RYCT), both separately and in combination, with usual care. (3) A HTP for dementia, including the most promising interventions and components, was developed by systematically reviewing the literature and qualitative studies including consensus approaches. The HTP for dementia was evaluated in practice by conducting in-depth field testing.Results(1) Continuing MCST improved quality of life and improved cognition for those taking AChEIs. It was also cost-effective. The CST implementation studies indicated that many staff will run CST groups following a 1-day training course, but that outreach support helps staff go on to run maintenance groups and may also improve staff sense of competence in dementia care. The study of CST in practice found no change in cognition or quality of life at 8-month follow-up. (2) The CSP/RYCT study found no benefits for family carers but improved quality of life for people with dementia. RYCT appeared beneficial for the quality of life of people with dementia but at an excessively high cost. (3) Case management for people with dementia reduces admissions to long-term care and reduces behavioural problems. In terms of managing crises, staff suggested more costly interventions, carers liked education and support, and people with dementia wanted family support, home adaptations and technology. The easy-to-use home treatment manual was feasible in practice to help staff working in crisis teams to prevent hospital admissions for people with dementia.LimitationsGiven constraints on time and funding, we were unable to compete the exploratory trial of the HTP package or to conduct an economic evaluation.Future researchTo improve the care of people with dementia experiencing crises, a large-scale clinical trial of the home treatment manual is needed.ConclusionThere is an urgent need for effective psychosocial interventions for dementia. MCST improved quality of life and was cost-effective, with benefits to cognition for those on AChEIs. MCST was feasible in practice. Both CSP and RYCT improved the quality of life of people with dementia, but the overall costs may be too high. The HTP was useful in practice but requires evaluation in a full trial. Dementia care research may improve the lives of millions of people across the world.Trial registrationsCurrent Controlled Trials ISRCTN26286067 (MCST), ISRCTN28793457 (MCST implementation) and ISRCTN37956201 (CSP/RYCT).FundingThis project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 5, No. 5. See the NIHR Journals Library website for further project information.

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What is meaningful activity for people with dementia living in care homes? A comparison of the views of older people with dementia, staff and family carers

Abstract: People with dementia staff and carers had differing views about what made activities meaningful. Organisational limitations and social beliefs limited the provision of meaningful activities for this population. The study also indicates areas for improving activity provision in care homes.

Cited by 214 publications

References 35 publications

Care home design for people with dementia: What do people with dementia and their family carers value?

Care home design for people with dementia: What do people with dementia and their family carers value?

An Activity Program for Older People

Support at Home: Interventions to Enhance Life in Dementia (SHIELD) – evidence, development and evaluation of complex interventions

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