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AwareCare: a pilot randomized controlled trial of an awareness-based staff training intervention to improve quality of life for residents with severe dementia in long-term care settings

  • Linda Clare (a1), Rhiannon Whitaker (a2), Robert T Woods (a3), Catherine Quinn (a1), Hannah Jelley (a1), Zoe Hoare (a2), Joan Woods (a3), Murna Downs (a4) and Barbara A. Wilson (a5)...
Abstract
ABSTRACT

Background: The extent to which care home residents with severe dementia show awareness is influenced by the extent to which the environment provides opportunities for engagement and by the way in which care staff interact with them. We aimed to establish whether training care staff to observe and identify signs of awareness in residents with severe dementia resulted in improved quality of life for residents.

Methods: In this pilot cluster randomized trial, care staff in four homes (n = 32) received training and supervision and carried out structured observations of residents using the AwareCare measure (n = 32) over an eight-week period, while staff in four control homes (n = 33) had no training with regard to their residents (n = 33) and no contact with the research team. The primary outcome was resident quality of life. Secondary outcomes were resident well-being, behavior and cognition, staff attitudes and well-being, and care practices in the home.

Results: Following intervention, residents in the intervention group had significantly better quality of life as rated by family members than those in the control group, but care staff ratings of quality of life did not differ. There were no other significant between-group differences. Staff participating in the intervention identified benefits in terms of their understanding of residents’ needs.

Conclusions: Staff were able to use the observational measure effectively and relatives of residents in the intervention homes perceived an improvement in their quality of life.

Copyright
Corresponding author
Correspondence should be addressed to: Professor Linda Clare, School of Psychology, Bangor University, Bangor, Gwynedd LL57 2AS, UK. Phone: +44 1248 388178. Email: l.clare@bangor.ac.uk.
References
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Asplund K., Norberg A., Adolfsson R. and Waxman H. M. (1991). Facial expressions in severely demented patients – a stimulus-response study of four patients with dementia of the Alzheimer type. International Journal of Geriatric Psychiatry, 6, 599606. doi:10.1002/gps.930060809.
Ballard C. et al. (2001). Quality of care in private sector and NHS facilities for people with dementia: cross-sectional survey. BMJ, 323, 426427. doi:10.1136/bmj.323.7310.426.
Brooker D. J. R., Sturmey P., Gatherer A. J. H. and Summerbell C. (1993). The Behavioural Assessment Scale of Later Life (BASOLL): a description, factor analysis, scale development, reliability and validity data for a new scale for older adults. International Journal of Geriatric Psychiatry, 8, 747754. doi:10.1002/gps.930080907.
Clare L., Rowlands J., Bruce E., Surr C. and Downs M. (2008). “I don't do like I used to do”: a grounded theory approach to conceptualising awareness in people with moderate to severe dementia living in long-term care. Social Science and Medicine, 66, 23662377. doi:10.1016/j.socscimed.2008.01.045.
Clare L., Woods R. T., Whitaker R., Wilson B. A. and Downs M. (2010). Development of an awareness-based intervention to enhance quality of life in severe dementia. Trials, 11, 73. doi:10.1186/1745-6215-11-73.
Clare L., Markova I., Roth I. and Morris R. (2011). Awareness in Alzheimer's disease and associated dementias: theoretical framework and clinical implications. Aging and Mental Health, 15, 936944. doi:10.1080/13607863.2011.583630.
Clare L. et al. (2012). AwareCare: development and validation of an observational measure of awareness in people with severe dementia. Neuropsychological Rehabilitation, 22, 113133. doi:10.1080/09602011.2011.640467.
Cohen J. (1988). Statistical Power Analysis for the Behavioral Sciences, 2nd edn.Hillsdale, NJ: Lawrence Erlbaum Associates.
Crespo M., de Quiros M. B., Gomez M. M. and Hornillos C. (2012). Quality of life of nursing home residents with dementia: a comparison of perspectives of residents, family and staff. The Gerontologist, 52, 5665. doi:10.1093/geront/gnr080.
Donoghue C. (2010). Nursing home staff turnover and retention: an analysis of national level data. Journal of Applied Gerontology, 29, 89106. doi:10.1177/0733464809334899.
Edelman P., Fulton B. R., Kuhn D. and Chang C.-H. (2005). A comparison of three methods of measuring dementia-specific quality of life: perspectives of residents, staff and observers. The Gerontologist, 45 (Special Issue 1), 2736. doi:10.1093/geront/45.suppl_1.27.
Goldberg D. (1992). General Health Questionnaire (GHQ-12). Windsor, UK: NFER-Nelson.
Götell E., Brown S. and Ekman S.-L. (2003). Influence of caregiver singing and background music on posture, movement, and sensory awareness in dementia care. International Psychogeriatrics, 15, 411430. doi:10.1017/S1041610203009657.
Hintze J. (2004). NCSS and PASS. Kaysville, Utah. Available at: www.NCSS.com (Number Cruncher Statistical Systems); last accessed 1 October 2007.
Kuske B., Hanns S., Luck T., Angermeyer M. C., Behrens J. and Riedel-Heller S. G. (2007). Nursing home staff training in dementia care: a systematic review of evaluated programs. International Psychogeriatrics, 19, 818841. doi:10.1017/S1041610206004352.
Lintern T., Woods B. and Phair L. (2000). Training is not enough to change care practice. Journal of Dementia Care, 8, 1517.
Magai C., Cohen C., Gomberg D., Malatesta C. and Culver C. (1996). Emotional expression during mid-to late-stage dementia. International Psychogeriatrics, 8, 383395. doi:10.1017/S104161029600275X.
Magai C., Cohen C. I. and Gomberg D. (2002). Impact of training dementia caregivers in sensitivity to nonverbal emotion signals. International Psychogeriatrics, 14, 2538. doi:10.1017/S1041610202008256.
Maslach C., Jackson S. E. and Leiter M. P. (1996). Maslach Burnout Inventory: Manual. Palo Alto, CA: Consulting Psychologists Press.
McCabe M. P., Davidson T. E. and George K. (2007). Effectiveness of staff training programs for behavioural problems among older people with dementia. Aging and Mental Health, 11, 505519. doi:10.1080/13607860601086405.
Moniz-Cook E. et al. (1998). Can staff training reduce behavioural problems in residential care for the elderly mentally ill? International Journal of Geriatric Psychiatry, 13, 149158. doi:10.1002/(SICI)1099-1166(199803)13:3<149::AID-GPS746>3.0.CO;2-Q.
Norberg A., Melin E. and Asplund K. (1986). Reactions to music, touch and object presentation in the final stage of dementia: an exploratory study. International Journal of Nursing Studies, 23, 315323. doi:10.1016/0020-7489(86)90054-4.
Perrin T. (1997). The positive response schedule for severe dementia. Aging and Mental Health, 1, 184191. doi:10.1080/13607869757290.
Reisberg B. (1988). Functional assessment staging (FAST). Psychopharmacology Bulletin, 24, 653659.
Visser S., McCabe M. P., Hodgson C., Buchanan G., Davison T. E. and George K. (2008). Managing behavioral symptoms of dementia: effectiveness of staff education and peer support. Aging and Mental Health, 12, 4755. doi:10.1080/13607860701366012.
Walter S. D., Eliasziw M. and Donner A. (1998). Sample size and optimal designs for reliability studies. Statistics in Medicine, 17, 101110. doi:10.1002/(SICI)1097-0258(19980115)17:1<101::AID-SIM727>3.0.CO;2-E.
Ward T., Dawe B., Procter A., Murphy E. and Weinman J. (1993). Assessment in severe dementia: the Guy's Advanced Dementia Schedule. Age and Ageing, 22, 183189. doi:10.1093/ageing/22.3.183.
Weiner M. F., Martin-Cook K., Svetlik D. A., Saine K., Foster B. and Fontaine C. S. (2000). The quality of life in late-stage dementia (QUALID) scale. Journal of the American Medical Directors’ Association, 1, 114116.
Zimmerman S. et al. (2005a). Attitudes, stress and satisfaction of staff who care for residents with dementia. Gerontologist, 45 (Special Issue 1), 96105. doi:10.1093/geront/45.suppl_1.96.
Zimmerman S. et al. (2005b). Dementia care and quality of life in assisted living and nursing homes. Gerontologist, 45 (Special Issue 1), 133146. doi:10.1093/geront/45.suppl_1.133.
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International Psychogeriatrics
  • ISSN: 1041-6102
  • EISSN: 1741-203X
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