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The Enriched Opportunities Programme: Maximising well-being of older people in extra care housing Dawn Brooker Elaine A

The Enriched Opportunities Programme: Maximising well-being of older people in extra care housing Dawn Brooker Elaine Argyle & David Clancy Bradford Dementia Group UK. Aims of presentation. Describe the Enriched Opportunities Programme intervention

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The Enriched Opportunities Programme: Maximising well-being of older people in extra care housing Dawn Brooker Elaine A

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  1. The Enriched Opportunities Programme: Maximising well-being of older people in extra care housing Dawn Brooker Elaine Argyle & David Clancy Bradford Dementia Group UK

  2. Aims of presentation Describe the Enriched Opportunities Programme intervention Outline RCT research in extra care housing Share some baseline results, early gains & obstacles

  3. Enriched Opportunities Programme 2002-2005: References Brooker, D. & Woolley, R. (2007) Enriching Opportunities for People living with Dementia: The Development of a Blueprint for a Sustainable Activity-Based Model of Care. Aging and Mental Health, 11(4): 371-383 Brooker, D., Woolley, R. & Lee, D. (2007) Enriching Opportunities for People living with Dementia in Nursing Homes: An evaluation of a multi-level activity-based model of care. Aging and Mental Health 11(4): 361-370

  4. Partnership • ExtraCare Charitable Trust • Bradford Dementia Group • External experts www.bradford.ac.uk

  5. Kate Allen Clive Ballard Paul Batson Karen Bryan Errollyn Bruce Sheila Cheyney Ann Childs Richard Coaten Carole Dinshaw Jim Ellis Jane Fossey Tina Free Penny Garner Margaret Goodall Margaret Hardware John Keady John Killick David Lee Rebecca Leech James Lindsay Hazel May Esme Moniz-Cook Sally Nocker Kate Reid Pam Schweitzer Claire Surr Graham Stokes Denise Westwood External Experts

  6. Essential elements of the Enriched Opportunities Programme Focus on those residents who are most at risk of exclusion • Specialist expertise - The Locksmith • Individual assessment & case work • External networking and liaison • A skilled staff team • The provision of activities • Management & Leadership

  7. ExtraCare Housing features • Tenancy rights and your own front door • Dining room and community facilities • Government funding and promotion • Physical environment • Mixed age & dependency levels • Care and assistance programmes

  8. People with dementia – a home for life?

  9. Current Research Programme Does the Enriched Opportunities Programme make any difference to the lives of residents with significant mental health problems living in extra care housing, over and above the impact of employing an extra staff member to help with activities? www.bradford.ac.uk

  10. Research design Evaluation of the Enriched Opportunities Programme in extra care housing compared to an attention placebo intervention by means of a Randomized Cluster Controlled Trial (RCT) over a period of eighteen months.

  11. Enriched Opportunities Programme Intervention • Locksmith staff • Individualised assessment, case work & liaison for target residents • A skilled staff team – training & mentoring • Activities geared to the needs of the target group • Management & Leadership

  12. Attention placebo Employment of an extra senior member of staff (Project Support Worker Coach) to generally assist with promoting activities within the housing scheme.

  13. Study sites & residents 10 extra care housing schemes & villages in the Midlands and North West of England ranging in size from 45 to 320 residents 35 residents per site selected according to their vulnerability to exclusion from the community. 5 schemes get Enriched Opportunities Programme for 18 months 5 schemes get attention placebo for 12 months followed by 6 months full Enriched Opportunities Programme

  14. Inclusion criteria screen • Dementia or confusion • Communication difficulties • Social isolation • Challenging behaviour • Depression or low mood

  15. Time table May-Dec 2006 Preparation, recruitment, ethics Jan–May 2007 Baseline measures June-Dec2007 6 month measures Jan-May 2008 12 month measures June–Dec 2008 18 month measures Jan– Feb 2009 Data Analyses Mar– June 2009 Feedback & dissemination

  16. Measures with participants • QOLAD • EQ5D • SF12 • Duke DSSI • GDS • MMSE • Rating enjoyment of activities and goals • Dementia Care Mapping

  17. Measures completed with key worker • QOLAD proxy • Bartel inventory • Basoll mood scale • Bristol Activities of daily living (BADLS) • Activities over past 4 weeks • Goals identified

  18. Measures of staff attitude and behaviour • Staff perception of nursing older people • Attitude to Dementia Questionnaire • Opinion of intervention • Numbers of Personal Detractions and Personal Enhancers observed on DCM • Staff turnover

  19. Cost effectiveness • Use of services • Psychotropic medication • Hospitalisations • Relocations • Deaths

  20. Qualitative enquiry • Locksmith learning logs • Interviews with locksmiths, project support worker coaches, managers • Compliance with intervention checklist • Case studies • Focus groups with residents • Focus groups with staff

  21. Participants: 1113 were screened294 approached for consent

  22. Diagnoses per scheme for participating residents

  23. Quality of life scores

  24. Depression & enjoyment of activity

  25. DCM Mood & Engagement

  26. Staff attitudes and interaction

  27. Early gains • Research process is a positive experience for residents • Target residents joining in general activities • Medication side effects ameliorated • Infections diagnosed • People with longstanding MH problems getting better support. • Liaison with CMHT’s, GP’s and AS • Lifestyle changes

  28. Early barriers • Where have all these frail residents come from? • Where have all these residents with dementia come from? • Stigma • Locksmiths feeling overwhelmed • PSWC’s being used to cover vacant shifts

  29. Thank you for listening! Dawn Brooker, Bradford Dementia Group, Email d.j.brooker@Bradford.ac.uk Tel 01274 235726 Website www.bradford.ac.uk/health/dementia

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