Professor Clive Ballard
Oxford Health NHS Foundation Trust
An Optimized Person Centred Intervention to Improve Mental Health and Reduce Antipsychotics amongst People with Dementia in Care Homes
NIHR (PGfAR Competition 5 Full)
Alzheimer's disease & other dementias
Aims and objectives: To improve mental health and reduce the prescription of antipsychotic drugs for people with dementia in care homes, by developing and evaluating an optimized intervention based upon the most effective currently available therapies that can provide a broad range of benefits and which can be routinely implemented as part of NHS care. We will also determine whether the intervention improves quality of life (QOL).
Background: There are 250,000 people with dementia in care homes in the UK. The mental health of these individuals, the high level of antipsychotic use and the variable quality of care are serious concerns. Key studies have reported specific interventions which either improve mental health or reduce antipsychotics, but no interventions achieved both of these goals and none improved QOL. In addition, no interventions have been widely implemented in routine practice.
Work Plan 1 A systematic review to update information on effective interventions. .
Work Plan 2 Optimize interventions and Adapt for NHS context.
The four interventions with established efficacy are:
(1) Person Centred Care
(2) Antipsychotic review
(3) Social Interaction
Work plan 3 Incremental Evaluation of Key Interventions
A 4 month period of evaluation will elucidate the breadth of benefits conferred by Person Centred Care, the incremental benefits added each of the other therapies and the cost consequence.
Work Plan 4 Developing an Optimized intervention
We will use a Delphi consensus process to develop the most effective, practical and cost-effective intervention to promote Wellbeing and Health in people with Dementia (WHELD) based upon Work Plans 2 and 3. A manual will be compiled.
Work Plan 5 Field Testing and RCT
Ongoing field testing will address practical implementation issues as an NHS intervention in 12 care homes over an extended period. Qualitative studies will identify and address obstacles to implementation.
A well powered cluster randomized controlled trial of the WHELD intervention will be undertaken over 12 months in 40 care homes involving 1000 people with dementia.
Work Plan 6: Dissemination
Dissemination tools will include written materials, web and new media, scientific publications and presentations, workshops and a roadshow; with follow-up meetings with commissioners, health and care professionals.
Research team The applicants have innovated high quality clinical research focusing upon psychological interventions for people with dementia and clinical trials in care homes. This is supplemented by consumer involvement, world class health economic, qualitative and statistical expertise and a core input from individuals with NHS management roles.
Programme Management Overall programme management will be coordinated by the Programme Management Group (PMG), chaired by Professor Bob Woods. Each work plan will have a management group convened by the Work Plan lead. Additional work groups will be convened for specific tasks and report back to the PMG. An independent trial steering group will oversee the RCT.
Reseach Environment The host NHS Trust has innovated psychological services to older people, was the lead NHS partner in FITS and has a DENDRON centre providing an excellent infrastructure for clinical research. Kings College London/Institute of psychiatry, is a centre of excellence for dementia research with an MRC centre for neurodegeneration and an NHS Biomedical Research Centre. The partner universities (University College London, Bangor, Hull) are all leaders in psychological interventions for people with dementia and coordinate NIHR programmes.
Anticipated Output The programme will deliver an an effective and practical NHS therapy to improve mental health and wellbeing and reduce the use of antipsychotic drugs in people with dementia living in care homes. The intervention (WHELD), will be underpinned by an operationalized mannual with a standardized training programme and a dissemination mechanism to enable effective implementation.
Patient and Public Involvement The Alzheimers Society developed the FITS intervention. Consumers from the Alzheimers Society will play an active role in the development of mannuals, monitoring of evaluations and the dissemination programme.
Ethical Implications All residents in the care homes will receive the benefits of any interventions. The research component will be the evaluation. For particpants without the capacity to consent, consent will be obtained from the next of kin or appointed guardian and best practice will ensure that the rights of potential participants are fully protected.
Justification of resources requested: The requested resources are almost £2m. The programme will deliver a series of work plans including a large RCT of 1000 people with dementia, extensive field testing and a comprehensive dissemination plan, requiring considerable staff input.