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P9. Residential care

Detailed programme and abstracts

P9.1. An ethnographic account of ageing in place with Down's syndrome and dementia in a residential setting


Thanks to advancements in health and social care, people with Down’s syndrome are living for longer. However, there is a higher prevalence of early onset dementia for people with Down’s syndrome, typically in their early fifties. In the UK, over 20% of people with an intellectual disability are supported to live in residential accommodation. Many of these settings use an 'ageing in place' or ‘home for life’ model. This model aims to support individuals to remain in their current residential setting, with necessary adaptations provided as a person’s needs develop. However, there is a lack of research around the suitability of the ageing in place model for individuals with Down’s syndrome and dementia.

The aim of this research was to investigate multiple perspectives (individuals with Down’s syndrome and dementia, staff, family and co-residents) of ageing in place with Down’s syndrome and dementia in a residential setting. This multi-method research consisted of an eight-month participant observation, in which the researcher participated in and observed the everyday lives of residents and staff. The observation was accompanied by semi-structured interviews with family members and focus groups with staff.

This presentation will highlight the key findings from the study, including; staff and family awareness of dementia in people with an intellectual disability, the experience of co-residents who live with an individual with Down syndrome and dementia, perceived benefits of ageing in place and the key factors which may enable individuals with Down’s syndrome and dementia to remain in a residential setting for as long as feasibly possible. The implications of the research will be discussed in terms of policy and practice.

P9.2. An evaluation of a program to implement consumer directed care in residential aged care facilities


Introduction: Consumer Directed Care (CDC) has been implemented widely in the community. In residential aged care facilities (RACFs) person centred care models have been adopted. There has been a move towards CDC in RACFs in recent years. This paper reports on an evaluation of a program to train staff in the implementation of CDC in RACFs. It presents information on the program as well as the facilitators and barriers that we found in relation to the implementation of CDC.

Method: Staff (n=150) and residents (n=142) were recruited to participate in the study from nine RACFs in Australia. The program focused on improving the communication between residents and staff so that the actual choices of residents in relation to their lives could be determined. Further, it worked with staff to determine what organisational changes need to occur to ensure that CDC was implemented within their facility: e.g., communication between staff members, trust, shared responsibility, respect. Data were gathered from staff after they had completed the program on the facilitators and barriers to implementing CDC as presented in the RCC program.

Results: The major barriers were the culture of the RACF, resources to implement CDC and communication between other staff and residents. Facilitators were staff supporting each other, respect and clear processes. Staff felt pressured, confused and that there was too much change.

Conclusions: The implementation of CDC into RACFs is not just a matter of educating staff on CDC and how to obtain resident choices. There is a need for significant changes in the structure, staff empowerment, time management and communication. This is a process that will take some time to achieve.

P9.3. Optimising dementia care in care homes: the TRaCAd


Introduction: Approximately 500,000 people live in 20,000 care homes in the UK.  With an increasing proportion of people living with dementia residing in care homes it is paramount that health care workers can deliver specialist dementia care.

Service Development: The development of an audit tool known as TRaCAd (Thematic Resident and Care Audit for dementia), underpinned by over 320 externally recognised standards, was developed by Four Seasons Health Care.  This audit tool is available on internal IPads which care staff complete.  The system then produces a report of actions that the member of staff (and care home unit) must complete to optimise the care that resident living with dementia receives.  The TRaCAd is made up of almost 300 questions and focuses on a variety of areas relating to the person’s holistic care including: washing and dressing, elimination, end-of-life care, activities, nutrition, cognition, capacity and mobility. 

Sample: 20 care homes throughout the UK.  13 care homes were recruited from England, 4 from Scotland and 3 from Northern Ireland.  451 residents living with dementia lived across these 20 care homes.

Results: The TRaCAd helped care teams identify 8,176 areas that could be improved within their dementia care units.  Of these 8,176 areas that required action, 2,118 of these were fixed and resolved immediately once identified (25.91%).  The remaining 6,084 actions were resolved before a care home became accredited (which was a maximum of 18 weeks later).  Specifically, improvements were noted in the domains of spiritual care (47.89%), psychological care (43.68%) and social care (43.02%).

Discussion: The TRaCAd audit helped care staff to improve quality of life for people living with dementia in care homes.  The tool enabled care staff to facilitate care experiences which focused on broader aspects of holistic care such as a person’s psychological, social and spiritual needs.

P9.4. The effectiveness of case conferences for people with dementia and challenging behavior on staff related outcomes in nursing homes


Background: Case conferences for people with dementia and challenging behaviors (e.g., apathy) are recommended as useful tools that enable staff in nursing homes to understand the behavior of people with this type of disease [1]. The two likely approaches for conducting case conferences include the following: Intervention A) using a structured assessment instrument and B) using a narrative approach in which the staff must identify the reasons for the residents’ behaviors in an unstructured manner [2]. Within the oral presentation the key results concerning the staff related outcomes are discussed.

Methods: A stepped wedge cluster randomized trial is used in the study [3]. On staff level the burnout measured with the Copenhagen Burnout Inventory (CBI) [4] and dementia-related stress (BelaDem) are used to measure the effectiveness of the intervention. The measurement took place over a period of 19 months (every 3 months). The outcomes will be analyzed using a linear mixed effect model and descriptive statistics [2]. The study will be accompanied by a parallel process evaluation [5]

Results: In total 12 nursing homes with 348 residents and 224 staff members take part in the study. The data of the process evaluation indicate that 51 of 96 (53%) case conferences were realized in intervention A, respectively 71 of 96 (74%) in intervention B. For the staff outcome a significant reduction in the mean score (-3.6 95%CI: [-7.26 -0.34], p=0.032) for the work related burnout (CBI) from control to intervention could be identified for intervention A. In the contrary no significant results according burnout and dementia related burden have been detected for intervention B.

Discussion: Case conferences using a structured assessment instrument are able to reduce work related burnout, although only half of the planned case conferences were realized by staff.  None of the interventions achieved a reduction in dementia related burden.

P9.5. Improving quality of life of people with dementia by research


Background: The “Cornelia Hoeve” is a small-scale home in a former farm, where twelve people with dementia live. The care is person-centred and based on the belief that the environment influences the mood and behaviour of people with dementia. Since the start of the “Cornelia Hoeve” in 2012, the people with dementia, their relatives and the nursing staff are participating in applied research.

Research goal: The research goal is to contribute to the quality of care and quality of life of the residents in the care farm. Through qualitative research, several aspects of living in the care farm are evaluated. The starting point is the perspective of the people with dementia, their relatives and the nursing staff. The results are used as input for the nursing staff to improve the quality of life.

Method: In the period from 2012 to 2016, interviews were conducted by senior bachelor students of the NHL University of Applied Sciences with the residents, their relatives, and nursing staff combined with observations. In addition, validated questionnaires like the Qualidem (Ettema, 2005) were used.

Results: All studies show that residents, relatives and staff are satisfied with the building, atmosphere and the approach. Improvement of activities is a recurring topic, despite the purchase of a magic table and the efforts of volunteers. Communication is another point for improvement. This concerns for example discussing the residents in their presence. Finally, relatives are concerned about the lack of continuous supervision in the living area, mainly during briefings.

Conclusion: This unique research method gives students the opportunity to practice applied science to persons with dementia, their relatives and staff. They also learn about persons with dementia and small-scale living. For the people at the “Cornelia Hoeve”, it’s a new experience to be part of a study.

P9.6. Use of customized digital games improves well-being for nursing home residents with dementia


Aim: This pilot study focuses on the impact of digital playing activities on well-being for people with dementia in nursing homes. An instrument to capture in-moment-well-being was used.

Background: Nursing home residents with advanced dementia are dependent on professionals to invite them to meaningful and customized activities.

Studies have pointed out that people with dementia (to some extent) can learn to handle tablets for pleasure and social purposes. However, the direct and secondary consequences of repeated gaming on the participant`s well-being are inadequately examined.

Materials & methods: Ten persons with moderate-severe dementia (primarily Alzheimer´s type; 8F/2M) from two Danish nursing homes were involved in tablet and big screen playing activities (Applikator), 2x/week for 4 weeks on voluntary basis. The Dementia Assessment Scales (MiDAS; McDermott et al., 2014-16; Ridder et al., 2017) was used for the staff to evaluate the degree of response (Interest, Response, initiation, Involvement and Enjoyment) Before, Under and After the activity. Finally, interviews with staff were conducted.

Results: MIDAS observations were performed in 49 out of 80 possible playing sessions (61%) along with Before/After observations. The participants showed significantly higher degree of responses when playing compared to Before and After observations (p<0,005). Most impact was on Interest, Response and Enjoyment. Before and After values were not significantly different. Furthermore, the interviews showed that the playing activity might positively influence the participant-caregiver interaction.

Conclusion: The study supports that some people with advanced dementia can enjoy and be positively stimulated by learning-differentiated digital games but that the time before or after is not affected. This is a small-scale non-RCT study so the results should be carefully interpreted.

VitaMind is an innovative partner project supported by EU-regional funding.



Last Updated: Monday 23 October 2017


  • Acknowledgements

    The 27th AE Conference in Berlin received funding under an operating grant from the European Union’s Health Programme (2014-2020). Alzheimer Europe and Deutsche Alzheimer Gesellschaft e.V. gratefully acknowledge the support of all conference sponsors.
  • European Union
  • Roche