The Enriched Opportunities Programme for people with dementia living in extra care housing: A randomised cluster controlled trial of a complex psycho-social intervention

Dawn Brooker, Association for Dementia Studies University of WorcesterElaine Argyle, David Clancy, Andy Scally, University of Bradford. Guy Page ExtraCare Charitable TrustHazel May Gloucester 2gether NHS Foundation Trust

1998-2009 EOP Research & Development1998- 2000 Between group comparison of nursing home residents participating in an activity challenge holiday and a matched control group.

2001-2003 The development of the EOP programme using qualitative enquiry and within group quantitative evaluation in four study sites

2005- 2009 Random cluster controlled trial in ten extra care housing schemes

University of Worcester Association for Dementia Studies

Bringing together expertise

University of Worcester Association for Dementia Studies

Extra Care Housing features Tenancy rights and your own front

door Restaurant, bar, shop, library, IT,

gym, hair salon and community facilities

People empowerment, ambassadors, awards, user feedback

Physical environment high spec Mixed age & dependency levels Care and assistance programmes

University of Worcester Association for Dementia Studies

People with dementia – a home for life?

University of Worcester Association for Dementia Studies

Cluster randomised controlled trial 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) in 10 ExtraCare housing schemes over a period of eighteen months. Study focussed on the lives of the 20-30 most vulnerable people living in each scheme.

University of Worcester Association for Dementia Studies

EOP: The 5 Components

1. Specialist Expertise – the Locksmith – unlocks potential, unpicks issues

2. Individual Assessment and case work -applies ‘Enriched Model’ - proactive liaison with community & resources

3. Activity, Occupation and interventions4. Training – enables whole team approach5. Management and Leadership – sustains over time

Attention placebo

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

Study sites10 extra care housing schemes & villages in the

Midlands and North West of England ranging in size from 45 to 320 residents

Randomised at site level 5 schemes Enriched Opportunities Programme, 5 schemes attention placebo

35 residents per site selected according to their vulnerability to exclusion from the community

Inclusion Criteria

• Dementia or confusion • Communication

difficulties• Social isolation• Challenging behaviour• Depression or low mood

Total of participants over 18 months

Condition Number of participants at baseline

Number at 18 months

Total EOP 33 male

111 female

TOTAL = 144

23 male

79 female

TOTAL = 102Total Placebo 39 male

110 female

TOTAL = 149

26 male

71 female

TOTAL = 97

Significant improvement EOP Rated Quality of Life more positively Reported decreased symptoms of depression

University of Worcester Association for Dementia Studies

QOLAD self-rated; time x intervention interaction: p < 0.001

Figure ? QOLAD Residents

27.5

28

28.5

29

29.5

30

30.5

31

31.5

32

Baseline 6 Month 12 month 18 month

Time period

Avera

ge s

co

re

EOP

PSWC

QOLAD staff-rated; time x intervention interaction: p = 0.004

Figure ? QOLAD Staff

24

25

26

27

28

29

30

31

32

33

Baseline 6 Month 12 month 18 month

Time period

Avera

ge s

co

re

EOP

PSWC

Depression GDS; time x intervention interaction: p = 0.003

Figure ? Average Geriatric Depression Score

0

1

2

3

4

5

6

7

Baseline 6 Month 12 month 18 month

Time period

Avera

ge s

co

re

EOP

PSWC

Significant improvement EOP Half as likely to have to move out into a care

home Spent significantly less time in hospital More likely to have a GP visit More likely to access community health

resources More likely to have a mental health diagnoses

University of Worcester Association for Dementia Studies

Reasons for drop-out from programme

GP visits, community OT, Physio and chiropody costs

• EOP rose from £26,643 (6 month costs) at baseline to £35,877 for the same time period at the end of the intervention.

• In comparison the Placebo costs fell from £30,269 to £24,702 for the same time period.

In-patient hospital Costs

• Costs for the EOP residents fell from £58,794 (6 month costs) to £34, 177 over the course of the intervention.

• Costs for the Placebo residents rose from £56,646 to £117,589 for the same period of time.

Changes observed over-time in EOP and PSWC sites Greater opportunity to be active Greater use of community facilities More fun Greater variety of things to do Improved well-being observed Dependency generally increased over time

University of Worcester Association for Dementia Studies

Things that didn’t change in 18 months

People remained satisfied with their level of support

Staff attitudes were positive to begin with and remained so

University of Worcester Association for Dementia Studies

References Brooker D., Argyle, E., Clancy, D. & Scally A. (2009) Enriched Opportunities Programme: A cluster randomised controlled trial of a new approach to living with dementia and other

mental health issues in ExtraCare housing schemes and villages. University of Bradford.May, H., Edwards, P. and Brooker, D. (2009). Enriched Care Planning for People with Dementia:

A Good Practice Guide to Delivering Person-Centred Care. London, Jessica Kingsley Publications

Brooker D., Argyle, E. & Clancy, D. (2009) Mental Health Needs of people living in extra care housing. Journal of Care Services Management, Vol 3.3 March/April

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

Brooker, D. (2001) Enriching Lives: evaluation of the ExtraCare Activity Challenge. Journal of Dementia Care. (Research Focus) 9 (3), 33-37.

University of Worcester Association for Dementia Studies

Next steps

• Writing up for peer-review• Roll-out across ExtraCare Charitable Trust

villages and schemes• Dissemination plan for Dept of Health• Development of leadership, “Locksmith” and

general dementia awareness training and education materials

University of Worcester Association for Dementia Studies

Thank you for listening!

Prof Dawn BrookerAssociation for Dementia Studiesd.brooker@worc.ac.uk

http://ihsc.worc.ac.uk/dementia www.extracare.org.uk

Photographs of people living with dementia taking part in The Enriched Opportunities Programme