Effectiveness of digital technologies to engage and support the wellbeing of people with dementia and family carers at home and in care homes: A scoping review.

Use of digital technologies to support meaningful engagement of people with dementia and carers increased during the COVID-19 pandemic. The purpose of this scoping review was to determine the effectiveness of digital technologies in supporting the engagement and wellbeing of people with dementia and family carers at home and in care homes. Studies published in peer reviewed literature were identified across four databases (CINAHL, Medline, PUBMED, PsychINFO). Sixteen studies met the inclusion criteria. Findings indicate that digital technologies can potentially support the wellbeing of people with dementia and family carers, although only a few studies had measured impact on wellbeing, as many were reporting on technology at proof-of-concept stage rather than commercially ready products. Moreover, current studies lacked meaningful involvement of people with dementia, family carers, and care professionals in the design of the technology. Future research should bring together people with dementia, family carers, care professionals and designers to coproduce digital technologies with researchers and evaluate them using robust methodologies. Codesign should start early in the intervention development phase and continue until implementation. There is a need for real world applications that nurture social relationships by focusing on how digital technologies can support more personalised, adaptive forms of care. Developing the evidence base to identify what makes digital technologies effective in supporting the wellbeing of people with dementia is crucial. Future interventions should therefore consider the needs and preferences of people with dementia, their families, and professional carers, as well as the suitability and sensitivity of wellbeing outcome measures.

Evaluation of strategies to recruit and retain older people with dementia and their informal carers into a Tai Chi Trial to improve balance and prevent falls.

Objectives: Randomised control trials (trials) involving people with dementia lack detailed analysis of recruitment and retention strategies. To address this, we examined the effectiveness of strategies in "The TACIT Trial: TAi ChI for people with demenTia". Methods: We recruited dyads (people with dementia and carers) from 3 South of England sites utilising different strategies. Recruitment strategy effectiveness was measured by percent yield (number randomised of total referrals) and cost per randomised participant. Our retention strategy (maintaining contact with participants during weekly telephone calls) was measured by percent yield (number retained by six-month follow-up). Results: Of 359 dyads, 24% were randomised into the study (n=85). The most resource-intensive strategy (research nurses spending 30 minutes explaining the study) had the highest referral to randomisation rate. An incremental cost-effectiveness ratio suggested an alternative approach (nurses and doctors spending 5 minutes explaining the study) was most cost-effective. Retention rates were 86% (n=36/42; intervention group) and 81% (35/43; control group); main reasons for attrition were worsening health and lack of study interest. Conclusions: The results demonstrate person-centred strategies enabling staff to spend time with participants were effective in supporting recruitment and retention. Those designing future trials must consider such strategies and the associated costs.

Barriers and enablers to implementing 'DEALTS2' simulation-based train-the-trainer dementia training programme in hospital settings across England: a qualitative study.

BACKGROUND: Despite approaches to provide effective dementia training in acute care settings, little is known about the barriers and enablers to implement and embed learning into practice. We were commissioned by Health Education England to develop and evaluate a new dementia training intervention 'Dementia Education And Learning Through Simulation 2' (DEALTS2), an innovative simulation toolkit to support delivery of dementia training in acute care across England. This study aimed to explore barriers and enablers experienced by trainers implementing DEALTS2 and extent to which it impacted on delivery of training and staff clinical practice. METHODS: We conducted twelve one-day DEALTS2 train-the-trainer (TTT) workshops across England in 2017 for National Health Service Trust staff employed in dementia training roles (n = 199 trainers); each receiving a simulation toolkit. Qualitative data were collected through telephone interviews 6-8 months after TTT workshops with 17 of the trainers. Open ended questions informed by the Kirkpatrick model enabled exploration of implementation barriers, enablers, and impact on practice. RESULTS: Thematic analysis revealed six themes: four identified interrelated factors that influenced implementation of DEALTS2; and two outlined trainers perceived impact on training delivery and staff clinical practice, respectively: (i) flexible simulation and implementation approach (ii) management support and adequate resources (iii) time to deliver training effectively (iv) trainer personal confidence and motivation (v) trainers enriched dementia teaching practice (vi) staff perceived to have enhanced approach to dementia care. Trainers valued the DEALTS2 TTT workshops and adaptability of the simulation toolkit. Those supported by management with adequate resources and time to deliver effective dementia training, were likely to implement DEALTS2. Trainers described positive impacts on their teaching practice; and perceived staff had enhanced their approach to caring for people with dementia. CONCLUSIONS: Trainers explained individual and organisational barriers and enablers during implementation of DEALTS2. The flexible simulation and implementation approach were key to supporting adherence of DEALTS2. To ensure wider implementation of DEALTS2 nationally, Trusts need to allocate appropriate time to deliver effective dementia training. Future research should measure staff behaviour change, patient perspectives of the intervention, and whether and how DEALTS2 has improved health and care outcomes.

Adherence to the Class-Based Component of a Tai Chi Exercise Intervention for People Living With Dementia and Their Informal Carers.

The objective of this study was to understand the experiences of people living with dementia and their informal carers' taking part together (in dyads) in Tai Chi classes and the aspects influencing their adherence. Dyads' experiences of taking part in Tai Chi classes for 20 weeks within the TACIT Trial were explored through class observations (n = 22 dyads), home-interviews (n = 15 dyads), and feedback. Data were inductively coded following thematic analysis. Tai Chi classes designed for people with dementia and their informal carers were enjoyable and its movements, easy to learn. Facilitators of participants' adherence were the socializing component and their enjoyment of the classes, whereas unexpected health problems were the main barrier. Finding the optimal level of challenge in the class setting might be crucial for people with dementia to feel satisfied with their progression over sessions and enable their continued participation.

Impact of 'DEALTS2' education intervention on trainer dementia knowledge and confidence to utilise innovative training approaches: A national pre-test - post-test survey.

BACKGROUND: Gaps in acute care staff knowledge, skills, and attitudes towards dementia exist. Innovative training approaches that improve the delivery of care for people with dementia are needed. We were commissioned by Health Education England to develop and evaluate a new dementia education intervention 'Dementia Education And Learning Through Simulation 2' (DEALTS2), a simulation toolkit to enhance delivery of dementia training nationally across England. OBJECTIVES: Evaluate differences in trainer dementia knowledge scores pre and post training, satisfaction with DEALTS2 Train-The-Trainer (TTT) workshops and simulation toolkit, confidence to use training approaches, and spread of implementation. DESIGN: A questionnaire survey using a pre-test - post-test design with measures completed: before (pre-test); after (T1); and 12 months post training (T2). SETTING: Twelve one-day DEALTS2 TTT workshops delivered across England in 2017. PARTICIPANTS: National Health Service Trust staff employed in dementia training roles (n = 199 trainers). METHODS: Trainers attended DEALTS2 TTT workshops and received the simulation toolkit. Data were collected between 2017 and 2018 using a questionnaire capturing differences in dementia knowledge scores, Likert scales and closed-ended questions measured satisfaction, confidence and implementation. Data were analysed using quantitative methods. RESULTS: Response rate was 92% (n = 183) at pre-test/T1 and 26% (n = 51) at T2. Trainer dementia knowledge scores increased from pre-test to T1 (p < 0.001) and were retained after 12 months in 5 of the 6 areas measured (pre-test to T2, p < 0.002); largest gains in 'humanised approaches to dementia care'. 96% (n = 176/183) were satisfied with DEALTS2 TTT workshops and simulation toolkit; 66.7% (n = 34/51) felt confident to deliver dementia training informed by DEALTS2. Adherence rates were good with 45% (n = 23/51) using the innovative training approaches within twelve months. CONCLUSIONS: The results show DEALTS2 effectively increased trainer dementia knowledge and confidence to utilise innovative dementia training approaches. Implementation of DEALTS2 varied across organisations, therefore further research should explore factors determining successful implementation.

People living with dementia and their family carers' adherence to home-based Tai Chi practice.

OBJECTIVES: The aim of this study was to understand what influenced people living with dementia and their family carers' adherence to the home-based component of a Tai Chi exercise intervention. METHOD: Dyads, of people living with dementia and their family carers, who participated in the intervention arm of the Tai Chi for people living with dementia trial, were invited to join weekly Tai Chi classes for 20 weeks and practice at home. Semi-structured dyadic home interviews were conducted on average after 16 weeks of classes. The views of 15 dyads with a range of home practice adherence were sought in semi-structured interviews. The interviews were analysed using an inductive thematic approach. RESULTS: Most participants found time to practise Tai Chi at home and practised for 18 hours on average. Amongst the barriers to adherence were participants' competing commitments and a booklet not sufficiently conveying the Tai Chi movements. Hence, a video or DVD was requested by participants. Facilitators of their adherence to the home-based component of the intervention were their enjoyment of the practice and the development of a habit, which was supported by their commitment to the study and their willingness to benefit from Tai Chi. CONCLUSION: Enjoyment and perceived benefits had a great impact on participants living with dementia and their carers' adherence to home-based Tai Chi practice. However, difficulties to perceive the Tai Chi movements through images might be hindering sustained participation. Hence, alternative aids such as videos and DVDs should be explored to facilitate adherence.

Design and evaluation protocol for 'DEALTS 2': a simulation-based dementia education intervention for acute care settings.

BACKGROUND: There is a paucity of simulation-based dementia education programmes for acute care settings that support the development of interpersonal skills pertinent to good care. Moreover, few studies measure the effectiveness of such programmes by evaluating the persistence of practice change beyond the immediate timeframe of the workshops. We were commissioned by Health Education England (HEE) to develop and evaluate 'DEALTS 2', a national simulation-based education toolkit informed by the Humanisation Values Framework, developed at Bournemouth University and based on an experiential learning approach to facilitate positive impacts on practice. This paper describes the process of developing DEALTS 2 and the protocol for evaluating the impact of this intervention on practice across England. METHODS: Intervention development: Following an initial scoping exercise to explore the barriers and enablers of delivering the original DEALTS programme, we developed, piloted, and rolled out DEALTS 2 across England through a Train the Trainer (TTT) model. Key stakeholders were asked to critically feedback during the development process. EVALUATION DESIGN: Mixed methods approach underpinned by Kirkpatrick Model for evaluating effectiveness of training; assessing reaction, learning, behaviour, and results. Evaluation forms and telephone interviews (quantitative and qualitative) with trainers that attended TTT workshops (n = 196) and, once implemented in individual Trusts, the staff that the trainers train. CONCLUSIONS: Evaluation of implementation and impact on care delivery for people with dementia will provide evidence of effectiveness. This will support the future development of simulation-based education programmes, amidst the current complexity of pressure in resource limited healthcare settings.

Research and education to understand fire risks associated with dementia: A collaborative case study (innovative practice).

This article reports on outcomes from the evaluation of a collaborative project between a University and a Fire and Rescue Service where research and education were developed to inform understanding of fire risks associated with dementia. Project outcomes were determined using a mixed-methods approach (survey, reports, statistics, case studies, course evaluation forms). Main outputs were a research report that identified dementia-specific fire risks and safety strategies, and an education package for Fire and Rescue Service staff and volunteers. The evaluation demonstrates the value of collaborative partnerships to develop understanding of risks pertinent to particular vulnerable groups and research-informed education.

Acceptability of a Dyadic Tai Chi Intervention for Older People Living With Dementia and Their Informal Carers.

Exercise is effective in preventing falls among older adults. However, few studies have included people living with dementia and their carers and explored their experiences. The aim of this study is to explore what affects the acceptability of exercise interventions to better meet the needs of people with dementia and their carers as a dyad. Observations, field notes containing participant's and instructor's feedback, and focus groups with 10 dyads involved in Tai Chi classes for 3 or 4 weeks in two sites in the South of England were thematically analyzed to understand their experiences. Findings suggest that dyads' determination to achieve the benefits of Tai Chi facilitated their adherence, whereas a member of the dyad's low sense of efficacy performing the movements during classes was a barrier. Simplifying class content and enhancing the clarity of instructions for home-based practice will be key to support the design of future exercise interventions.

Dementia-friendly communities: challenges and strategies for achieving stakeholder involvement.

Dementia-friendly communities (DFCs) are a UK policy initiative that aims to enable people with dementia to feel supported and included within their local community. Current approaches to DFC creation rely on stakeholder involvement, often requiring volunteer assistance. There is though a lack of evidence that examines the reality of achieving this. This paper critically assesses the challenges and strategies for achieving stakeholder involvement in DFCs. The evidence base is drawn from an inter-agency project funded by the National Health Service in the South of England where seven DFCs were developed by steering group partners and four part-time project workers (PWs). Data from the independent evaluation undertaken in the first year (2013-2014) of the project were analysed: 14 semi-structured interviews and a focus group examined PWs' experiences; while progress and key milestones are determined from monthly progress forms, good news stories, locality steering group minutes and press releases. Analysis was undertaken using a directed content analysis method, whereby data content for each locality was matched to the analytical framework that was drawn from Alzheimer's Society guidance. Challenges to achieving stakeholder involvement were identified as: establishing networks and including people representative of the local community; involving people affected by dementia; and gaining commitment from organisations. Strategies for achieving stakeholder involvement were recognised as: a sustainable approach; spreading the word; and sharing of ideas. By highlighting these challenges and the approaches that have been used within communities to overcome them, these findings form the foundation for the creation of DFC initiatives that will become embedded within communities. Stakeholder involvement is unpredictable and changeable; therefore, reliance on this approach questions the long-term sustainability of DFCs, and must be considered in future policies designed to enhance quality of life for people affected by dementia.

Social care and support needs of community-dwelling people with dementia and concurrent visual impairment.

OBJECTIVES: This study explored the social care and support needs of people with dementia and visual impairment, and the barriers and facilitators for meeting these needs. METHOD: Twenty-six semi-structured interviews were conducted: 21 joint and 5 individual interviews with the person with dementia and visual impairment (n=4) or their family/paid carer (n=1). Interviews were analysed thematically. RESULTS: Three themes are presented. (1) Social care needs: having dementia can reduce an individual's ability to cope with their visual impairment, and lead to increased dependency and reduced daily stimulation. (2) Barriers to using technology to meet social care needs: difficulties were reported with learning to use unfamiliar technology and the cost of visual impairment aids, and for some, the presence of dementia made visual impairment aids unusable and vice versa. (3) Familiarity as a facilitator for meeting social care needs: living at home or taking furnishings and ornaments into a new home facilitated independence, and continuity of paid carers/volunteers facilitated the caring relationship between the individual and staff/volunteer. CONCLUSION: Care workers will better serve older people if they are aware of the social care and support needs that arise from having both dementia and visual impairment.