The feasibility of increasing physical activity in care home residents: Active Residents in Care Homes (ARCH) programme.

OBJECTIVES: Maintaining physical activity for older residents in care homes maximises their physical and mental health and wellbeing, independence, dignity and quality of life. Unfortunately, most residents do not participate in regular physical activity. Active Residents in Care Homes, ARCH, was designed to increase physical activity by facilitating whole-system change in a care home. We evaluated whether ARCH can be delivered, its effects on resident's physical activity, wellbeing and costs. DESIGN: Feasibility study. SETTING: Three residential care homes. PARTICIPANTS: Care home residents and staff. INTERVENTION: Occupational and physiotherapists implemented ARCH over 4 months with an 8-month follow-up. MAIN OUTCOME MEASURES: Assessment of Physical Activity, Pool Activity Level, EQ5D-5L, Dementia Care Mapping, cost of implementing ARCH, health and social care utilisation. RESULTS: After implementing ARCH, residents displayed more positive behaviours, better mood and engagement and higher physical activity levels, but these improvements were not sustained at 8-month follow-up. The cost (2016 prices) of implementing ARCH was £61,037, which equates to £1,650/resident. Healthcare utilisation was £295/resident (SD320) in the 4 months prior to ARCH, £308/resident (SD406) during the 4-month implementation and £676/resident (SD438) in the 8-month follow-up. CONCLUSIONS: The ARCH programme can be delivered, it may have some short-term benefits and is affordable. Rather than have unrealistic increases in the health and longevity of older care home residents, ARCH may slow the decline in physical, mental and emotional well-being usually seen in older people in care homes, return some dignity and improve their quality of life in their last months or years.

Active Residents in Care Homes (ARCH): study protocol to investigate the implementation and outcomes of a whole-systems activity programme in residential care homes for older people.

OBJECTIVES: To evaluate the effectiveness, acceptability and costs of Active Residents in Care Homes, ARCH - a programme aiming to increase opportunities for activity in older care home residents. DESIGN: Feasibility study. SETTING: Residential care homes for older people. PARTICIPANTS: 10-15 residents, staff and family members will be recruited in each of the three participating care homes. INTERVENTION: ARCH is a 12-month 'whole-systems' programme implemented by occupational therapists and physiotherapists. They will conduct a comprehensive assessment of each care home, considering the physical environment, working practices and organisation structure as well as residents' individual needs, and recommend ways to address barriers and increase residents' activity levels. The therapists will then work with staff to improve understanding of the issues, instigate training, environmental, organisational and working practice changes as necessary. MAIN OUTCOME MEASURES: Residents' activity levels, health and quality of life will be tested using several measures to see which are practicable and appropriate for this population in this context. This includes: Assessment of Physical Activity in Frail Older People; Pool Activity Level Checklist; Dementia Care Mapping observations; and EQ-5D-5L. Residents will be assessed prior to programme implementation then 4- and 12-months post-implementation. Semi-structured interviews will explore the experiences of residents, staff, family members and therapists. CONCLUSIONS: Providing evidence of effectiveness and acceptability of ARCH, and documenting factors that impede/facilitate implementation will help us identify ways to enhance the care and quality of life of older people in residential care, and our understanding of how to implement them. TRIAL REGISTRATION: ISRCTN24000891.

Using a sonographic simulator to assess residents before overnight call.

OBJECTIVE: The purpose of our study was to evaluate the effectiveness of a sonographic simulator in evaluating residents before their taking overnight call. MATERIALS AND METHODS: A sonographic simulator was used to teach and evaluate two consecutive classes of first-year radiology residents. A test consisting of 10 cases was given to each resident. Tests were scored with respect to image quality, measurement accuracy, and interpretation of results. Constructive feedback for improvement and additional training before taking call were provided, as needed. Surveys were given before and after the study to evaluate perceived knowledge and skills. RESULTS: In the first year of the study, five of eight residents scanned appropriately, giving reasonable differential diagnoses, whereas three residents performed suboptimally and were given feedback, additional training, or both. The sonography curriculum was restructured based on initial resident performance. In the subsequent year, all eight residents performed satisfactorily on the test. Comparing the 2 years of the study, mean test scores increased from 3.5 to 4.0 (p > 0.05) for abdominal test questions and from 3.4 to 4.2 (p < 0.05) for early obstetric and gynecologic test questions. The residents' self-assessment of knowledge and scanning ability also significantly improved. CONCLUSION: Sonographic simulation allows objective assessment and identification of weaknesses. These weaknesses can then be addressed before taking call, with resultant improved resident education and the presumed benefit of improved patient care.