Care homes with dementia 'carer champions' reduce agitation and antipsychotics

Care homes using dementia ‘carer champions’ to deliver person-centred care lessen agitation in people with dementia and reduce their usage of antipsychotic drugs.

Sixty-nine care homes took part in the Wellbeing and Health for people with Dementia (WHELD) training programme. The outcomes on health and social care costs, agitation and quality of life were analysed by a team jointly led by the University of Exeter, King’s College London and Oxford Health NHS Foundation Trust.

They said previous research found the average care home resident engages in just two minutes of social interaction in a six hour period. They found WHELD increased this to ten minutes of activity, focussed around the interests of the resident, involving them in decisions that affected them. The programme also included GP training to reduce prescribing antipsychotics, known to significantly increase the risk of stroke and death in people with dementia.

The researchers found the programme saved thousands of pounds a year due to a reduction in emergency and routine hospital admissions. A drop in residents’ level of agitation also lessened their contact with GPs which saved further costs.

Senior author, Clive Ballard, Professor of Age-Related Diseases at the University of Exeter Medical School, said: “People with dementia living in care homes are among the most vulnerable in our society.

“We now know we have a programme that provides huge value in improving their quality of life and reducing agitation – and now crucially, we know this saves money. Our research has previously shown that only four of 170 carer training manuals available on the market were based on evidence that they work. We must roll this out to benefit those in need.”

The study looked at 549 residents with clinically significant agitation in dementia. Once the cost of delivering WHELD was taken into account, there was a saving of up to £2,000 per care home.

Renee Romeo, co-author and senior lecturer in Health Economics at King’s College London, said: “As a person’s dementia progresses they will need more intensive care and support and often residential care is seen as the best option by those who care for them. Our research can assist commissioning decisions around care and treatment options in these settings. By providing the evidence, that effective and affordable care responses following consultation around individual preferences do exist. The failure to recognise and introduce such interventions in not only ethically questionable but very costly.”

The research was funded by the National Institute for Health Research.

Alzheimer’s Society policy director Sally Copley added: “As 70 per cent of people in care homes have dementia, it is essential that staff working there have the right training to provide good quality dementia care.

“With many care homes on the brink of collapse and the NHS under pressure, cost-efficient initiatives like WHELD could make all the difference.

“But specialist training costs money, so without Government investment in social care to allow innovative solutions like WHELD to be put in practice, it won’t be possible to provide this for everyone who needs it. I urge Matt Hancock to take bold steps in the forthcoming Green Paper and commit to the sustainable social care funding that people with dementia have already waited too long for.”

The paper, entitled ‘Improving the quality of life of care home residents with dementia: Cost effectiveness of an optimised intervention for residents with clinically significant agitation in dementia’ was published in Alzheimer's & Dementia: The Journal of the Alzheimer's Association. Authors are Renee Romeo, Darshan Zala, Martin Knapp, Martin Orrell, Jane Fossey, and Clive Ballard.