Occupational therapy and people with dementia in care homes.
Doctoral thesis, UCL (University College London).
Abstract: Occupational therapy and people with dementia in care homes Background: Lack of activity within care homes decreases quality of life. Staff often lack knowledge and skills to provide meaningful activity at an appropriate level for residents with dementia. Aim: To assess if occupational therapy intervention for people with dementia in care homes improves quality of life. Study 1: The validity and reliability of the Pool Activity Level (PAL) Checklist was assessed. A survey of activity providers demonstrated good content validity. When completed with 60 people with dementia, it showed: strong criterion, construct and concurrent validity with other measures; good internal consistency; and adequate inter-rater and test-retest reliability. Study 2: This was a matched pair design cluster randomised controlled trial. Eight care homes (n = 104 residents) received the intervention, and eight (n = 106) continued usual care. The intervention comprised: environmental assessment; education sessions and individual coaching for staff who used the PAL Checklist to assess and provide meaningful activities with two residents each. Primary outcome was quality of life. Measures were completed at baseline; 4, and 12 weeks post intervention. Assessors were blinded to allocation and intervention content. Data from 159 residents at final follow-up were analysed by intention to treat. Quality of life, cognition, dependency declined; challenging behaviour increased; and symptoms of depression and anxiety reduced significantly in both groups. Multi level modelling, adjusted for baseline, found no significant differences between groups on the primary outcome (quality of life) or other outcome measures. Conclusion: Compliance to the intervention programme varied, so not all residents received enhanced activity provision. Homes with strong management commitment reported better quality of life for their residents. Future studies should consider alternative implementation and programme fidelity strategies, and more sensitive outcome measures to fully capture the potential impact of occupational therapy interventions.
|Title:||Occupational therapy and people with dementia in care homes|
|Additional information:||Authorisation for digitisation not received|
|UCL classification:||UCL > School of Life and Medical Sciences > Faculty of Brain Sciences > Division of Psychiatry|
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