Rapaport, Penny; (2018) Development of an evidence-based intervention to improve agitation for people with dementia in care homes. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Background Agitation is common, persistent and distressing and can lead to care home admission. There is a paucity of evidence for the sustained effects of interventions to manage agitation and little is known about how care home staff understand and respond to residents’ agitation. Aim To co-produce and initially test the feasibility and acceptability of the MARQUE (Managing Agitation and Raising Quality of Life) intervention, an evidence-based, manualised training intervention to reduce agitation. Methods I conducted a systematic review of effective components of psychosocial interventions delivered by care home staff to people with dementia and a qualitative study of care home staff experiences of caring for agitated residents. I integrated these findings with additional stakeholder involvement, co-producing the intervention. I conducted a mixed methods feasibility and process evaluation in one home. Results Care home staff experienced agitation as diverse, unpredictable and persistent and tried to prevent agitation from emerging and manage episodes once they occurred. Responding to agitation was not a linear process and staff faced dilemmas when attempts to respond to residents’ needs were inhibited by structural and procedural constraints. I co-produced a manualised training intervention with a system of on-going support to reduce agitation in people living with dementia in care homes. I successfully recruited and retained staff and residents with dementia and delivered the intervention to eligible staff in the care home. Conclusions To ensure sustainability and maximise implementation, I developed an intervention to support staff to identify and respond to resident unmet needs, to look after themselves and to minimise the impact of agitation, building upon the approaches and strategies already being used by care home staff. In initial testing, I found that the co-produced MARQUE intervention was feasible to deliver, acceptable to staff and ready for testing in a randomised controlled trial (RCT).

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