Over 600,000 older people in the UK have dementia, and many end up in hospital or care homes because their families cannot manage crises at home. This five-year programme tests four practical, non-drug approaches to keep people with dementia living at home longer and with a better quality of life. The problem is that many psychosocial interventions—like cognitive stimulation therapy, joint reminiscence groups, and peer carer mentoring—have never been rigorously tested or widely implemented. Without solid evidence, health services cannot know which approaches work, for whom, or whether they save money. If successful, this research could change how dementia care is delivered across the NHS and social care. Maintenance cognitive stimulation therapy might delay care home admissions as effectively as dementia drugs. A home treatment team for crises could prevent unnecessary hospital stays. Training former carers to mentor new ones could reduce carer burnout. Each project includes an economic evaluation, so funders will know whether these interventions are cost-effective enough to roll out nationally. The result would be fewer emergency admissions, less strain on families, and more people with dementia supported to stay in their own homes.
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AimThe aim of this applied research programme is to prevent excess disability, promote social inclusion, improve health outcomes, and enhance the quality of life for people with dementia and their carers. The aim will be achieved by a rigorous 5 year programme of psychosocial research building on existing work by the applicant team; in cognitive stimulation, reminiscence work, and carer support, and also by a new initiative developing intensive home support to manage crises at home, and prevent admission to hospital for people with dementia.BackgroundIn the UK over 600,000 older people have dementia resulting in progressive cognitive deterioration, increasing disability and social exclusion. This has an enormous social and economic impact on health and social care services, and on family carers. There are many psychosocial interventions for dementia but often these have not been standardised, adequately evaluated or systematically implemented. CST is an evidenced based approach which has been shown to be both beneficial to cognitive function and quality of life, and also cost-effective. Since the degree of cognitive benefit from CST is similar to cholinesterase inhibitors, longer term CST may have an impact on admissions to long term care. Reminiscence work with people with dementia taps into early memories and encourages communication and wellbeing and a recent meta-analysis indicates that involving people with dementia and their carers is more effective than working only with carers. Our trial platform successfully developed a manual for joint reminiscence (RYCT) and suggests that RYCT improves the caring relationship and benefits both. Our experience from the BECCA programme showed many ex-carers are motivated to support others at an earlier stage in their role as a family carer through mentoring and teaching. There is some evidence that home treatment teams may reduce admissions for people with dementia however better evidence for their effectiveness is required before wider implementation is considered. This research programme will provide essential evidence to clarify the role of each of these interventions in: helping to support people at home, reducing hospital and care home admissions; and improving the quality of life for people with dementia and their carers. Research PlanProject 1: will develop, evaluate, and implement a training package and carry out a multicentre RCT of Maintenance Cognitive Stimulation Therapy for people with dementia. Project 2 will develop, evaluate and implement a training programme for reminiscence groups (RYCT) for people with dementia and their carers. Project 3 will develop, evaluate and implement a training package to train ex-carers to be ‘Expert Carers’ who will then mentor and train new carers of people with dementia. This will include an exploratory trial and a full RCT comparing the Expert Carer programme with RYCT separately and together vs usual care. Project 4 will develop a evaluate and implement a home treatment approach to intensively support and manage people with dementia experiencing crises at home, and prevent admissions to hospital or care homes. Each project will include an economic evaluation.Research Team Applicants: Professor Martin Orrell, Professor Bob Woods, Professor Ian Russell (Statistician/Trials Advisor), Professor Martin Knapp, (Health Economist) Professor Esme Moniz Cook, Professor David Challis, Dr Georgina Charlesworth, Judy Wilson (Chief Executive –NELMHT). The applicants have substantial expertise in psychosocial research and have recruited over 1000 people with dementia into such studies in last 5 years. In addition the application benefits from close links with Dementia Services Development Centres in London, Wales and North West England. Research Environment: NELMHT covers 4 boroughs in North East London with a catchment of approximately 9299 have dementia. It has a strong R&D Department, 3 well established memory clinics, and is a member of the No
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