Research & Development

There are many ways to get involved with research, at Oxford Health NHS Foundation Trust

Improving wellbeing and health for people with dementia

Aims of WHELD

Improving Wellbeing and Health for People with Dementia (WHELD) was a 5 year NIHR funded programme which aimed to develop and evaluate an intervention based upon the most effective, currently available therapies. The intended outcome of the programme was to develop an intervention which provides a broad range of benefits to people with dementia living in care homes. Specifically, WHELD aimed to;

Improve mental health & quality of life
Improve the quality of prescription of antipsychotic drugs
Reduce agitation for people with dementia in care homes

The WHELD study developed a training programme for care for care home staff, based on person-centred care and a range of non-drug approaches such as social interaction.

How has WHELD made a difference?

Care home staff who participated in the WHELD programme reveal what a difference it made to the well-being of the people they cared for, and the way it gave a new richness to their work:

What has WHELD achieved

Three systematic reviews;

To identify the existing evidence for effective psychosocial treatments for people with dementia who experience behavioural and psychiatric symptoms of dementia
To understand what factors influence staff working in care homes in using psychological and social interventions in practice
To identify training materials which are evidence based and effective in improving outcomes for people with dementia in care homes

Adaptation of the most effective approaches to make an optimised intervention applicable to UK care home settings
Completion of two randomised control trials to evaluate the WHELD intervention, the first with 277 people and 16 care homes and the second with over a thousand people and 69 care homes.

Results from WHELD

Oxford Health NHS Foundation Trust reports on the findings from WHELD;

WHELD training

Information about the WHELD intervention has been shared through a programme of workshops, written communications and road-shows with health professionals, care professionals and commissioners to promote widespread use of the intervention. An e-learning module for GPs has been created and best practice guidance for GPs has been updated. The intervention was selected as case example of good practice at the Making the Case for Social Sciences event held at the House of Commons in 2016 – Improving skilled care means less medication.

Useful resources

Publications

Ballard C, et al Impact of person-centred care training and person-centred activities on quality of life, agitation and antipsychotic use in people with dementia living in nursing homes: A cluster-randomized controlled trial of the WHELD intervention. PLoS Med 2018 Ballard C, et al. Impact of Antipsychotic Review and Nonpharmacological Intervention on Antipsychotic Use, Neuropsychiatric Symptoms, and Mortality in People with Dementia Living in Nursing Homes: A Factorial Cluster-Randomized Controlled Trial by the Well-Being and Health for People with Dementia (WHELD) Program. The American journal of psychiatry 2016 Fossey J, et al. “We should see her like part of the team”: an investigation into care home staff’s experiences of being part of an RCT of a complex psychosocial intervention. Aging & Mental Health, DOI: 10.1080/13607863.2018.1525603 Fossey J, et al. A qualitative analysis of trainer/coach experiences of changing care home practice in the Well-being and Health in Dementia (WHELD) randomised control trial, Dementia 2018 Fossey J, et al. The disconnect between evidence and practice: a systematic review of person-centred interventions and training manuals for care home staff working with people with dementia. International journal of geriatric psychiatry 2014 Garrod L, Fossey J & Ballard C. The WHELD programme: showing the benefits. Journal of Dementia Care 2019 Lawrence V, et al. Helping staff to implement psychosocial interventions in care homes: augmenting existing practices and meeting needs for support. International journal of geriatric psychiatry 2016 Lawrence V et al. Improving quality of life for people with dementia in care homes: making psychosocial interventions work. The British Journal of Psychiatry: The Journal of Mental Science 2012 Romeo R, et al. 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. Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association 2018 Testad I, et al. The value of personalized psychosocial interventions to address behavioural and psychological symptoms in people with dementia living in care home settings: a systematic review. International Psychogeriatrics 2014

Project funding

This project was funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research Programme (grant: RPPG-0608-10133). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. NIHR | National Institute for Health Research