Home Care Setting Research Articles

Clinical efficacy and satisfaction of a digital wheeze detector in a multicentre randomised controlled trial: the WheezeScan study.

Wheezing is common in preschool children and its clinical assessment often challenging for caretakers. This study aims to evaluate the impact of a novel digital wheeze detector (WheezeScan™) on disease control in a home care setting. A multicentre randomised open-label controlled trial was conducted in Berlin, Istanbul and London. Participants aged 4-84 months with a doctor's diagnosis of recurrent wheezing in the past 12 months were included. While the control group followed usual care, the intervention group received the WheezeScan™ for at-home use for 120 days. Parents completed questionnaires regarding their child's respiratory symptoms, disease-related and parental quality of life, and caretaker self-efficacy at baseline (T0), 90 days (T1) and 4 months (T2). A total of 167 children, with a mean±sd age of 3.2±1.6 years, were enrolled in the study (intervention group n=87; control group n=80). There was no statistically significant difference in wheeze control assessed by TRACK (mean difference 3.8, 95% CI -2.3-9.9; p=0.2) at T1 between treatment groups (primary outcome). Children's and parental quality of life and parental self-efficacy were comparable between both groups at T1. The evaluation of device usability and perception showed that parents found it useful. In the current study population, the wheeze detector did not show significant impact on the home management of preschool wheezing. Hence, further research is needed to better understand how the perception and usage behaviour may influence the clinical impact of a digital support.

Amputation-free Home Management of Infected Lower Extremity Pressure Ulcer through Shared Decision-making: Enhancing the Quality of Life and Highlighting Societal Significance in Home Care.

Home healthcare is important for allowing patients to live their lives. However, home-care bedridden patients often experience pressure ulcers in the lower extremities, which can lead to life-threatening infections requiring decisions on the need for amputation. We herein report a patient with an infected lower-limb pressure ulcer with a history of spinal injury. The patient, his family, and the home-care physician repeatedly shared decision-making to deliver home-based treatment instead of amputation. Administration of wound dressing, AQUACEL® Ag, led to complete epithelialization. Such shared decision-making and dressing were feasible in a home-care setting and broadened its scope.

Understanding interaction in problematic dementia and social care encounters: Protocol for a micro-level study combining video-ethnography and Conversation Analysis (CA).

It is well established that the actions and behaviour of dementia care workers are fundamental to the wellbeing of the people they care for. Not only do they deal with basic healthcare needs, but they also perform a vital psycho-social function by providing-through their regular presence-an underlying continuity for residents. This has been shown to improve well-being, particularly for those in the advanced stages of dementia. It has also been suggested that there are additional psycho-social benefits of such contact which can directly influence the need for anti-psychotic medication. However, unlike most other healthcare and medical settings, the specialised and often difficult interactions that dementia care workers handle every day have not yet been the subject of detailed micro-level analysis. This is particularly significant because much of the impact that care-workers have relates to the way in which they interact with the people they care for. Not having a clear understanding of how their interactions 'work' at the micro-level-particularly ones that are specific to dementia care settings, and that care workers report to be difficult or challenging-means that any training interventions that are developed may not resonate with their real-world experience, and ultimately run the risk of failing. This video-based observational study aims to provide a detailed micro-exploration of problematic and challenging interactions involving care-workers and people living with dementia. The study is based in the UK and will involve up to 20 dementia care staff and 60 people living with dementia. Fieldwork will be conducted in 5 dementia care home and community-based dementia day care settings using naturalistic observational methods (primarily video-ethnography). Data will be analysed using Conversation Analysis (CA).

Nursing activities for health promotion in palliative home care: an integrative review

Palliative care in community contexts is undergoing significant change as a result of public policy and new models of care, which link health promotion principles with palliative care practices. These models support the creation of partnerships between formal care structures and the communities in which care is provided. Given the central role of nurses in the institutional delivery of palliative care, particularly in the home, it is important to provide a systematic description of the activities of nurses that fall within the principles of health promotion. The objective was to describe the diverse range of nursing activities for health promotion that are provided in the palliative home care setting. This is an integrative review. Fifty-five studies listed in the MEDLINE, CINAHL and EMBASE databases, and published between 1999 and December 2022, were identified. Data analysis and presentation of the results were guided by Kellehear’s Health-Promoting Palliative Care (HPPC) model. Six themes were identified to describe nursing activities for health promotion in the context of palliative home care: creating a meaningful relationship, supplying medical information, promoting self-care throughout the trajectory, providing emotional support, involving professional or community services and supporting change. The findings point to nurses focusing more on the individual context and on direct care. The relationship with communities in which they work remains unidirectional. However, some HPPC principles are relevant to nursing activities through the contextualization of nurses’ actions and their moral responsibility to work towards the respect of patient’s values. Being poorly described, how nurses can truly engage their practice towards health-promoting principles, such as the enhancement of support and control over their lives for people living with serious illness, still requires further empirical research.

Demanding yet supportive and developing: Nurse preceptors’ experiences of peer learning in nursing education in municipal elderly care homes

Nursing students commonly engage in clinical education in municipal elderly healthcare. Therefore, it is important to use a pedagogical model that provides the best conditions for nursing students to develop clinical competence. The aim of this study was to describe and interpret nurse preceptors’ experiences of a newly implemented pedagogical model, peer learning, in municipal elderly care home settings. Nine registered nurses from elderly care homes with precepting experience participated. Data were collected through individual interviews, and a thematic content analysis was performed. The study followed the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist. The findings revealed four sub-themes: ‘requiring careful preparation’; ‘contributing control and trust in the learning process’; ‘changing perspectives brings new opportunities and challenges’; and ‘enabling students to believe in themselves’, all interpreted into the main theme of ‘demanding yet supportive and developing’. In conclusion, municipal elderly care homes seemed to be a learning environment well suited for using the peer learning pedagogical model.

IA model for the creation of automatic and personalized health literacy plans for home care services and protocol for its validation

Background: Health Literacy (HL) is considered a social determinant of health with a direct and significant impact on health-related quality of life, especially in groups of elderly, polymedicated or chronically ill persons. According to the WHO, HL implies achieving a level of knowledge, personal skills and confidence that allows the adoption of measures to improve health through a change in lifestyle. It is a concept that combines elements of health and education. HL is the result of health education. In fact, a poor understanding of health recommendations or instructions is related to poor disease self-management and limited use of preventive resources. Furthermore, a low level of HL translates into an increase in (a) avoidable hospitalizations, (b) healthcare costs and (c) mortality rates. Artificial intelligence (AI) can help create personalized HL plans for each patient automatically. Moreover, thanks to digital education platforms these plans can be delivered and monitored remotely and digitally, reducing the resource of professional hours. The application of AI in health literacy is especially interesting in home health services, where the resources of professionals are scarce and care falls mainly on the family and the patient him/herself.
 Aim: The aim of this study is to develop an IA model for the creation of automatic and personalized HL plans for home care settings that can be consumed by families through a digital tool. The protocol for validation of the HL plans created by the model is also presented.
 Method: At the beginning, (1) a comprehensive geriatric assessment is performed that identifies the needs and capabilities of the care ecosystem (patient-caregiver) in a model of comprehensive person-centered care in the home care setting. (2) After analysis of the data collected in the assessment using validated diagnostic algorithms the IA model automatically generates an individualized training itinerary HL plan adapted to each user profile. (3) Using nursing indicators defined in the NNN taxonomy (NANDA, NOC, NIC) we measure at the beginning and at the end of the HL plan: (a) the knowledge acquired; (b) the change in behavior/behavior and (c) objective results of the health status.
 Main Results: We present an AI model for automated and scalable HL plan creation for home care settings. This model has the potential to improve the HL of the 65+ population (chronicity, complexity, multi-pathology, dependency, frailty, pre-frailty or autonomy) and their informal caregiving ecosystem (non-professional caregivers) in the home setting, especially if long-term care is present. The learning programs created for the HL plan were carried out under a rigorous protocol based on criteria of accessibility and scientific evidence.
 Conclusions: Thanks to the protocol, it will be possible to validate the impact of the HL plans created by the IA model on both the patient and the caregiver. The IA model is currently in the process of validation but shows promising results in reducing the time spent on direct intervention by professionals and improving the population's accessibility to HL plans thanks to the IA model.

Reablement for the new generation elderly in the Netherlands, a personalised integrated care approach.

Introduction: The new generation elderly, the babyboomers, expect that elderly-care reflects their need to remain independent. In general elderly are perceived as inactive and vulnerable with negative outcomes on quality of care. However babyboomers don’t identify themselves as elderly and they have a higher level of self-efficacy. An elderly-care organisation in a medium-sized town in the Netherlands, strived for a suitable care design, that meets expectations of babyboomers and wanted to know how this care design could be implemented in the local setting.
 Theory/methods: The implementation Framework for Aged Care, developed by Meyers (1), was applied to a practice-oriented trajectory design. This framework is a fit-for-purpose implementation framework in the local social, cultural and economic context. The applied methodologies were literature research, desk and field research, which resulted in problem-clarification, an intervention design and an implementation advice. 
 Results: Self-efficacy and self-reliance are determinants which influence the measure of independence of babyboomers. Therefore it is necessary for elderly-care to give attention to the increasing independence needs of babyboomers. Literature states that reablement is an effective intervention which increases independence by influencing self-efficacy and self-reliance. Reablement is a time-bound (six to twelve weeks) interdisciplinary, intensive and person- and goal orientated intervention in the homecare setting, delivered by trained staff (2). Homecare staff is not yet trained in the current situation to work from a perspective that increases independence. Therefore a training programme and reablement trajectory was developed based on literature. This training program focusses on changing behavioural determinants of homecare staff by using social influence from peers. Babyboomers can only be empowered to increase self-efficacy and self-reliance if homecare staff believes they contribute to this independence. The Implementation strategy was mainly oriented on the adoption of reablement, since this is a condition of success of reablement. 
 Discussion: There is a risk of using untrained staff in reablement which may have negative outcomes on independence. Homecare staff can feel devalued as they perceive part of their care-role ‘to care for’ instead of ‘to care that’. 
 Conclusions: By influencing the determinants of homecare staff and babyboomers, reablement shows to be effective by focusing on increasing independence of babyboomers. After a training programme which uses the social influence of peers, reablement can be implemented in the local context.
 Lessons learned: How we perceive elderly has an influence on the outcome and organisation of elderly care. Scandinavian research shows that reablement can be an intervention with positive societal effects on care in general and the prevailing paradigm of getting older.

ORGANIZATIONAL READINESS FOR A VIRTUAL REALITY TRAINING PROGRAM CALLED BE EPIC-VR

Abstract An essential first step to implementing virtual reality programming in home care and long-term care settings is to assess organizational readiness by determining factors that enhance the likelihood of its successful implementation. Be EPIC-VR is one such virtual reality program that supports dementia-specific, person-centered communication training for frontline healthcare workers. Guided by the Consolidated Framework for Implementation Research (CFIR), the current study aimed to identify factors influencing Be EPIC-VR’s implementation in home care and long-term care settings. Semi-structured interviews were conducted with nine managers from home care and long-term care settings in Canada. Transcripts from these interviews were analyzed using the Framework Analysis’ five-step ongoing, iterative process: familiarization, identifying a thematic framework, indexing, charting, and mapping/interpretation. Textual data were open-coded and organized deductively (using CFIR’s pre-set codes) and inductively (for emergent codes) into themes and subthemes. Four themes emerged as factors contributing to organizational readiness including 1) openness to virtual reality as a training tool, 2) staffing and training logistics, 3) organizational culture supporting staff development, and 4) external pressures for organizational sustainability. These findings will guide how the Be EPIC-VR implementation team collaborates with organizational decision makers to ensure that Be EPIC-VR is a good fit for those organizations, to prepare for its implementation, and to optimize the likelihood of success. The study findings offer valuable insights for researchers and practitioners working to implement new virtual reality interventions in home care and long-term care settings.

CLINICAL NOTES AND CARE COORDINATION CALLS AS IMPORTANT PREDICTORS OF EMERGENCY CARE UTILIZATION IN HOME HEALTH CARE

Abstract Home care patients experience a high illness burden and a heightened risk of negative health outcomes. There is a need to understand how clinician behaviors, including notetaking and care coordination activities, can be better integrated into risk modelling in home care settings. This study predicted hospitalization/ED visits using data from 86,866 home care episodes from an agency in the Northeastern United States. We began our analysis with nearly 200 variables, including patient-related factors (e.g., comorbidities, types of medications taken, functional status), and factors relating to clinician behavior, such as problems documented in clinical notes, and calling patterns to the patient or medical care providers. We used least absolute shrinkage and selection operator (LASSO) to aid in the selection of the best subset of variables. In our preliminary analysis, we found that two clinician behavior-related factors were the strongest risk factors for experiencing hospitalization/ED visits, specifically the proportion of concerning notes generated during the care episode (OR 8.97, 95% CI 7.64, 10.52), and a measure reflecting frequent calls to the patient’s family (OR 4.51, 95% CI 3.80, 5.37). Clinician documentation of specific problems, and the clinician’s decision to conduct a medication review were also risk factors. Patient risk factors included prior hospitalization, health conditions such as cancer and renal disease), functional limitations, certain medication classes (e.g., anticoagulants, diuretics), the use of oxygen, and the use of a urinary catheter. This study demonstrates that clinician behaviors and documentation patterns can be incorporated in risk models to yield important insights.

DAILY ENGAGEMENT IN MEANINGFUL ACTIVITY FOR HOME CARE PATIENTS WITH SUBJECTIVE COGNITIVE DECLINE AND CAREGIVERS

Abstract Patients with subject cognitive decline (SCD) often lose sense of control, disengage from meaningful activities, and have less confidence in their ability to manage daily challenges. The objectives of pragmatic pilot phase study were to evaluate the feasibility and benefits of a Daily Engagement in Meaningful Activity Professional (DEMA-Pro) for patients with SCD; and explore nurses’ experience of DEMA-Pro implementation. Forty-nine patients at four home healthcare sites received six weekly DEMA-Pro telephone sessions. The Outcome and Assessment Information Set-D were collected at starting date (pre-intervention) and discharge date (post-intervention). Quantitative surveys and qualitative focus group methods were used to explore the DEMA-Pro nurses (n = 3) experiences. The consent rate was 67.1%, the completed intervention rate 36.7%, and the partial completed intervention rate 25.5%. For 36 subjects with discharge data available, both IADLs and self-care scores improved (d = 3.11 and d = 2.66, respectively). Specifically, those that completed all DEMA-Pro sessions (n=14), partial completers (n=12), and non-completers (n=10), had improved scores on IADLs (d = 4.0, 4.2, and 2.5, respectively) and Self-Care (d = 3.7, 3.1 and 2.0, respectively). Completers had greater improvement than non-Completers for both outcomes and greater improvement on IADLs than partial completers (all p-values < 0.03). Nurses reported high satisfaction with their training, and high confidence that the implementation of the intervention met patient and caregiver needs. The DEMA-Pro has shown benefits and feasibility that will need further testing in a large pragmatic trial in homecare settings.

DEVELOPING A TOUCHSCREEN COMMUNICATION DEVICE TO EMPOWER PEOPLE WITH DEMENTIA AND THEIR CAREGIVERS

Abstract People living with dementia (PLWD) often experience communication deficits that create frustration and challenges to caregiving and clinical care for this population. It also constrains person-centered care. To address communication challenges, an interdisciplinary team developed a mobile communication app that promotes communication by PLWDs about their daily care preferences and experiences. This app, My Person Assisted Touchscreen Interface (My PATI), empowers PLWDs and their caregivers by supporting communication with a fully-customizable platform. This platform allows the PLWD to express preferences for daily activities, such as preferred foods and clothing options. It also enables the PLWD to express their experiences relevant to symptoms of pain, depression, and sleep quality. This presentation will describe a multi-phase Quality Implementation Framework that the research team has applied in developing My PATI to maximize its potential for being adopted into the home and residential care settings and used by multiple caregivers. The presentation will include the My PATI implementation video and foundational research: qualitative interviews with PLWDs, caregivers of PLWD, alpha and beta testing with dyads of caregivers and PLWDs, and extensive assessment and development planning with clinicians, geriatric researchers, computer scientists, and a graphic artist to inform My PATI functions and design. The presentation will also describe the designs of future pilot testing and randomized control trial studies that are planned for 2024.

BRIDGING RESEARCH TO PRACTICE: PRO-HOME EMPOWERS CARE PARTNERS TO PROMOTE EXERCISE IN HOME CARE

Abstract Regular physical activity (PA) benefits people of all ages. Mounting scientific evidence shows PA’s health benefits in older persons with chronic conditions. However, there remains a large research-to-practice gap in PA, especially in long-term services and supports (LTSS). Older adults who need help with basic daily activities, such as walking or standing, continue to face barriers at multiple levels of LTSS to become and remain physically active. This symposium will address the much-debated research-to-practice gaps, focusing on frail community-dwelling older adults in the context of a NIA-funded clinical trial. “Promoting Seniors’ Health with Home Care Aides (Pro-Home)” tests the effectiveness of a gentle, low-intensity PA program delivered by home care aides (HCAs) for community-dwelling older adults with nursing-home eligible care needs in real-world home care settings. Pro-Home is innovative because it empowers direct care workers (HCAs) with an easy-to-learn toolkit to deliver the program and keep their older clients motivated. The symposium starts with an overview of Pro-Home (Muramatsu), barriers and facilitators of Pro-Home at multiple levels of the LTSS system (Cruz Madrid), followed by Pro-Home’s critical elements: of research and practice: client-HCA dyad relationships and partnerships with stakeholders (Hu), in-home assessment of motor function in frail older adults (Yin), and inter-professional co-learning (Skowronski). The symposium concludes with a dialogue with the audience to identify actionable policy and practice strategies for building research-to-practice and practice-to-research bridges to build health promotion into LTSS to promote the well-being of older adults with disabilities and their care partners.

BE EPIC-VR: TRANSLATING AN IN-PERSON, PERSON-CENTERED COMMUNICATION TRAINING PROGRAM INTO VIRTUAL REALITY

Abstract Be EPIC is a dementia-specific, person-centered communication training program for frontline healthcare workers that uses simulations with trained actors, reflection, and feedback. Scaling Be EPIC is limited by resource and methodology demands of recruiting and training actors and consistency of delivery across sites. Virtual reality (VR) is a promising solution to the problem of scaling Be EPIC because it provides interactive, realistic, and consistent simulations. However, there is limited research on implementing VR to train frontline healthcare workers. Guided by the Consolidated Framework for Implementation Research, the current study used an effectiveness-implementation hybrid design to compare simulation experiences of Be EPIC-VR with Be EPIC-in person and real-world clinical encounters. The study also explored factors that can influence the future implementation of Be EPIC-VR in long-term care home settings during the pre-implementation period. Six frontline healthcare workers who completed the Be EPIC in-person version with trained actors also completed the same assessment simulation in VR, followed by an interview. Thematic analyses revealed two themes that contributed to the simulation’s realism: the immersive nature of the virtual environment and the accuracy of the avatar’s visual, verbal, and behavioral characteristics. Moreover, the factors influencing the successful implementation of VR simulations in long-term care home settings include sufficient technological infrastructure and workplace personnel who can assist with Be EPIC-VR implementation. The findings highlight the potential to scale Be EPIC using VR and provides insights into the iterative process involved in translating an in-person training into a VR training program.

Exploring the Holistic Needs of People Living with Cancer in Care Homes: An Integrative Review.

Up to 26% of individuals residing in care homes are impacted by cancer. This underscores the importance of understanding the holistic needs of care home residents living with cancer to enhance the quality of their care. The primary objective of this integrative literature review was to consolidate the available evidence concerning the comprehensive needs of people living with cancer in care home settings, providing valuable insights into addressing their diverse needs. An integrative literature review was conducted using a systematic approach. Extensive searches were conducted in three databases, complemented by a thorough examination of grey literature and reference lists of relevant papers. The review focused on literature published between 2012 and 2022. The screening process involved two independent reviewers, with a third reviewer resolving any discrepancies. The review identified twenty research papers that met the eligibility criteria. These papers shed light on three primary themes related to the holistic needs of care home residents with cancer: physical, psychological, and end-of-life needs. Physical needs encompassed pain management, symptom control, and nutrition, while psychological needs involved social support, emotional well-being, and mental health care. End-of-life needs addressed end-of-life care and advance care planning. These themes highlight the multifaceted nature of cancer care in care homes and underscore the importance of addressing residents' holistic needs in a comprehensive and integrated manner. Improving care home education about cancer and integrating palliative and hospice services within this setting are vital for addressing the diverse needs of residents with cancer.

Supporting care home agency and bank staff

Adrian Ashurst discusses the importance of supporting agency and bank staff in a care home setting.

Psychosocial Well-Being of Siblings of Pediatric Patients in Palliative Home Care.

Despite the proposed high burden of siblings of children and adolescents with life-limiting conditions receiving pediatric palliative care (PPC) at home, little is known about their psychosocial well-being. In this prospective, cross-sectional trial siblings of patients of a large pediatric palliative home care team were asked to answer the KINDL survey of health-related quality of life, the strengths and difficulties questionnaire (SDQ) to assess problems and resources of children and adolescents as well as the LARES questionnaire, a potential tool for early screening of distress in siblings of chronically ill children. The results of the KINDL total and subdomains as well of the SDQ-subdomains were compared to recent German normative data using multiple t-tests. In total, 44 siblings (28 female; age 7-18 years, mean 11.8 ± 3.03) of 29 families participated in this study. The subgroup which matches the age range of current normative data of 11-17 years old siblings (n=25) reported a significant lower total quality of life as measured by KINDL in comparison to normative data. Subscale analyses revealed a significant lower physical and psychological well-being and self-esteem. Siblings of PPC patients yielded significant higher scores in the subdomain prosocial behavior compared to normative data as measured by the SDQ. Siblings of children receiving PPC in a home care setting are at risk for a relevant impairment of their health-related quality of life. Future studies should address the potential for possible interventions specific for this population-at-risk.

Clinical Manifestations.

Delirium is common in elderly, frail residents in care home settings, who may already be suffering from dementia. The prevalence of delirium in nursing homes can be up to 60%. Care home staff are potentially in a unique position to identify the subtle changes that can precede a full-blown episode of delirium. Towards this aim, as a part of frailty initiative West Midlands, a delirium app, called 'Delirium Wheel' (https://rb.gy/ns80hw) was developed. In order to explore the feasibility of the Delirium Wheel (DW) app to support care home staff to care for patients experiencing delirium, a feasibility study was carried out between October 2022 to May 2023 in 6 care homes in Staffordshire. The care homes were given delirium app training and a survey was carried out to assess their baseline knowledge and skills in the identification and management of delirium. A further survey was carried out 12 weeks following the implementation of the app, with qualitative interviews carried out with a sample of the care home staff. The study is currently at Stage 1 of the data collection phase and the initial surveys have been collected evaluating baseline knowledge and practice within the care homes. Staff members have now been interviewed as part of Stage 2 of the study process, with the qualitative data currently being transcribed. The full results are expected to be reported by the end of April 2023. This study is the first research which formally tests this unique app as a digital tool to support healthcare professionals in the identification and management of a very common condition such as delirium. This empowers care home staff to have confidence in their own skills and have an app to support if there is any clinical uncertainty. As a result of this intervention, the probability of patient's being able to be managed within the care home setting increases, leading to better patient related outcomes.

Feasibility of Using Wearable Actigraphy for Behavioural Monitoring in Care Home Residents Living with Moderate to Severe Alzheimer’s Disease and Agitation

AbstractBackgroundMeasuring and monitoring behaviour is difficult in people living with later stage Alzheimer’s disease and specific behavioural symptoms such as agitation and aggression (AA). Currently, subjective information given by these patients is highly susceptible to inaccurate recall, clinicians rely on answers provided by care givers, which can be biased and lack fine‐grain temporal detail. Although actigraphy watches have been useful tools for research, little is known about the feasibility of their use in agitated dementia participants and on the factors influencing watch compliance.MethodPeople diagnosed with Alzheimer’s disease and significant AA symptoms living in care homes were asked to wear an actigraphy watch (GENEactiv Original) for 4 consecutive weeks. Demographic data, Functional Assessment Staging Tool (FAST) score, behavioural symptom pattern and severity were recorded using the Neuropsychiatric Inventory Nursing Home Version (NPI‐NH). Watch‐recorded wearing time and activity data were used to evaluate adherence. Care home staff were interviewed to explore factors influencing watch wearing by participants and to develop solutions to improve compliance.ResultWe recruited 28 participants (14 female) and found wearing the watch feasible overall. No statistical compliance difference was found between different groups based on age, FAST score, agitation pattern or severity; however, a significant gender difference was found with male participants being more adherent (Table). Participants were more compliant in weeks 3‐4, and first week adherence predicted overall adherence (Figure). Factors influencing compliance include the design and appearance of the watch, previous watch wearing habit, and the perceived purpose of the study. Using documents easily readable to participants and care givers to facilitate understanding of the study and to communicate challenging clinical scenarios appeared to enhance adherence.ConclusionWearing an actigraphy watch for behavioural monitoring was feasible for moderate to severe Alzheimer’s disease patients with AA symptoms in care home settings. Gender‐specific design and appearance should be considered when selecting the actigraphy watch. For dementia studies planning to use an actigraphy watch, compliance can be improved by incorporating a short lead‐in phase to establish a watch wearing routine and by providing reader‐friendly documents about the watch purpose to communicate with participants and care givers.

P188: Engagement and refusals of care: a naturalistic observation study of personal care interactions between caregivers and people with advanced dementia

Objective:Personal care interactions can provide important opportunities for caregivers to engage with a person living with advanced dementia but may also prove to be a difficult experience; why this so is not completely understood. We aimed to examine the person’s engagement and refusals of care in personal care interactions and identify both successful and difficult interpersonal dynamics to enable learning from each setting to inform educational resources.Methods:One-off video-recorded observations of personal care interactions between caregivers (care-home staff or family carers) and people with advanced dementia in the UK (total observation time 03:01:52). Observations were analysed using the Menoh Park Engagement Scale (MPES) (Camp et al., 2015) and the Resistance-to-Care scale (RTC-DAT) (Mahoney, 2015) to score 5-minute video sections, and inductively with qualitative content analysis.Results:Active engagement of people with dementia was observed in 66% of observations. Refusals of care were present in 32% of observation time. Generally, caregivers emanated a nurturing attentiveness and people with dementia were focused and engaged throughout care activities. Rare difficult interactional components were characterised by the person with dementia appearing to show uneasiness and caregivers being flustered and uncertain. However, caregivers from both family and care-home settings were predominantly attuned to the person and skilled in effortlessly supporting them through the care activity.Conclusions:Findings provide real-world empirical evidence which reenergises the concept of person-centredness in dementia care. Personal care activities typically created opportunities of engagement, rather than sites of conflict, for people with advanced dementia. The findings provide much needed insight into ways to improve care experiences for people with advanced dementia. Appropriate training/guidance for care-home staff and family carers could support more engaged and pleasurable care experiences for people with dementia.

A Pragmatic Pilot Phase Preliminary Results of Daily Engagement in Meaningful Activity Professional Program for home care patients with subjective cognitive decline

AbstractBackgroundA substantial number of home health older patients with subjective cognitive decline (SCD) require more time, structure, and guidance to complete tasks and adjust to new skills and environments, thereby presenting complex demands on home health services and caregivers. Without support, patients with SCD often lose their sense of control, have fewer personal choices, disengage from meaningful activities, and have less confidence in their ability to manage daily challenges and other chronic illness issues. Our multi‐component intervention titled, Daily Engagement in Meaningful Activities Professional (DEMA‐Pro) intervention was developed based on five preliminary studies shown to improve health outcomes and promote confidence in managing daily challenges in patients with SCD. The objectives of pragmatic pilot phase study were to 1) evaluate the feasibility and benefits of a DEMA‐Pro for patients with SCD; 2) explore nurses’ experience of DEMA‐Pro implementation.MethodWe used a one‐group, pre‐ and post‐intervention design and recruited 49 patients with SCD, aged 50+, from the four home healthcare sites to receive six weekly DEMA‐Pro telephone sessions. The Outcome and Assessment Information Set D (OASIS‐D) were collected at starting date (pre‐intervention) and discharge date (post‐intervention). Quantitative surveys and qualitative focus group methods were used to explore the DEMA‐Pro nurses (n = 3) experiences of implementation.ResultThe consent rate was 67.1%, the completed intervention rate 36.7%, and the partial completed intervention rate 25.5%. For 36 subjects with discharge data available, both IADLs and self‐care scores improved (d = 3.11 and d = 2.66, respectively). Specifically, those that completed all 6 DEMA‐Pro sessions (n = 14), partial completers (n = 12), and non‐completers (n = 10), had improved scores on IADLs (d = 4.0, 4.2, and 2.5, respectively) and Self‐Care (d = 3.7, 3.1 and 2.0, respectively). Completers had greater improvement than non‐Completers for both outcomes and greater improvement on IADLs than partial completers (all p‐values < 0.03). Nurses reported high satisfaction with their training, and high confidence that the implementation of the intervention met patient and caregiver needs.ConclusionThe DEMA‐Pro has shown benefits and feasibility that will need further testing in a large pragmatic trial in homecare settings.