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Fund specialist dementia training to improve care and save money

GP and care home staff training could reduce agitation, improve lives and save thousands of pounds

Louise Prime

Tuesday, 20 November 2018

GP training to reduce antipsychotic prescribing and better training for care home staff on person-centred care help to reduce agitation in people with dementia and improve their quality of life – as well as saving thousands of pounds a year, UK research has shown. The authors of the UK study* published today in Alzheimer’s & Dementia: The Journal of the Alzheimer's Association said their results could aid commissioning decisions, and have urged the health and social care secretary to provide funding for such specialist training, which they said is crucial to providing good-quality dementia care.

The research team, from the University of Exeter, King’s College London and Oxford Health NHS Foundation Trust, studied the cost-effectiveness of an intervention conducted in 69 care homes, with a total of 549 residents suffering clinically significant agitation in dementia. They compared outcomes – including health and social care costs, agitation and quality of life – among people under usual care, to outcomes in those taking part in the Wellbeing and Health for people with Dementia (WHELD) training programme.

WHELD involved providing GP training to reduce prescribing levels of antipsychotics, as the drugs are known to significantly increase the risk of stroke and death in people with dementia. It also involved training two ‘carer champions’ from each care home in delivering person-centred care, involving residents in decisions that affect them, increasing social engagement to 10 minutes focused on their own interests; the study authors noted that previous research had revealed that the average care home resident engages in only two minutes’ social interaction in a six-hour period.

The researchers reported that compared with usual treatment, WHELD saved up to £4,000 per care home over the nine-month study, which meant savings of £2,000 per home even after considering the cost of delivering the intervention itself. Most of the savings were from reductions in emergency and routine hospital admissions and fewer GP contacts, resulting in part from a reduction in agitation.

The study authors also calculated that the WHELD programme cost £660 per resident to achieve significant improvements in their quality of life. They pointed out that when cholinesterase inhibitors were first approved for UK use, they cost about £35,000 to achieve similar measures of improvement. In comparison, the WHELD programme cost about £1,400 per resident to significantly improve agitation.

They commented: “We now know we have a programme that provides huge value in improving their quality of life and reducing agitation – and now crucially, we know this saves money… We must roll this out to benefit those in need.”

They added: “As a person’s dementia progresses they will need more intensive care and support and often residential care is seen as the best option by those who care for them. Our research can assist commissioning decisions around care and treatment options in these settings… The failure to recognise and introduce such interventions in not only ethically questionable but very costly.”

The Alzheimer’s Society argued that as 70% of people in care homes have dementia, it is essential for staff to have the right training to provide good quality dementia care. The charity’s policy director Sally Copley commented: “With many care homes on the brink of collapse and the NHS under pressure, cost-efficient initiatives like WHELD could make all the difference.

“But specialist training costs money, so without government investment in social care to allow innovative solutions like WHELD to be put in practice, it won’t be possible to provide this for everyone who needs it. I urge Matt Hancock to take bold steps in the forthcoming Green Paper and commit to the sustainable social care funding that people with dementia have already waited too long for.”

*Romeo R, Zala D, Knapp M, 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; published online 20 November. DOI:10.1016/j.jalz.2018.08.010.

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