A nurse helping an older woman in a care home setting

Wellbeing and Health for People with Dementia (WHELD)

The Wellbeing and Health for People with Dementia (WHELD) study was a randomised controlled trial in 16 care homes examining non-pharmacological interventions for people with dementia. The interventions tested were a person-centred care training programme for care home staff, used alone or in combination with a social interaction package, an exercise programme or a structured antipsychotic review process. These interventions were based on person-centred care, personhood in dementia, personalized care planning and problem-solving theory. The aim was to develop and test a realistic approach to care for use in care homes, which improves key symptoms and quality of life of residents.

The trial demonstrated that the combination of person-centred care training, social intervention and antipsychotic review can reduce antipsychotic use and improve quality of life without worsening neuropsychiatric symptoms such as agitation and aggression. These interventions also resulted in a 30% reduction in mortality, which is statistically significant. These findings provide a clear indication that these programmes are effective when used in care homes.

We have recently completed an randomised controlled trial of more than a 1000 people with dementia in 70 care homes to evaluate the efficacy of this optimized intervention (person-centred care plus social interaction and antipsychotic review). This is the largest evaluation ever completed of a non-pharmacological intervention in people with dementia. Results are expected soon.

This study recruited care homes through the NIHR Maudsley Biomedical Research Centre (BRC) Care Home Research Network. This core infrastructure was critical to its success.

The work is now moving into a phase of dissemination to ensure the findings of this study are implemented in practice.  This includes running GP workshops and webinars (approved by the Royal College of General Practitioners), a British Medical Journal (BMJ) training module and an updated Department of Health / Alzheimer’s Society best practice guide for Behavioural and Psychological symptoms in dementia. We are updating national guidance on the management of behavioural symptoms, and we are also working with care homes to make sure that the final package of care is best suited to their needs.

This work is therefore moving into a space where people with dementia in care homes will experience a direct benefit, and care home staff will have better training and support for their caring role. Furthermore, by improving antipsychotic review this intervention has the potential to keep antipsychotic prescribing levels low, thus reducing costs and improving overall health of residents.