title: Providing activity for people with dementia in care homes: a cluster randomised controlled trial.
abstract: BACKGROUND
  Activity levels remain low in care homes, but activity engagement can enhance residents' quality of life.
  
  
  OBJECTIVE
  This study aimed to assess an occupational therapy programme designed to enable care home staff to increase activity provision.
  
  
  METHODS
  A cluster randomised controlled trial with blinded assessment of outcome was conducted. A total of 210 residents with dementia in 16 care homes were recruited. Intervention homes received the programme, and control homes were provided usual care. Primary outcome is quality of life; secondary measures are dependency, challenging behaviour, depression, anxiety, severity of dementia and number and type of medication.
  
  
  RESULTS
  Quality of life decreased overall with statistically significant change in staff ratings (p < 0.001). At follow-up, staff-rated quality of life was slightly lower in the intervention group (mean difference in staff ratings = -1.91, 95% CI -3.39 to -0.43, p = 0.01). There were no significant differences between the two groups for self-rated quality of life or secondary outcomes.
  
  
  CONCLUSIONS
  The results may be related to the following: wide variability in how the intervention was implemented, such as low staff attendance at the education and coaching sessions, and patchy provision of additional activities to residents; or the residents' severity of dementia or the choice of outcome measures. Future studies need to pay more attention to process measures such as implementation and fidelity strategies, and outcome measures that better capture the focus of the intervention such as level of engagement and activity.
authors: UCL Mental Health Sciences Unit, University College London, London, UK; Dementia Research Centre, North East London NHS Foundation Trust, UK.
authors: Jennifer
authors: J
authors: Wenborn
authors: David
authors: D
authors: Challis
authors: Jenny
authors: J
authors: Head
authors: Claudia
authors: C
authors: Miranda-Castillo
authors: Carolyn
authors: C
authors: Popham
authors: Ruchi
authors: R
authors: Thakur
authors: Jacqueline
authors: J
authors: Illes
authors: Martin
authors: M
authors: Orrell
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D016000:Cluster Analysis; D003704:Dementia / Q000523:psychology; D005260:Female; D006282:Health Personnel / Q000193:education*; D006801:Humans; D008297:Male; D001523:Mental Disorders; D009735:Nursing Homes / Q000592:standards*; D009788:Occupational Therapy; D011788:Quality of Life
keywords: activity; care homes; dementia; occupational therapy; older people