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Background and study aims 250,000 people with dementia in the UK live in care homes. These individuals have complex mental health problems, disabilities and social needs, which are made worse by widespread prescription of sedative drugs. The inconsistent quality of care, the poor management of mental health problems and the widespread overuse of sedative drugs are matters for serious concern. The launch of the National Dementia Strategy (2009) and a parallel Department of Health report (2009) regarding the use of sedative drugs provides an opportunity to move forward on a national basis to provide a better trained workforce that can improve the mental health of people with dementia living in care homes and reduce the use of sedative drugs. The main goal of the WHELD programme is to develop an effective, simple and practical programme (intervention), which improves the mental health of, and reduces sedative drug use in, people with dementia in care homes; which can be rolled out nationally. This study will determine the most effective elements of existing approaches. This will be achieved by training care staff to provide care that is focused on an understanding of the individual and their needs; and by using additional elements such as exercise, activities and social interaction to improve mental health, reduce the use of sedative drugs and improve quality of life. The interventions studied will be Person Centred Care training either alone or in combination with Antipsychotic Review, Exercise and Social Interaction. The main aim of the study is to determine whether the combination of Person Centred Care and Antipsychotic Review results in the reduction of antipsychotic prescribing and improvement of participant outcomes compared to Person Centred Care training alone. The secondary objective is to establish the specific impact of each therapy (Antipsychotic Review, Social Intervention and Pleasant Activities, Exercise) in addition to Person Centred Care training on a range of outcomes including: mental health; psychotropic drug use; physical health; and quality of life. We also aim to determine the impact on potentially important mediating factors such as: activities; social interactions; staff attitudes; and the quality of the interaction between care staff and people with dementia. The findings from this study will be used to develop the programme further for a larger study. Who can participate? All individuals with dementia living in the care homes participating in the study, aged between 40 and 120 years, will be invited to participate. Individuals for whom consent has not been obtained will not be included in the study. What does the study involve? This study will be conducted in 16 care homes recruited into the study across Oxfordshire, Buckinghamshire, North & South London. A minimum of 12 participants from each care home will be recruited into the study. Data will be collected on all consenting residents who meet the inclusion criteria at each participating care home. Each care home will receive a randomly allocated intervention for 9 months. Evaluations will be undertaken to understand the breadth of benefits conferred by the 3 key interventions to be assessed when used in addition to the Person Centred Care training package, which has already been shown to work. The interventions involve the following: • Person Centred Care: This intervention uses best practice guidelines to improve care. It provides ways of reviewing and adapting individual residents’ care to ensure that it reflects their needs and choices and includes elements of leadership training and approaches that address common team concerns about change. • Antipsychotic Review: This involves a specific review of antipsychotic drugs based on expert opinion and guidelines. Ideas for assessment and alternative approaches are also included. • Social Interaction: This intervention aims to develop skills and techniques amongst the care team for delivering individual and group activities to enhance interactions between staff and residents. • Exercise: This intervention aims to promote exercise through encouraging enjoyable positive activities that involve exercise, through implementing exercise plans, which are realistic and appropriate to residents’ level of dementia, and designed to increase balance, strength, endurance and flexibility. What are the possible benefits and risks of participating? Participants will receive benefits as a result of training of care staff. There are minimal risks or burdens for participants. Where is the study run from? Oxford Health NHS Foundation Trust and King’s College London. When is the study starting and how long is it expected to run for? The study started in August 2011 and ended in November 2012, running for 16 months Who is funding the study? National Institute for Health Research (NIHR) Who is the main contact? Professor Clive Ballard, Wolfson Centre for Age Related Diseases, King’s College London

Inclusion criteria

• Dementia

Links

• isrctn
• ictrp