Evidence-Based Supported Digital Intervention for Improving Wellbeing and Health of people living in Care Homes (WHELD) During COVID-19

Lead Research Organisation: UNIVERSITY OF EXETER
Department Name: Institute of Health Research

Abstract

The COVID-19 crisis is severely affecting care staff and the 400,000 older people living in care homes. Care home residents include the frailest members of society, many with dementia, mental and physical health symptoms. Care home staff are finding it challenging to provide support in these times and they face an increasingly difficult and distressing work environment. We urgently need to support care staff and provide the best environment possible for care home residents. Our care home training (WHELD) has shown benefits in two large clinical trials; and we have also demonstrated benefits from a digital version, incorporating virtual supervision in a new trial. We will optimise this programme by adapting it for the COVID crisis, to include peer networking and solution sharing. This will add to the person-centred approach, enhanced activities and reduction in sedative medications that the current WHELD programme already achieves. This digital intervention with virtual supervision will be available to 160 care homes within 4 weeks. We will further improve eWHELD based on benefits, feedback and barriers to implementation, make it available to almost 1500 care homes during the programme and ensure that it is ready to roll out to all UK care homes.

Technical Summary

The 400,000 people living in care homes and those caring for them are severely impacted by the COVID-19 crisis. The residents are the frailest members of society, many with dementia, mental health/neuropsychiatric symptoms and/or concurrent physical illnesses. Providing support for these individuals is challenging for care staff who are facing a difficult, distressing and isolated work environment. We urgently need to support care staff and provide the best environment possible for care home residents. We developed a care home training intervention which improved quality of life, mental health and reduced sedative drug use across two large clinical trials in the NIHR WHELD programme. Subsequently we have evaluated and demonstrated benefits from a digital version of WHELD with virtual supervision. We will provide an adapted version of this programme to almost 1500 care homes. We will first develop specific adaptations for the COVID-19 crisis, such as peer networking and solution sharing, alongside evidence-based elements focussing on person-centred care, personalised activities, and reduction of unnecessary sedative medications. We will implement the optimized digital intervention in 160 care homes within four weeks, including virtual supervision. We will evaluate outcomes relating to staff mental health and attitudes, and resident quality of life, attainment of care goals, and use of sedative medications, and examine facilitators of and barriers to effective implementation. Building on the findings we will evaluate efficacy and cost-effectiveness in 1280 care homes using a randomized delayed start design. We will then make the programme "implementation ready" for national care home roll-out.
 
Description The COVID WHELD study successfully recruited 739 care home residents with dementia across 149 care homes into an RCT during the COVID 19 pandemic. The programme was well received by care homes, with high levels of engagement and conferred significant benefits in improving quality of life and reducing the use of sedative medications without worsening agitation in participants/car homes receiving the I WHELD person centred care digital intervention with virtual coaching compared to treatment as usual over 16 weeks.

The baseline data also demonstrated a concerning increase in the use of antipsychotic medications (with known harms including stroke and death for people with dementia) in people with dementia living in care homes compared to pre-pandemic levels.
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The paper regarding the increased use of antipsychotic medication has been published (and included in this ResearchFish return). We are currently writing up study papers from the RCT, and the main findings have been presented as oral presentations at 2 major international conferences (AAIC, CTAD). Philanthropic funding has been secured for a pilot implementation phase to begin roll out.
Exploitation Route The data regarding the increase in the use of antipsychotic medications for people with dementia living in care homes will have important implications for policy.

The successful delivery of the study highlights a novel digital approach that can be used to support recruitment, undertake consents and complete many of the study assessments - and potentially provides an infra-structure that can be utilized by academic and commercial collaborators.

The main findings demonstrating the benefits of the digitalized iWHELD training programme with virtual coaching, provides an opportunity for the roll-out of an effective, evidence based and affordable programme to support skills development, improved care and improved quality of life for care home residents with dementia.
Sectors Digital/Communication/Information Technologies (including Software),Education,Healthcare

 
Description We were able to contribute evidence from the study to the All Party Parliamentary group for dementia in their consideration of residential and nursing home care for older individuals.
First Year Of Impact 2022
Sector Digital/Communication/Information Technologies (including Software),Healthcare
Impact Types Policy & public services

 
Description NIHR ARCs National Priority Area in Healthy Ageing, Dementia and Frailty
Amount £464,427 (GBP)
Organisation National Institute for Health Research 
Sector Public
Country United Kingdom
Start 08/2021 
End 02/2023
 
Title Capture of research process data through WHELD digital coaching platform 
Description Capture of research process data through WHELD digital coaching platform 
Type Of Material Technology assay or reagent 
Year Produced 2021 
Provided To Others? No  
Impact Efficient collection of research data for the WHELD RCT 
 
Title WHELD digital coaching platform with virtual coaching support 
Description WHELD digital coaching platform with virtual coaching support 
IP Reference  
Protection Trade Mark
Year Protection Granted 2021
Licensed No
Impact Still at the stage of RCT
 
Title WHELD digital platform and virtual coaching 
Description WHELD digital coaching platform with virtual coaching support 
Type Health and Social Care Services
Current Stage Of Development Late clinical evaluation
Year Development Stage Completed 2022
Development Status Under active development/distribution
Clinical Trial? Yes
Impact Improvement in staff skills and knowledge 
URL http://www.wheld.org
 
Title iWHELD digital learning platform 
Description The iWHELD programme has 3 main components Interactive digital learning, peer support and virtual coaching. The first 2 components have been developed and optimized with co-creation from stakeholders. They are available to participating care homes through an online link and as an APP. 
Type Of Technology Webtool/Application 
Year Produced 2022 
Impact The product has so far just been evaluated as part of the RCT supported by the UKRI funding. Further impacts will hopefully become more evident over the next 12-24 months. 
 
Description Expert Stakeholder engagement with 40 to optimise co-creation of platform 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Review of Field testing of materials leading to further recommendations by expert group
Year(s) Of Engagement Activity 2020,2021
URL http://www.wheld.org
 
Description Stakeholder engagement with 160 participating care homes to optimise co-creation of platform 
Form Of Engagement Activity Engagement focused website, blog or social media channel
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Field testing of materials and engagement through website and focus group interviews
Year(s) Of Engagement Activity 2020,2021
URL http://www.wheld.org