Assessing the mental health needs of older people
Riordan J M & Bennett A V (1998) An evaluation of an augmented domiciliary service to older people with dementia and their carers Aging and Mental Health 2 (2) pp.137-143
Aims and method
This study aimed to discover if providing practical and emotional support to people with dementia and their main carer would make a significant impact on their ability to copy at home.
19 matched pairs of people with dementia and their carers from one local authority in NE London were studied over 2 years. The study group received the new Dementia Support Service (DSS), a more flexible and specialist domiciliary dementia service, while the control had traditional support (home care, day care and meals on wheels). The principal carer did not necessarily live with the client. It was not a randomised controlled study.
The domiciliary DSS was characterised by flexibility and continuity of care to meet the changing needs of carer and client. Specially trained care assistant staff delivered the service for 3 days a week on average, including weekends. Practical, emotional and social support was offered.
The principal service activities for the client centred on protecting their safety, bathing and hygiene, toileting, dressing, getting out of bed and helping with general mobility. There was minimal involvement in medication and feeding. 'General companionship' was the most frequently recorded category of social care, characterised by outings and dealing with the fears and anxieties of clients. A range of age appropriate activities were undertaken, including gardening, simple construction tasks and reminiscence work.
Carers needed information from the care assistants. The social and emotional care given included providing support during a crisis or substituting directly for the carer to offer respite. Providing company for the carer was also an important aspect of social support.
There was a significant difference in admission to long-term care between the 2 groups at the 6-month follow-up. Nearly twice as many clients from the DSS group were still living at home after 6 months. At 12 months twice as many clients from the control group had been admitted to long-term care. At 18-months the outlook for both groups was similar, with no significant differences in outcome.
No statistical significance could be found for differences between the functional and mental ability of clients in the different groups.
Carer satisfaction ratings for the DSS were uniformly high at 6-month follow-up with maximum scores for 'respectful treatment' and 'benefit to client and carer'. At 12-months ratings relating to appropriate and easily obtainable service had dropped slightly, but all other ratings remained the same, including replication of the maximum scores at 6-months.
Although the study design has flaws it generated some useful findings.
Families in receipt of the Dementia Support Service were able to support their relative with dementia at home for up to a year longer than those receiving traditional home support services.
Care assistants had different patterns of activity to that provided by a traditional home help, having fewer domestic than personal care tasks, and a distinct number of social and emotional support tasks undertaken with both client and carer. The constancy and companionship offered strongly influenced the high carer satisfaction ratings.
Well targeted and modestly augmented home support services for people with dementia and their carers can have a significant effect in enabling people with dementia to live in their own homes for longer.