Analysis

Advancing care of residents in care homes

The National Institute for Health Research wants to change the way care is delivered to 416,000 older residents living in care homes in the UK. 
Care home

The National Institute for Health Research wants to change the way care is delivered to 416,000 older residents living in care homes in the UK

There are more than twice as many people living in care homes in the UK than there are inpatients in NHS hospitals, yet there is much less research about how to provide the best care for these 416,000 residents.

The National Institute for Health Research (NIHR) is attempting to change that by funding a number of different studies and has now pulled together what has been learned over the past decade.

Its review, Advancing Care Research with

...

The National Institute for Health Research wants to change the way care is delivered to 416,000 older residents living in care homes in the UK

There are more than twice as many people living in care homes in the UK than there are inpatients in NHS hospitals, yet there is much less research about how to provide the best care for these 416,000 residents.


Family-style, rather than pre-plated, meals are a suggestion for improving care quality in care homes 
Picture: Alamy

The National Institute for Health Research (NIHR) is attempting to change that by funding a number of different studies – and has now pulled together what has been learned over the past decade.

Its review, Advancing Care – Research with Care Homes, looks at three themes:

  • Living well by maintaining good health.
  • Ageing well by managing chronic conditions and illness.
  • Dying well by providing good end of life care.

The review acknowledges that residents' care is becoming evermore challenging. The average age of residents is 85, with a life expectancy of between 12 and 30 months and multiple diagnoses, one of which is likely to be dementia.

One nurse-led study found that care homes were relying on up to 15 different services, from district nurses and opticians to continence services and community psychiatric nurses. The researchers concluded that building good working relationships between the NHS and social care is paramount.

19,000

independently owned care homes in the UK

Source: NIHR

British Geriatrics Society nurses and allied health professionals council vice chair Esther Clift agrees.

‘Things are moving forward with the vanguard programmes, but we need to go further,’ she says. ‘All staff working with older people should have some of their training in a care home. That would help build a better understanding and develop relationships immediately.’

Individual recommendations

But the review, which looked at 44 different studies, 21 of which are still ongoing, also made detailed recommendations about individual elements of care.

Report co-author Kristina Staley says the evidence is still emerging in many areas, but the NIHR, which has traditionally focused on the NHS, is keen to do more on social care.

‘A lot of good practice is already happening in care homes, but without an evidence base.

‘We need to better share what we already know in terms of what works and what conditions make the best outcomes most likely.’

Findings

So what has the review found? In terms of maintaining good health, ensuring residents are well nourished, stay hydrated, active and socialise is essential.

But with approximately 70% of residents living with dementia, anxiety and stress at mealtimes are a risk. Studies suggest playing music, particularly piano pieces and bird and whale songs at a volume that can just be heard, can help.

Replacing pre-plated meals with ‘family-style’ meals where food is placed on the table and served to people could also help.

18%

of people dying in England each year die in a care home

Source: NIHR

In terms of better supporting people with dementia more broadly, the review recommends reducing the use of antipsychotic drugs, although it acknowledges that more needs to be done to establish what alternative support should be used.

More training for staff to manage people with agitation and delirium would certainly help.

A wider range of treatments also needs to be considered to deal with pain, which studies suggest eight in ten residents experience. Paracetamol and, for more severe pain, opioid patches tend to be used.

Staff also need more help dealing with incontinence as dementia can mean alternative approaches may need to be considered, according to one study.

‘The challenge for us is finding a way to meet everyone’s needs at the same time’

Joyce Pinfield

Regular eye tests and reviewing medication regimens are also important. One of the most common medication errors is residents continuing to take drugs they no longer need.

There also needs to be more focus on preventing sudden worsening of health for those with chronic conditions, such as chronic obstructive pulmonary disease or congestive cardiac failure.

End of life care

The review also makes recommendations for end of life care. After hospital, care homes are the most common environment in which people die. It recommends extra training for staff, more use of advance care planning and engaging and collaborating with relatives about the end of life. Greater support is also needed from the NHS as the review noted it can be difficult for a GP to visit, particularly out of hours.

Care home owner and National Care Association board member Joyce Pinfield says: ‘The challenge for us is finding a way to meet everyone’s needs at the same time.’

7 in 10

people in care homes have dementia

Source: NIHR

For example, she says that while playing music at mealtimes might be helpful for some residents, these kind of interventions ‘won’t work for everyone’.

‘Research needs to recognise that every resident is different,’ she adds.

RCN professional lead for older people and dementia care Dawne Garrett says she is hopeful research in this area will grow, describing the review as a ‘mark in the sand’.

‘We now need more. I would like to see an emphasis on outcomes as well as the descriptive research included here. We need the whole sector to get involved so we can innovate. Only by gathering the evidence can we ensure care consistently improves.’

Dementia and incontinence

There needs to be more consideration given to the effect of dementia on faecal incontinence (FI), research suggests.

A nurse-led review by the University of Hertfordshire concludes there is ‘limited value’ in focusing solely on FI or one possible cause of FI such as constipation as care home residents are likely to be doubly incontinent.

Instead, lead researcher Claire Goodman (pictured) says care homes need to investigate how an individual’s dementia may affect continence.

‘They may not recognise the need to go to the toilet, not be able to find it, or be too frail to go. These things need to be considered in addition to what we know about treating FI. But it is often the most junior staff that provide personal care. They need support,’ she says.

 

Further information

National Institute for Health Research (2017) Advancing Care Research with care homes. NIHR Dissemination Centre 


Nick Evans is a freelance health writer 

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