Ritchard Ledgerd Clinical Researcher. United KingdomNorway 33,383 occupational therapists3,756 occupational therapists Number of OT’s per 10,000 head.

Ritchard Ledgerd

Clinical Researcher

United Kingdom Norway

33,383 occupational therapists 3,756 occupational therapists

Number of OT’s per 10,000 head of population = 5

Number of OT’s per 10,000 head of population = 8

70% work in jobs funded by the government 95% work in jobs funded by the government

30 universities offering 60 education programmes

6 universities offering 6 education programmes

All programmes WFOT Approved All programmes WFOT Approved

72% join their national occupational therapy association

91% join their national occupational therapy association

92% female 91% female

National Health Service (public) no charge Health Service no charge

Average life expectancyMale =79.5Female = 82.5

Average life expectancyMale = 79.4Female = 83.4

Number of people with dementia set to double by 2040

Number of people with dementia set to double by 2040

General overview of health & social care provision in the UK

Community Health Services(Intermediate Care)

Hospitals - Physical(Acute)

Social Services/CareIncluding 6 weeks reablement

General Practitioners(Primary Care)

Community Mental Health Services (Intermediate Care)

Hospitals - Psychiatric(Acute)

Costs of care in 2008:£10.5 billion on dementia £4.5 billion on cancer£2.7 billion on stroke£2.3 billion on coronary heart disease

Approximately 1.5 billion hours of unpaid care is provided to people living in the community through informal care equating to £12 billion a year.

(Comma-Herra et al., 2007).

Costs of care

Quality Standards in Dementia (National Institute for Clinical Excellence, 2010)Covers the care provided by health and social care staff in direct contact with people with dementia in hospital, community, home-based, group care, residential or specialist care settings

UK Policy and Strategy Documents

National Dementia Strategy (Department of Health, 2009)Ensure better knowledge about dementia and reduce stigmaEnsure early diagnosis support and treatmentDevelop services to meet peoples needs better17 objectives

UK Policy and Strategy Documents

Improving Dementia Services in England (National Audit Office, 2010)Report on the National Dementia Strategy

Dementia Commissioning Pack (Department of Health, 2011)Provides practical resources for health and social care commissioners to work together to improve the quality of both specialist dementia services and general health and care services for people with dementia and their carers

The Prime Minister’s challenge on dementia (Department of Health, 2012)There are 3 dementia challenge champion groups: driving improvements in health and care, creating dementia friendly communities and improving dementia research

Care plans should always include an assessment and care-planning advice regarding ADLs, and ADL skill training from an occupational therapist

Guideline on supporting people with dementia and their carers in health and social care

National Clinical Practice Guideline Number 42 (2006)

Providing 10 sessions of occupational therapy to those with dementia over 5 weeks improves functioning and reduces burden on the care giver. Effects remain significant after 3 months (Graff et al 2008).

Postponing entry into residential care by just one year through adapting peoples home saves £28,080 per person (Allen et al 2010).

Evaluations from local telecare interventions reveal savings around emergency hospital and residential care admissions i.e. £85,837 as a result of saved bed days (Bowes et al 2006).

British Association/College of Occupational Therapists

Centre for Evidence Based Medicine www.cebm.net

Centre for Health Evidence www.cche.net

Critical Appraisal Skills Programme http://www.casp-uk.net/

Database of Abstracts of Reviews of Effects(DARE) http://www.crd.york.ac.uk/crdweb/

Trip Database http://www.tripdatabase.com/

Examples of useful websites

Research funding

In 2012 pledge to double funding for dementia research to over £66 million (688,865,752 NOK) by 2015. £13 million (135,685,678) for social sciences research on dementia.

£36 million (375,819,776 NOK) over 5 years for a new National Institute for Health Research (NIHR) to pull discoveries into real benefits for patients.

In December 2013, the UK Government hosted a G8 summit on dementia

Committed to identify a cure or a disease-modifying therapy for dementia by 2025 and to increase the amount of funding for dementia research.

Dementia Services in the United Kingdom

Memory Services

Replaced Day Hospital Services Multidisciplinary

Diagnosis and Assessment4-6 weeks from referral

Variation in delivery of services

Role of the occupational therapist

People have access to personally tailored occupational therapy to assist them with their occupational and functional needs and to help maintain their health and wellbeing, independence and community living

Dementia Services in the United Kingdom

Community Mental Health

Teams

Multi-disciplinary including social care and Admiral Nurses

Care coordination and generic working

Functional and organic diagnosis

Complex and enduring mental health needs

Core mental health assessment and duty rota

Variation - access and staff

Role of the occupational therapist

Crisis Teams

Usually doctors, nurses,occupational therapists and support workers

Intensive time limited support at home

Functional and organic diagnosisVariation and access

Role of the occupational therapistRapid response

Dementia Services in the United Kingdom

Community Groups

Dementia Services in the United Kingdom

Inpatient Units

Care Homes

National research studies

CBT and Anxiety in Dementia

Dementia and Physical Activity (DAPA)

Prevalence of Visual Impairment and

Dementia (ProViDe)

Facilitating Early Diagnosis – Dementia

(FED-D)

Promoting Independence in Dementia (PRIDE)

Carer Supporter Programme (CSP)

Remembering Yesterday Caring Today (RYCT)

Home Treatment Programme

Valuing Active Life in Dementia (VALID)

Cognitive Stimulation Therapy/Maintenance/

Individual

National research studies

Background

• Researchers in The Netherlands developed a Community Occupational Therapy in Dementia Programme (COTiD) for people with mild to moderate dementia and their family carers (Graff et al., 2006)

• Ten x 1 hour sessions of home based occupational therapy.• COTiD improved the person with dementia’s ability to carry out activities,

quality of life and mood

• Carers quality of life, mood and sense of competence also improved

• The effect sizes of all primary outcomes were higher than those found in trials of drugs or other psychosocial interventions and still present at 3/12

• Cost effective, total mean costs £1279 (13,321 NOK) lower in intervention group

COTiD-UKAim

The VALID programme aims to adapt, develop, evaluate and implement an occupation based intervention (COTiD-UK) which will promote independence, meaningful activity and quality of life for people with dementia and

their family carers living in the community.

CommunityOccupationalTherapyinDementia -UK

Hypotheses:1. COTiD-UK will significantly improve Activities of Daily Living (ADL)

abilities in people with dementia2. COTiD-UK will significantly improve quality of life of people with

dementia and their family carers3. The Programme will demonstrate cost effectiveness

Intervention & Manual Development

Next Stages

• Pilot Study – 3 sites (October 2014 – January 2015)25 dyads control group25 dyads in treatment group

• Randomised Controlled Trial (February 2015 – Dec 2015)

240 dyads in control group240 in treatment group

More information

www.ucl.ac.uk/valid