Systematic policy and evidence review to consider how dementia education and training is best delivered in the social care workforce, and how policy does or can enable its implementation in England

Systematic policy and evidence review to consider how dementia education and training is best delivered in the social care workforce, and how policy does or can enable its implementation in England | medRxiv /* */ /* */ <!-- <!-- /*! * yepnope1.5.4 * (c) WTFPL, GPLv2 */ (function(a,b,c){function d(a){return"[object Function]"==o.call(a)}function e(a){return"string"==typeof a}function f(){}function g(a){return!a||"loaded"==a||"complete"==a||"uninitialized"==a}function h(){var a=p.shift();q=1,a?a.t?m(function(){("c"==a.t?B.injectCss:B.injectJs)(a.s,0,a.a,a.x,a.e,1)},0):(a(),h()):q=0}function i(a,c,d,e,f,i,j){function k(b){if(!o&&g(l.readyState)&&(u.r=o=1,!q&&h(),l.onload=l.onreadystatechange=null,b)){"img"!=a&&m(function(){t.removeChild(l)},50);for(var d in y[c])y[c].hasOwnProperty(d)&&y[c][d].onload()}}var j=j||B.errorTimeout,l=b.createElement(a),o=0,r=0,u={t:d,s:c,e:f,a:i,x:j};1===y[c]&&(r=1,y[c]=[]),"object"==a?l.data=c:(l.src=c,l.type=a),l.width=l.height="0",l.onerror=l.onload=l.onreadystatechange=function(){k.call(this,r)},p.splice(e,0,u),"img"!=a&&(r||2===y[c]?(t.insertBefore(l,s?null:n),m(k,j)):y[c].push(l))}function j(a,b,c,d,f){return q=0,b=b||"j",e(a)?i("c"==b?v:u,a,b,this.i++,c,d,f):(p.splice(this.i++,0,a),1==p.length&&h()),this}function k(){var a=B;return a.loader={load:j,i:0},a}var l=b.documentElement,m=a.setTimeout,n=b.getElementsByTagName("script")[0],o={}.toString,p=[],q=0,r="MozAppearance"in l.style,s=r&&!!b.createRange().compareNode,t=s?l:n.parentNode,l=a.opera&&"[object Opera]"==o.call(a.opera),l=!!b.attachEvent&&!l,u=r?"object":l?"script":"img",v=l?"script":u,w=Array.isArray||function(a){return"[object Array]"==o.call(a)},x=[],y={},z={timeout:function(a,b){return b.length&&(a.timeout=b[0]),a}},A,B;B=function(a){function b(a){var a=a.split("!"),b=x.length,c=a.pop(),d=a.length,c={url:c,origUrl:c,prefixes:a},e,f,g;for(f=0;f<d;f++)g=a[f].split("="),(e=z[g.shift()])&&(c=e(c,g));for(f=0;f<b;f++)c=x[f](c);return c}function g(a,e,f,g,h){var i=b(a),j=i.autoCallback;i.url.split(".").pop().split("?").shift(),i.bypass||(e&&(e=d(e)?e:e[a]||e[g]||e[a.split("/").pop().split("?")[0]]),i.instead?i.instead(a,e,f,g,h):(y[i.url]?i.noexec=!0:y[i.url]=1,f.load(i.url,i.forceCSS||!i.forceJS&&"css"==i.url.split(".").pop().split("?").shift()?"c":c,i.noexec,i.attrs,i.timeout),(d(e)||d(j))&&f.load(function(){k(),e&&e(i.origUrl,h,g),j&&j(i.origUrl,h,g),y[i.url]=2})))}function h(a,b){function c(a,c){if(a){if(e(a))c||(j=function(){var a=[].slice.call(arguments);k.apply(this,a),l()}),g(a,j,b,0,h);else if(Object(a)===a)for(n in m=function(){var b=0,c;for(c in a)a.hasOwnProperty(c)&&b++;return b}(),a)a.hasOwnProperty(n)&&(!c&&!--m&&(d(j)?j=function(){var a=[].slice.call(arguments);k.apply(this,a),l()}:j[n]=function(a){return function(){var b=[].slice.call(arguments);a&&a.apply(this,b),l()}}(k[n])),g(a[n],j,b,n,h))}else!c&&l()}var h=!!a.test,i=a.load||a.both,j=a.callback||f,k=j,l=a.complete||f,m,n;c(h?a.yep:a.nope,!!i),i&&c(i)}var i,j,l=this.yepnope.loader;if(e(a))g(a,0,l,0);else if(w(a))for(i=0;i (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0];var j=d.createElement(s);var dl=l!='dataLayer'?'&l='+l:'';j.src='//www.googletagmanager.com/gtm.js?id='+i+dl;j.type='text/javascript';j.async=true;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-P4HH5NV'); Skip to main content Home About Submit ALERTS / RSS Search for this keyword Advanced Search Systematic policy and evidence review to consider how dementia education and training is best delivered in the social care workforce, and how policy does or can enable its implementation in England Saskia Delray , View ORCID Profile Sube Banerjee , View ORCID Profile Sedigheh Zabihi , Madeline Walpert , View ORCID Profile Karen Harrison-Dening , View ORCID Profile Charlotte Kenten , View ORCID Profile Yvonne Birks , Clarissa Giebel , Mohammed Akhlak Rauf , Sally Reynolds , View ORCID Profile Claudia Cooper DeNPRU-Queen Mary doi: https://doi.org/10.1101/2024.08.24.24312532 Saskia Delray 1 Queen Mary University of London Find this author on Google Scholar Find this author on PubMed Search for this author on this site Sube Banerjee 1 Queen Mary University of London Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Sube Banerjee Sedigheh Zabihi 1 Queen Mary University of London Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Sedigheh Zabihi Madeline Walpert 3 Dementia UK Find this author on Google Scholar Find this author on PubMed Search for this author on this site Karen Harrison-Dening 3 Dementia UK Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Karen Harrison-Dening Charlotte Kenten 1 Queen Mary University of London Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Charlotte Kenten Yvonne Birks 4 University of York Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Yvonne Birks Clarissa Giebel 5 University of Liverpool Find this author on Google Scholar Find this author on PubMed Search for this author on this site Mohammed Akhlak Rauf 6 Meri Yaadain Find this author on Google Scholar Find this author on PubMed Search for this author on this site Sally Reynolds 7 PPI representative Find this author on Google Scholar Find this author on PubMed Search for this author on this site Claudia Cooper 1 Queen Mary University of London Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Claudia Cooper For correspondence: claudia.cooper{at}qmul.ac.uk Abstract Full Text Info/History Metrics Data/Code Preview PDF Abstract Background Very many social care clients have dementia, but few social care workers receive dementia-specific training. Objective To systematically review dementia training interventions for social care, review past policies and hold stakeholder workshops considering how future policy can support quality dementia training in social care. Methods We searched electronic databases, November 2015 to February 2024, including studies describing dementia training and support interventions for social care workers, assessing risk of bias with the Mixed Methods Appraisal Tool. We reviewed English policies January 2015 to April 2024 to identify social and policy contexts relevant to dementia training. We consulted home care and care home stakeholders regarding how findings could inform future policy. Results We included 56 studies (50 in care homes, 6 in home care). There was good quality evidence that dementia training interventions in care homes that engaged staff “champions” to integrate practice-based learning reduced agitation, neuropsychiatric symptoms and antipsychotic prescribing and improved life quality of residents with dementia. One study found this approach was cost-effective. In home care, evidence was limited; group training was valued, and improved staff sense of dementia care competence in one study. We identified 27 policies and related documents; and consulted 18 stakeholders. Stakeholders supported mandatory dementia training but considered implementation very challenging in current economic contexts. Conclusions We found strong evidence for dementia training in care homes, but a relative lack of research in home care. Policy options identified to implement evidence require investment, which could deliver substantial savings across health and social care. Introduction Around 982,000 people in the UK live with dementia, often undiagnosed. Many require care which employs specific skills and knowledge ( 1 ). A million people work as care workers in UK social care ( 2 ). Nearly half of home care residents have significant cognitive impairment, a third have a dementia diagnosis ( 3 ) and over three-quarters of care home residents have dementia ( 4 ). Care workers are low-paid, often undervalued and expected to provide skilled care to people with dementia with little or no training ( 5 – 7 ). Dementia care should be personalised, enabling, inclusive and collaborative ( 8 , 9 ), but current provision is inconsistent in quality ( 5 ). We aimed to update a 2015 review of effectiveness of social care sector dementia training, which found most effective programmes comprised 12+ hours of training by experienced facilitators; were tailored to staff needs, included active participation, and underpinned practice-based learning with theory ( 10 ). This update is timely. The 2015 Dementia Training Standards Framework benchmarked training for the health and care workforce ( 11 ); benchmarks which contemporary provision mostly failed to meet ( 12 ). Developing an appropriately skilled social care workforce is a policy priority ( 13 ). The previous UK government planned to build upon the Care Certificate with a careers pathway and new qualifications ( 14 , 15 ). In July 2024, the new government announced long-term plans for a National Care Service underpinned by national standards, to deliver consistency of care ( 16 ). To inform future policy regarding dementia training for social care, we aimed to review policy and academic evidence, adapting a previous framework ( 17 ) to answer the following research questions: What is the social and policy context determining how dementia training is delivered to social care workers in England? What is the current evidence on how dementia training is best delivered to improve care quality and care worker wellbeing? How do stakeholders consider current evidence might inform future policies to positively change social care workforce training? Methods 1. Defining social and policy context This review was conducted within the NIHR Dementia and Neurodegeneration Policy Research Unit - at Queen Mary (DeNPRU-QM), overseen by a study group comprising: a psychiatrist, two social care academics, two lived experience members, two researchers and two senior nurses. We consulted the wider DeNPRU-QM group, and an external oversight group with policy and clinical expertise in November 2023. The study group agreed sources and terms to search policy and grey literature (from 2015) to respond to RQ1. SD and CC conducted the search (Supplementary Table 1a) using terms: “social” and “training” and “dementia” to identify potentially relevant documents. SD and CC independently identified documents in April 2024, then discussed those to include, based on relevance to the research question, consulting the study group iteratively. They tabulated findings, meeting regularly with the study group to discuss emerging data, and develop descriptions of contexts and problems as our empirical and conceptual understanding evolved during the review ( 17 ). 2. Systematic review of academic evidence We prospectively registered the review protocol [PROSPERO: CDR42024509026]. Search strategy and selection criteria We reviewed the following electronic databases from 01.12.15 (updating ( 10 )) to 20.02.2024: Pubmed, Embase, Scopus, CINAHL and the Cochrane library. We planned the search strategy around RQ2. Terms related to ‘education’/‘training’, ‘staff’, and ‘dementia’ were combined with the Boolean operators ‘AND’ and ‘OR’, linking search terms within concepts. Supplementary Table 1b outlines the Pubmed search; we developed similar strategies for other databases. We asked experts to identify unpublished studies. We included primary research (quantitative and/or qualitative) studies, in English, reporting the effectiveness of training/education interventions aiming to develop dementia-specific knowledge, values and skills to improve dementia care, delivered to social care workers in care home or home care settings. We excluded individual case studies, dissertations and meeting abstracts. Because our focus was on training to manage dementia symptoms, we excluded studies evaluating training limited to care for co-morbid conditions, or end-of-life care in the context of dementia rather than dementia symptom management. Data extraction Using Covidence software, two reviewers independently assessed potential studies against inclusion criteria, in an initial title and abstract screening, then full paper review, discussing divergences. Tables 1 - 2 show the data extracted. We used Kirkpatrick’s model to classify outcomes: learner’s reaction to/ satisfaction with training (Level 1); knowledge, skills, confidence, and attitudes (Level 2); staff behavior or practices (Level 3); client/staff wellbeing (Level 4)( 18 ). View this table: View inline View popup Download powerpoint Table 1: Characteristics of included studies based in home care View this table: View inline View popup Table 2: Characteristics of included studies based on care homes – studies meeting criteria for higher priority Analysis SD and CC independently assessed risk of bias of included studies using the Mixed Methods Appraisal Tool (MMAT)( 19 ). We calculated rater percentage agreement, then resolved discrepancies through discussion. We prioritised evidence from studies scoring 4+ on MMAT (indicating high quality), that were Randomised Controlled Trials (RCTs) (or implementation studies of interventions for which RCT evidence is published), which, in line with our aim to identify evidence that may inform future training programmes, reported a significant finding on a main outcome in a between-group comparison. We descriptively synthesised findings for care home and home care settings by Kirkpatrick’s levels ( 18 ). 3. Stakeholder consultation To answer RQ3, we held two workshops in April and June 2024 with (1) home care managers and workers and (2) care home workers and managers. We presented groups with findings in accessible formats (Supplementary Tables 5-6) and asked them to consider how evidence-supported interventions might be used to lever change to improve care quality and potential outcomes of any proposed policy changes. SD/CK synthesised the discussion and fed this back to attendees, inviting corrections or further comments. Results 1. Defining social and policy context We identified 27 relevant policy and related documents (Supplementary Table 8), from which our study group summarised key policies and contexts and problems to explore in stakeholder groups (RQ3) ( Figure 1 ). Identified documents advocated for quality training as an essential part of providing good quality ( 20 ), culturally competent ( 21 ), personalised dementia care ( 22 ) ( 23 ). The Dementia Core Skills Education and Training Framework delineates learning objectives for care workers; with 3 Tiers, Tier 2 the level expected of care workers and Tier 3 expected of managers and leaders ( 24 ). NICE dementia guidelines recommend in-person, case-based training encompassing strategies to reduce distress and antipsychotic use, promote freedom of movement, and have difficult conversations ( 25 ). Training expectations that new social care staff are expected to work towards completing in their first three months are operationalised through the Care Certificate ( 26 ), which two-thirds of care workers in England engage with; a qualification based on it ( 27 ) with funding for 37,000 care workers to enrol was developed by the previous government ( 28 ). Dementia training is not mandatory for social care workers ( 29 ), but the All-Party Parliamentary Group (APPG) for Dementia has called for Tier 2 training for care workers to be mandatory ( 30 ). A new Care Workforce Pathway ( 31 ), advocates leadership training for managers ( 32 ) ( 33 ). Training needs have been cited around digitisation (of care records) ( 34 )( 35 ) and wider digital skills ( 36 ). Health and social care integration implementation work has proposed greater cross-sector training, including support for extended roles in skills traditionally performed within healthcare ( 13 ). An integrated skills passport has been proposed across health and social care ( 15 ). Download figure Open in new tab Figure 1: Summary of evidence developed across stages of our review Care Quality Commission (CQC) inspections can drive quality improvement ( 37 ). Providers are private businesses facing recruitment (including international) and retention challenges ( 38 ) ( 39 ) and adverse economic conditions ( 40 ), but training could improve retention ( 41 ), care quality and help meet needs of informal carers for support ( 42 ). There are geographic and socioeconomic inequalities in resources with lower CQC ratings linked to fewer resources (likely including training) potentially due to fewer self-funded clients in care homes ( 43 ) ( 44 ). 2. Systematic review Search results (see PRISMA, Figure 2 ) We identified 5,939 studies in our electronic search and after screening 56 studies (6 in home care settings, 50 in care homes) met our inclusion criteria. Download figure Open in new tab Figure 2: PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) diagram of included and excluded studies. Description of studies 22/56 (39%) studies were rated 5/5 on the MMAT, the lowest risk of bias; thirteen were rated 4. Rater agreement was 90.7% (245/270) for MMAT items. Supplementary Table 2 shows MMAT ratings. Thirteen studies met our criteria for priority evidence (see methods for criteria). Home Care Studies (n=6; Table 1 ) Studies were conducted in Taiwan (n=2), Australia (n=1), England (n=2) and Japan (n=1). 4/6 studies rated as priority evidence, described four interventions. Level 4 evidence: In the Japanese Behaviour Analytics & Support Enhancement (BASE) program ( 45 ), care managers (social workers) and home care workers attended a two day training event with expert trainers. Home care workers used a web tool to identify client unmet needs and record behaviours that challenged; they sought other care workers’ views and organised interdisciplinary case conferences for included clients. The control group continued standard client support, including monthly meetings with care managers mandated by the Japanese Public Long Term Care Insurance Plan. In the primary analysis, challenging behaviour (Neuropsychiatric Inventory—Nursing Home version (NPI-NH)) reduced in the intervention (mean score: 18.3 to 11.2) relative to the control group at six months (11.6 to 10.8; P<0.05). Level 2 evidence: The Promoting Independence Through quality dementia Care at Home (PITCH) group training intervention delivered by an expert trainer, focused on valuing home care workers, and person-centred care skills ( 46 ). Delivery was in-person or, during the COVID-19 pandemic, online ( 47 ). In a stepped wedge RCT, the primary outcome, home care worker Sense of Competence in Dementia Scale (SCIDS) (F=4.48, p=0.04), and Dementia Attitudes Scale (DAS) and Dementia Knowledge Assessment Scales (DKAS) improved significantly in the intervention relative to control group. In the E-learning and Group Mentoring with Virtual Reality (EGM-VR) study, Sung ( 48 ) compared EGM with and without an hour of VR training. EGM involved eight, 15-minute interactive e-modules, monthly in-person mentoring in groups of 8-10, and social network app support. The VR condition immersed participants in perspectives of people living with dementia, with a facilitated 50-minute discussion. Over three months, DKAS (P<0.001), Approaches to Dementia Questionnaire (ADQ (P<0.001), the Jefferson Scale of Empathy (P=0.001) and SCIDS (p<0.001) scores increased in the EGM + VR relative to EGM only group. Level 1 evidence: A UK, RCT feasibility study evaluated six, interactive, manualised, one-hour, fortnightly group video-calls focused on valuing and supporting staff, developing communication skills, empathy with clients and strategies for managing behaviours that challenge, over three months with monthly catch-up group calls to discuss implementation. Intervention development drew on the PITCH intervention ( 47 ). The primary outcome was intervention feasibility and acceptability, with 65.9% of sessions attended. The average cost per agency of training provided was £1,606 ( 49 ). Evidence from studies rated as lower priority: Su ( 50 ) evaluated EGM alone, relative to usual care. DKAS, ADQ, SCIDS scores significantly improved in the intervention compared to control group. Kelleher published a qualitative pilot study, which like the feasibility RCT of the same intervention above, was found to be acceptable ( 51 ). Summary of Home Care evidence We found good quality evidence from single studies that two days of group, expert training, client behaviour monitoring and monthly case conferences were better than case conferences alone at reducing neuropsychiatric symptoms; six hours of group training with an expert trainer improved staff sense of competence, attitude, knowledge and empathy in dementia care. Care home Studies Higher priority Evidence (n=8/50 Table 2 ) Studies were conducted in the Netherlands (n=1), UK (n=1), USA (n=3), Australia (n=1), Canada (n=1) and Mexico (n=1) and evaluated six interventions. Level 4 evidence: A Dutch study compared usual training to a Stepwise Multicomponent Intervention (STA OP!) involving five, 3-hour meetings teaching step-wise management of behavioural symptoms of distress in people with severe dementia ( 52 ). This considered basic care needs, then pain and physical needs, affective needs, non-pharmacological comfort interventions, trials of analgesia and finally antipsychotic medication. Key messages were reiterated in team meetings, and a coordinator visited homes weekly and evaluated fidelity. This cluster RCT reported a significant reduction in agitation, the primary outcome in the intervention versus control (Cohen-Mansfield Agitation Inventory (CMAI) mean difference −4.07, 95% CI= −7.90 to −0.24, P=0.02), NPI-NH and depression scores. Though the intervention was intended to support all residents, in practice only a small proportion, likely those with most challenging behaviours were discussed. The UK WHELD intervention described a 9-month in-person training course in person-centred care, social interaction and antipsychotic medication reviews ( 53 ). An Occupational Therapist (1 per 9 nursing homes) visited staff and residents for 2 days and identified WHELD champions who received one day of training per month, to cascade training to staff, and guide implementation. The cluster RCT showed significant improvement in quality-of-life in the treatment versus control arm (DEMQOL-Proxy mean difference 2.54, 95% CI 0.81, 4.28). WHELD cost £8,627 more per nursing home to deliver compared to usual training, but client health and social care costs were lower in the intervention than usual training group. There were statistically significant benefits in agitation (CMAI) and NPI-NH, and positive care interactions. Intervention adherence was not reported. Three studies evaluated the US Staff Training in Assisted Living Residences (STAR) intervention, which reduced resident distress and challenging behaviours and increased staff job satisfaction over eight weeks in an earlier RCT ( 54 ). STAR involves a 3-day staff workshop in expectations, communication and managing distress behaviours in people with dementia, attended by staff champions who then cascade training to sites, supported through ongoing training to implement the approach. In implementation studies, weekly consultation video calls with the STAR team supported staff to apply learning. Mohr ( 55 ) found that over 6 months, STAR was associated with lower staff injury rates (b=-0.04, Standard Error (SE)=0.02, p=0.04). Curyto ( 55 ) and Karel ( 56 ) reported that over six years, STAR reduced distressed behaviour (DBID) (t test (t)= 12.9, P<0.001, Cohen’s d= 0.8), depression (CSDD) (t=14.0, P<0.001, d=0.8), anxiety (RAID) (t=13.4, P<0.001, d= 0.6) and CMAI-short form (CMAI_SF) (t=14.7, P<0.001, d= 0.9) scores. There was significant improvement in self-perceived staff confidence after the STAR-VA training and consultation compared to usual training ( 57 ). Level 3 evidence: Two studies tested interventions that sought to decrease antipsychotic prescribing. A six-month Australian program involved one hour of e-learning, then eight video conferences with a focus on medication audits and non-pharmacological strategies, delivered by Dementia Training Australia consultants to care home staff. In a cluster RCT, antipsychotic use was lower relative to the control group at six months (IRR, 0.56, 95% CI, 0.32-0.99; P=0.048), but not at 12 months ( 58 ). A five-month Canadian program, comprising a 90-minute in-person group staff training session with three subsequent, monthly interdisciplinary video calls, case-based discussions, to reduce inappropriate prescribing of antipsychotics in long-term care. There was a 16.1% relative reduction in the inappropriate antipsychotic prescribing rate (receiving antipsychotics without a diagnosis of psychosis) over 12 months (SD=2.8%, P< 0.0001) ( 59 ). Level 1 evidence: A Mexican feasibility RCT evaluated two days of on-site group staff training around understanding dementia, teamwork, and using psychosocial interventions with support to put learning into practice over 12 weeks. Medical staff attending care homes received training in antipsychotic reviews. Fidelity, acceptability and satisfaction scores were high ( 60 ). Summary of high priority evidence Three studies provided good quality evidence that training in person-centred care approaches reduced resident agitation and neuropsychiatric symptoms and improved quality of life. Methods to embed learning in team meetings and care included training and supporting staff champions, video-call case conferences with project experts, and project coordinator visits. In one study evaluating cost-effectiveness, WHELD cost £8,627 more than usual training; but was cost-effective from a health and social services perspective. Two studies provided good quality evidence that interventions comprising initial training, then video-conference case-based discussions reduced antipsychotic prescribing. Lower priority Evidence Low risk of bias RCTs reporting negative findings (n=3, Table 2 ) Surr ( 61 ) evaluated Dementia Care Mapping (DCM) training and three DCM cycles, the first supported by an expert. Livingston ( 62 ) evaluated six manualised interactive group sessions by a supervised graduate facilitator, then monthly supervision, alternating between a clinical psychologist and graduate facilitator. Neither study reported significantly improved clinical (agitation) or cost-effectiveness. Kinderman ( 63 ) evaluated a one-day staff training offer framed in a human-rights based tool, then three-monthly booster sessions and found no between-group difference in quality of life. Higher risk of bias-rated RCTs (n=9) (Supplementary Table 3) Two interventions involving up to 12 hours of expert training and group, case-based, discussion, reduced behavioural distress ( 64 , 65 ) and psychotropic prescribing ( 64 ). The CHAnging Talk staff education program (CHAT) ( 66 , 67 ) and CHAT Online (CHATO) ( 68 ) comprised of three, one-hour, group/online interactive training modules; they reduced ‘elderspeak’ and antipsychotic use compared to state averages ( 59 ); CHATO also improved staff communication ( 68 ). Digital WHELD (eWHELD), involved a two-month virtual coaching phase plus five 25-minute e-modules focusing on person-centred care. McDermid ( 69 ) compared eWHELD with and without virtual coaching. Resident wellbeing, positive activities, staff attitudes, staff hope and personhood, improved in the group receiving virtual coaching. Testad ( 70 ) evaluated a seven month intervention by research nurses, which did not reduce restraint use. A staff training for people with advanced dementia did not reduce unplanned hospital transfers, though low staff participation was reported. ( 71 ). Non-RCT evidence (n=30) (Supplementary Tables 4-5) We rated 19 non-RCT studies as high quality (Supplemental Table 3) and 11 as lower quality (Supplemental Table 4). We summarise here studies rated as low risk of bias, reporting effectiveness. Level 4: In-person interventions, involving group workshops focused on person-centred care, were associated with improvements in neuropsychiatric symptoms ( 72 ), agitation ( 73 ), fewer clinical symptoms ( 74 ), and with resident quality of life and reduced carer burden in a Canadian training program involving development of individualised communication plans ( 75 ). A German study found that a “train the trainer” communication intervention reduced resident depressive symptoms ( 76 ). Level 3: Hanson’s findings echoed those from RCT evidence, that with training, inappropriate antipsychotic prescribing reduced; cost per prescription avoided was $5,679 ( 77 ). Project ECO-AGE, was a US intervention involving online video case discussions with clinical experts bi-weekly, over 18 months. Residents in ECO-AGE facilities were 75% less likely to be physically restrained and 17% less likely to be prescribed antipsychotic medication compared to control facilities ( 78 ). Level 2: A Chinese programme, delivered face-to-face, weekly for eight weeks was associated with improvement in sense of competence in dementia care ( 79 , 80 ). Further studies showed significant improvements in staff knowledge following in-person training ( 79 )( 81 )( 82 )( 83 )( 84 )( 85 ). Level 1: Four studies reported good acceptability of interventions ( 86 , 87 ) ( 88 ) ( 89 ). 3. Stakeholder consultation We consulted 18 care managers and workers; meeting on 30.4.24 in-person with nine home care managers and workers from two franchises; and 25.6.24, online, with eight care home managers and workers from four organisations. Both groups raised the policy option of mandatory dementia training and concerns about implementing this without additional funding, referencing resource challenges delivering Oliver McGowan Mandatory training on learning disability and autism ( 90 ). Care workers pay and agency reimbursement for local authority clients were perceived as major barriers to implementing any training, though staff valued training opportunities. The home care group discussed how training could enhance retention and job satisfaction. When asked how evidence-based interventions might work in practice (Supplementary Tables 5-6), home care staff gave workforce geographical dispersal and high turnover as reasons for preferring online, regular training, with most considering NIDUS-professional the most practical option to implement of the options presented ( 49 ). Care home staff favoured approaches used in interventions, such as WHELD ( 53 ), of training staff “champions” to cascade training, so content could be tailored to the home’s culture. Figure 1 summarises policy options discussed. Discussion Increasing dementia training for the (circa) million social care workers caring for people living with dementia is critical. Policies have outlined frameworks for learning objectives, qualifications and regulatory systems that could drive this. There is a good evidence base for dementia training in care homes, but significant evidence gaps in home care. This sector presents a different care delivery context; lone working, domiciliary settings and working alongside family carers require specific expertise. We found good quality evidence that training and supporting care home staff “champions” to integrate practice-based learning reduced agitation, neuropsychiatric symptoms and antipsychotic prescribing and improved life quality of residents with dementia. In home care, group training was valued, and improved staff sense of dementia care competence in one study ( 47 ). In July 2024, Skills for Care ( 91 ) called for mandatory dementia training. Stakeholders we consulted supported such calls but considered implementation unfeasible in current economic and workforce contexts. Policy options that the new government might consider to implement this training base would require investment, but could deliver substantial savings across health and social care in care homes ( 53 ). There was no cost-effectiveness data published for home care training, though one intervention that staff valued cost £1,606 per agency, suggesting that if relatively modest health and social care savings were accrued, training could be cost-effective. Though challenging, widespread implementation of dementia training across social care is necessary to equip professionals to deliver the high quality, personalised care that people with dementia and their family carers need. Evidence to drive this is available for care homes but would most likely require regulatory enforcement and investment if care home residents with dementia are to benefit. Half a million people living in UK care homes, and the majority have dementia so successful implementation would support many. In the home care sector, definitive intervention trials are needed. Data Availability All data produced in the present study are available upon reasonable request to the authors Funding This research is funded through the NIHR Policy Research Unit in Dementia and Neurodegeneration – Queen Mary University of London, reference NIHR206110. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. Footnotes Added Yvonne Birks as author (to pdf as well as author list) References 1. ↵ Alzheimer’s society . The economic impact of dementia [Internet] . London : Alzheimer’s society ; 2024 May. Available from: https://www.alzheimers.org.uk/sites/default/files/2024-05/the-annual-costs-of-dementia.pdf 2. ↵ Hawkins J . The state of the adult social care sector and workforce 2022 . 3. ↵ Burgdorf JG , Sen AP , Wolff JL . Patient cognitive impairment associated with higher home health care delivery costs . Health Serv Res . 2022 Jun ; 57 ( 3 ): 515 – 23 . OpenUrl PubMed 4. ↵ Livingston G , Barber J , Marston L , Rapaport P , Livingston D , Cousins S , et al. Prevalence of and associations with agitation in residents with dementia living in care homes: MARQUE cross-sectional study . BJPsych Open . 2017 ; 3 ( 4 ): 171 – 8 . OpenUrl PubMed 5. ↵ Leverton M , Burton A , Beresford-Dent J , Rapaport P , Manthorpe J , Mansour H , et al. ‘You can’t just put somebody in a situation with no armour’ . An ethnographic exploration of the training and support needs of homecare workers caring for people living with dementia. Dementia [Internet ]. 2021 Jun 10 ; Available from : doi: 10.1177\%2F14713012211023676 OpenUrl CrossRef 6. Leverton M , Burton A , Beresford-Dent J , Rapaport P , Manthorpe J , Azocar I , et al. Supporting independence at home for people living with dementia: a qualitative ethnographic study of homecare (Apr, 10.1007/s00127-021-02084-y, 2021) . SOCIAL PSYCHIATRY AND PSYCHIATRIC EPIDEMIOLOGY . 2021 Sep 4 ; 56 ( 12 ): 2337 – 2337 . OpenUrl PubMed 7. ↵ Brown P , Leverton M , Burton A , Harrison-Dening K , Beresford-Dent J , Cooper C . How does the delivery of paid home care compare to the care plan for clients living with dementia? Health & Social Care in the Community [Internet ]. 2022 Feb 22 ; Available from : doi: 10.1111/hsc.13761 OpenUrl CrossRef PubMed 8. ↵ Lord K , Beresford-Dent J , Rapaport P , Burton A , Leverton M , Walters K , et al. Developing the New Interventions for independence in Dementia Study (NIDUS) theoretical model for supporting people to live well with dementia at home for longer: a systematic review of theoretical models and Randomised Controlled Trial evidence . Social Psychiatry and Psychiatric Epidemiology . 2020 ; 55 ( 1 ): 1 – 14 . OpenUrl PubMed 9. ↵ Dalgarno EL , Gillan V , Roberts A , Tottie J , Britt D , Toole C , et al. Home care in dementia: The views of informal carers from a co-designed consultation . Dementia (London ). 2021 Oct ; 20 ( 7 ): 2261 – 77 . OpenUrl PubMed 10. ↵ Surr CA , Gates C , Irving D , Oyebode J , Smith SJ , Parveen S , et al. Effective Dementia Education and Training for the Health and Social Care Workforce: A Systematic Review of the Literature . Review of Educational Research . 2017 Oct 1 ; 87 ( 5 ): 966 – 1002 . OpenUrl CrossRef PubMed 11. ↵ Health Education England [Internet] . 2018 [cited 2024 Jan 17 ]. Dementia Training Standards Framework . Available from: https://www.hee.nhs.uk/our-work/dementia-awareness/core-skills 12. ↵ Smith SJ , Parveen S , Sass C , Drury M , Oyebode JR , Surr CA . An audit of dementia education and training in UK health and social care: a comparison with national benchmark standards . BMC Health Services Research . 2019 Oct 21 ; 19 ( 1 ): 711 . OpenUrl PubMed 13. ↵ NHE England . NHS Long Term Workforce Plan [Internet] . NHS England; 2023 . Available from: https://www.england.nhs.uk/wp-content/uploads/2023/06/nhs-long-term-workforce-plan-v1.2.pdf 14. ↵ Manthorpe J , Purcell C . A decade after the Francis report: let’s build on the success of the care certificate . BMJ . 2023 Apr 14 ; 381 : p827 . OpenUrl FREE Full Text 15. ↵ Department of Health and Social Care . Joining up care for people, places and populations [Internet] . London : HM Government ; 2022 Feb [cited 2022 Sep 8 ]. Report No.: CP573. Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1055687/joining-up-care-for-people-places-and-populations-web-accessible.pdf 16. ↵ Written statements - Written questions, answers and statements - UK Parliament [Internet] . [cited 2024 Aug 1 ]. Available from: https://questions-statements.parliament.uk/written-statements/detail/2024-07-30/HLWS50 17. ↵ Collins T . Health policy analysis: a simple tool for policy makers . Public Health . 2005 Mar ; 119 ( 3 ): 192 – 6 . OpenUrl CrossRef PubMed 18. ↵ Smidt A , Balandin S , Sigafoos J , Reed VA . The Kirkpatrick model: A useful tool for evaluating training outcomes . J Intellect Dev Disabil . 2009 Sep ; 34 ( 3 ): 266 – 74 . OpenUrl CrossRef PubMed 19. ↵ Hong QN , Gonzalez-Reyes A , Pluye P . Improving the usefulness of a tool for appraising the quality of qualitative, quantitative and mixed methods studies, the Mixed Methods Appraisal Tool (MMAT) . J Eval Clin Pract . 2018 Jun ; 24 ( 3 ): 459 – 67 . OpenUrl PubMed 20. ↵ NHS England. Dementia wellbeing pathway [Internet] . [cited 2024 Jul 20 ]. Available from: https://www.england.nhs.uk/publication/dementia-wellbeing-pathway/ 21. ↵ NHS England . Intercultural dementia care guide . 2023 Jun ; Available from: https://www.england.nhs.uk/wp-content/uploads/2023/05/intercultural-dementia-care-guide.pdf 22. ↵ Alzheimer’s Society . Fix Dementia Care: Homecare [Internet] . 2016 . Available from: www.alzheimers.org.uk/sites/default/files/migrate/downloads/fix_dementia_care_homecare_report.pdf 23. ↵ Cabinet Office . Prime Minister’s challenge on dementia 2020 [Internet] . 10 Downing Street, London : Department of Health and Social Care ; 2015 . Available from: www.gov.uk/government/publications/prime-ministers-challenge-on-dementia-2020/prime-ministers-challenge-on-dementia-2020 24. ↵ Skills for Health, Health Education England and Skills for Care . Dementia Core Skills Education and Training Framework . 2018 . 25. ↵ Recommendations | Dementia: assessment, management and support for people living with dementia and their carers | Guidance | NICE [Internet] . NICE ; 2018 [cited 2023 Jun 29 ]. Available from: https://www.nice.org.uk/guidance/ng97/chapter/Recommendations#managing-non-cognitive-symptoms 26. ↵ Skills for Care. Care Certificate [Internet] . [cited 2024 Jul 21 ]. Available from: https://www.skillsforcare.org.uk/Developing-your-workforce/Care-Certificate/Care-Certificate.aspx 27. ↵ GOV.UK [Internet] . [cited 2024 Jul 21 ]. Next steps to put People at the Heart of Care . Available from: https://www.gov.uk/government/publications/adult-social-care-system-reform-next-steps-to-put-people-at-the-heart-of-care/next-steps-to-put-people-at-the-heart-of-care 28. ↵ GOV.UK [Internet] . [cited 2024 Jul 21 ]. Adult Social Care Training and Development Fund: a guide for employers . Available from: https://www.gov.uk/government/publications/adult-social-care-training-and-development-fund/adult-social-care-training-and-development-fund-a-guide-for-employers 29. ↵ The state of the adult social care sector and workforce in England . Skills for Care ; 2021 . 30. ↵ All Party Parliamentary Group (APPG) on Dementia . Hidden no more: dementia and disability [Internet] . 2019 Jun. Available from: https://www.alzheimers.org.uk/sites/default/files/2019-06/APPG_on_Dementia_2019_report_Hidden_no_more_dementia_and_disability_media.pdf 31. ↵ GOV.UK [Internet] . [cited 2024 Jul 20 ]. Care workforce pathway for adult social care . Available from: https://www.gov.uk/government/publications/care-workforce-pathway-for-adult-social-care 32. ↵ Department of Health and Social Care . GOV.UK . 2022 [cited 2023 May 21 ]. People at the Heart of Care: adult social care reform white paper. Available from: https://www.gov.uk/government/publications/people-at-the-heart-of-care-adult-social-care-reform-white-paper 33. ↵ GOV.UK [Internet] . [cited 2024 Jul 21 ]. Health and social care review: leadership for a collaborative and inclusive future . Available from: https://www.gov.uk/government/publications/health-and-social-care-review-leadership-for-a-collaborative-and-inclusive-future 34. ↵ Digitisation is the power to improve care – Social care [Internet] . 2023 [cited 2024 Jul 21 ]. Available from: https://socialcare.blog.gov.uk/2023/09/08/digitisation-is-the-power-to-improve-care/ 35. ↵ GOV.UK [Internet] . [cited 2024 Jul 21 ]. Major conditions strategy: case for change and our strategic framework . Available from: https://www.gov.uk/government/publications/major-conditions-strategy-case-for-change-and-our-strategic-framework/major-conditions-strategy-case-for-change-and-our-strategic-framework--2 36. ↵ NHS England . Dementia wellbeing in the COVID-19 pandemic [Internet] . [cited 2024 Jul 21 ]. Available from: https://www.england.nhs.uk/publication/dementia-wellbeing-in-the-covid-19-pandemic/ 37. ↵ Our position on the Care Certificate - Care Quality Commission [Internet] . [cited 2024 Jul 20 ]. Available from: https://www.cqc.org.uk/guidance-providers/our-position-care-certificate 38. ↵ DHSC . Introducing Integrated Care Systems: joining up local services to improve health outcomes . 2022 Oct ; 39. ↵ Association H . Rising demand and hospital discharge - how big are the challenges facing health and social care? [Internet] . 2023 [cited 2024 Jul 21 ]. Available from: https://www.homecareassociation.org.uk/resource/rising-demand-and-hospitalr 40. ↵ Thompson I . There is neither ‘the funding nor the workforce’ needed to meet the needs of older and disabled people this winter [Internet] . ADASS . 2024 [cited 2024 Jul 21 ]. Available from: https://www.adass.org.uk/there-is-neither-the-funding-nor-the-workforce-needed-to-meet-the-needs-of-older-and-disabled-people-this-winter/ 41. ↵ Skills for the Future | UNISON College [Internet] . 2019 [cited 2024 Jul 21 ]. Available from: https://learning.unison.org.uk/2019/11/14/skills-for-the-future/ 42. ↵ Overview | Dementia | Quality standards | NICE [Internet] . NICE ; 2019 [cited 2024 Jul 21 ]. Available from: https://www.nice.org.uk/guidance/QS184 43. ↵ LaingBuisson, delivered on behalf of the Care Provider Alliance . Fair cost of Care homes for older people and dementia . 2023 Sep . 44. ↵ Bridging The Gap: Tackling Inequalities in England’s Social Care Sector and Beyond - Care England [Internet] . 2023 [cited 2024 Jul 21 ]. Available from: https://www.careengland.org.uk/bridging-the-gap-tackling-inequalities-in-englands-social-care-sector-and-beyond/ 45. ↵ Nakanishi M , Endo K , Hirooka K , Granvik E , Minthon L , Nägga K , et al. Psychosocial behaviour management programme for home-dwelling people with dementia: A cluster-randomized controlled trial . Int J Geriatr Psychiatry . 2018 Mar ; 33 ( 3 ): 495 – 503 . OpenUrl PubMed 46. ↵ Savvas S , Goh AMY , Batchelor F , Doyle C , Wise E , Tan E , et al. Promoting Independence Through quality dementia Care at Home (PITCH): a research protocol for a stepped-wedge cluster-randomised controlled trial . Trials . 2021 Dec 20 ; 22 : 949 . OpenUrl PubMed 47. ↵ Dow B . RESULTS FROM THE AUSTRALIAN PITCH STUDY: A NATIONAL STEPPED-WEDGE CLUSTER RCT EVALUATING A DEMENTIA TRAINING PROGRAM FOR HOME CARE WORKERS . Melbourne, Australia ; 2024 . 48. ↵ Sung HC , Su HF , Lee WL , Yamakawa M , Wang HM . Effects of a dementia virtual reality-based training with peer support for home care workers: A cluster randomized controlled trial . Int J Geriatr Psychiatry . 2022 Sep ; 37 ( 9 ). 49. ↵ Cooper C , Zabihi S , Akhtar A , Lee T , Isaaq A , Le Novere M , et al. Feasibility and acceptability of NIDUS-professional, a training and support intervention for homecare workers caring for clients living with dementia: a cluster-randomised feasibility trial . Age and Ageing . 2024 Apr 1 ; 53 ( 4 ): afae074 . OpenUrl PubMed 50. ↵ Su HF , Koo M , Lee WL , Sung HC , Lee RP , Liu WI . A dementia care training using mobile e-learning with mentoring support for home care workers: a controlled study . BMC Geriatr . 2021 Feb 16 ; 21 ( 1 ): 126 . OpenUrl PubMed 51. ↵ Kelleher D , Lord K , Duffy L , Rapaport P , Barber J , Manthorpe J , et al. Time to reflect is a rare and valued opportunity; a pilot of the NIDUS-professional dementia training intervention for homecare workers during the Covid-19 pandemic . Health and Social Care in the Community [Internet ]. 2022 Feb 6 ; Available from : doi: 10.1111/hsc.13737 OpenUrl CrossRef 52. ↵ Pieper MJC , van der Steen JT , Francke AL , Scherder EJA , Twisk JWR , Achterberg WP . Effects on pain of a stepwise multidisciplinary intervention (STA OP!) that targets pain and behavior in advanced dementia: A cluster randomized controlled trial . Palliat Med . 2018 Mar ; 32 ( 3 ): 682 – 92 . OpenUrl PubMed 53. ↵ Ballard C , Corbett A , Orrell M , Williams G , Moniz-Cook E , Romeo R , et al. Impact of person-centred care training and person-centred activities on quality of life, agitation, and antipsychotic use in people with dementia living in nursing homes: A cluster-randomised controlled trial . PLoS Med . 2018 Feb 6 ; 15 ( 2 ): e1002500 . OpenUrl PubMed 54. ↵ Teri L , Huda P , Gibbons L , Young H , van Leynseele J . STAR: A Dementia-Specific Training Program for Staff in Assisted Living Residences: Nancy Morrow-Howell, MSW, PhD, Editor . The Gerontologist . 2005 Oct 1 ; 45 ( 5 ): 686 – 93 . OpenUrl CrossRef PubMed Web of Science 55. ↵ Mohr DC , Curyto K , Jedele JM , McConeghy KW , Intrator O , Karel MJ , et al. Impact of STAR-VA on Staff Injury and Disruptive Behavior Reports in VA Nursing Homes . J Am Med Dir Assoc . 2022 Jul ; 23 ( 7 ): 1159 – 1165 .e1. OpenUrl PubMed 56. ↵ Karel MJ , Teri L , McConnell E , Visnic S , Karlin BE . Effectiveness of Expanded Implementation of STAR-VA for Managing Dementia-Related Behaviors Among Veterans . Gerontologist . 2016 Feb ; 56 ( 1 ): 126 – 34 . OpenUrl CrossRef PubMed 57. ↵ Curyto K , Wray LO , Sullivan JL , McConnell ES , Jedele JM , Minor L , et al. Implementation Lessons Learned: Distress Behaviors in Dementia Intervention in Veterans Health Administration . Gerontologist . 2024 Feb 1 ; 64 ( 2 ): gnad060 . OpenUrl PubMed 58. ↵ Almutairi H , Stafford A , Etherton-Beer C , Flicker L . Association of Psychotropic Education with Quality of Life: A Before-After Study in Residential Aged Care Facilities . Drugs Aging . 2022 Dec ; 39 ( 12 ): 949 – 58 . OpenUrl PubMed 59. ↵ Kirkham J , Maxwell C , Velkers C , Leung R , Moffat K , Seitz D . Optimizing Prescribing of Antipsychotics in Long-Term Care (OPAL): A Stepped-Wedge Trial . J Am Med Dir Assoc . 2020 Mar ; 21 ( 3 ): 381 – 387 .e3. OpenUrl PubMed 60. ↵ Torres-Castro S , Rabaneda-Bueno R , López-Ortega M , Gutiérrez-Robledo LM , Guzmán A . Multicomponent Staff Training Intervention to Improve Residential Dementia Care (PROCUIDA-Demencia): A Mixed-Methods 2-Arm Cluster Randomized Controlled Pilot and Clinical Outcomes Study . J Am Med Dir Assoc . 2022 Mar ; 23 ( 3 ): 350 – 358 .e5. OpenUrl PubMed 61. ↵ Surr CA , Holloway I , Walwyn RE , Griffiths AW , Meads D , Kelley R , et al. Dementia Care Mapping TM to reduce agitation in care home residents with dementia: the EPIC cluster RCT . Health Technol Assess . 2020 Mar ; 24 ( 16 ): 1 – 172 . OpenUrl CrossRef PubMed 62. ↵ Livingston G , Barber J , Marston L , Stringer A , Panca M , Hunter R , et al. Clinical and cost-effectiveness of the Managing Agitation and Raising Quality of Life (MARQUE) intervention for agitation in people with dementia in care homes: a single-blind, cluster-randomised controlled trial . Lancet Psychiatry . 2019 Apr ; 6 ( 4 ): 293 – 304 . OpenUrl PubMed 63. ↵ Kinderman P , Butchard S , Bruen AJ , Wall A , Goulden N , Hoare Z , et al. A randomised controlled trial to evaluate the impact of a human rights based approach to dementia care in inpatient ward and care home settings [Internet] . Southampton (UK) : NIHR Journals Library ; 2018 [cited 2024 Apr 6 ]. (Health Services and Delivery Research). Available from: http://www.ncbi.nlm.nih.gov/books/NBK487726/ 64. ↵ Pinazo-Clapés C , Pinazo-Hernandis S , Sales A . Effects of an Educational Program for Professional Caregivers on Behavioral Alterations in Nursing Home Residents: Pilot Study . Int J Environ Res Public Health . 2020 Nov 28 ; 17 ( 23 ): 8845 . OpenUrl PubMed 65. ↵ Effects of the Staff Training for Assisted Living Residences protocol for caregivers of older adults with dementia: A pilot study in the Brazilian population - Silva Serelli - 2017 - Geriatrics & Gerontology International - Wiley Online Library [Internet] . [cited 2024 May 13 ]. Available from: https://onlinelibrary.wiley.com/doi/10.1111/ggi.12742 66. ↵ Williams KN , Perkhounkova Y , Herman R , Bossen A . A Communication Intervention to Reduce Resistiveness in Dementia Care: A Cluster Randomized Controlled Trial . Gerontologist . 2017 Aug 1 ; 57 ( 4 ): 707 – 18 . OpenUrl PubMed 67. ↵ Shaw C , Williams KN , Perkhounkova Y . Educating Nursing Home Staff in Dementia Sensitive Communication: Impact on Antipsychotic Medication Use . J Am Med Dir Assoc . 2018 Dec ; 19 ( 12 ): 1129 – 32 . OpenUrl PubMed 68. ↵ Williams KN , Coleman CK , Perkhounkova Y , Beachy T , Hein M , Shaw CA , et al. Moving Online: A Pilot Clinical Trial of the Changing Talk Online Communication Education for Nursing Home Staff . Gerontologist . 2021 Nov 15 ; 61 ( 8 ): 1338 – 45 . OpenUrl PubMed 69. ↵ McDermid J , Da Silva MV , Williams G , Khan Z , Corbett A , Ballard C . A Randomized Controlled Trial of a Digital Adaptation of the WHELD Person-Centered Nursing Home Training Program . J Am Med Dir Assoc . 2022 Jul ; 23 ( 7 ): 1166 – 70 . OpenUrl PubMed 70. ↵ Testad I , Mekki TE , Førland O , Øye C , Tveit EM , Jacobsen F , et al. Modeling and evaluating evidence-based continuing education program in nursing home dementia care (MEDCED)--training of care home staff to reduce use of restraint in care home residents with dementia. A cluster randomized controlled trial . Int J Geriatr Psychiatry . 2016 Jan ; 31 ( 1 ): 24 – 32 . OpenUrl PubMed 71. ↵ Tropea J , Nestel D , Johnson C , Hayes BJ , Hutchinson AF , Brand C , et al. Evaluation of IMproving Palliative care Education and Training Using Simulation in Dementia (IMPETUS-D) a staff simulation training intervention to improve palliative care of people with advanced dementia living in nursing homes: a cluster randomised controlled trial . BMC Geriatr . 2022 Feb 14 ; 22 ( 1 ): 127 . OpenUrl PubMed 72. ↵ Fukuda K , Terada S , Hashimoto M , Ukai K , Kumagai R , Suzuki M , et al. Effectiveness of educational program using printed educational material on care burden distress among staff of residential aged care facilities without medical specialists and/or registered nurses: Cluster quasi-randomization study . Geriatr Gerontol Int . 2018 Mar ; 18 ( 3 ): 487 – 94 . OpenUrl PubMed 73. ↵ Isaac V , Kuot A , Hamiduzzaman M , Strivens E , Greenhill J . The outcomes of a person-centered, non-pharmacological intervention in reducing agitation in residents with dementia in Australian rural nursing homes . BMC Geriatr . 2021 Mar 20 ; 21 ( 1 ): 193 . OpenUrl PubMed 74. ↵ Reinhardt JP , Burack OR , Cimarolli VR , Weiner AS . Dementia-Focused Person-Directed Care Training With Direct Care Workers in Nursing Homes: Effect on Symptom Reduction . J Gerontol Nurs . 2020 Aug 1 ; 46 ( 8 ): 7 – 11 . OpenUrl 75. ↵ Can We Help Care Providers Communicate More Effectively With Persons Having Dementia Living in Long-Term Care Homes? - Katherine S. McGilton, Elizabeth Rochon, Souraya Sidani, Alexander Shaw, Boaz M. Ben-David, Marianne Saragosa, Veronique M. Boscart, Rozanne Wilson, Karmit K. Galimidi-Epstein, M. Kathleen Pichora-Fuller, 2017 [Internet] . [cited 2024 May 13 ]. Available from: https://journals.sagepub.com/doi/10.1177/1533317516680899 76. ↵ Degen C , Frankenberg C , Meyer-Kühling I , Wendelstein B , Knebel M , Pantel J , et al. Communication skills in nursing home residents with dementia . Z Gerontol Geriat . 2022 Feb 1 ; 55 ( 1 ): 27 – 31 . OpenUrl 77. ↵ Hanson HM , Léveillé T , Cole M , Soril LJ , Clement F , Wagg A , et al. Effect of a multimethod quality improvement intervention on antipsychotic medication use among residents of long-term care . BMJ Open Qual . 2021 Apr ; 10 ( 2 ): e001211 . OpenUrl Abstract / FREE Full Text 78. ↵ Gordon SE , Dufour AB , Monti SM , Mattison MLP , Catic AG , Thomas CP , et al. Impact of a Videoconference Educational Intervention on Physical Restraint and Antipsychotic Use in Nursing Homes: Results From the ECHO-AGE Pilot Study . J Am Med Dir Assoc . 2016 Jun 1 ; 17 ( 6 ): 553 – 6 . OpenUrl CrossRef PubMed 79. ↵ Zhao Y , Ding Y , Liu L , Chan HYL . Feasibility of a Culturally Specific DEmentia Competence Education for Nursing Home Taskforce (DECENT) Programme: A Mixed-Method Approach . Int J Environ Res Public Health . 2022 Dec 12 ; 19 ( 24 ): 16679 . OpenUrl PubMed 80. ↵ Zhao Y , Liu L , Ding Y , Chan HYL . Effect of a culturally sensitive DEmentia Competence Education for Nursing home Taskforce (DECENT) programme in China: A quasi-experimental study . Nurse Educ Today . 2022 Sep ; 116 : 105434 . OpenUrl PubMed 81. ↵ Aberdeen SM , Byrne G . Concept mapping to improve team work, team learning and care of the person with dementia and behavioural and psychological symptoms . Dementia (London ). 2018 Apr ; 17 ( 3 ): 279 – 96 . OpenUrl PubMed 82. ↵ Gerolimatos LA , Page KS , Balestracci P , Hinrichs KLM . Interdisciplinary development and implementation of a dementia skills training program in a VA community living center: a pilot study . Geriatr Nurs . 2018 ; 39 ( 4 ): 400 – 6 . OpenUrl PubMed 83. ↵ Revolta C , Orrell M , Spector A . The biopsychosocial (BPS) model of dementia as a tool for clinical practice. A pilot study . Int Psychogeriatr . 2016 Jul ; 28 ( 7 ): 1079 – 89 . OpenUrl PubMed 84. ↵ Dobbs D , Hobday J , Roker R , Kaas MJ , Molinari V . Certified nursing assistants’ perspectives of the CARES® activities of daily living dementia care program . Appl Nurs Res . 2018 Feb ; 39 : 244 – 8 . OpenUrl PubMed 85. ↵ Karacsony S , Abela MR , Eccleston C . ‘There’s something they can do’: Educating aged care staff about the trajectory of dementia, palliative care and the Namaste Care TM program: A mixed methods study . Australas J Ageing . 2024 Mar ; 43 ( 1 ): 91 – 9 . OpenUrl PubMed 86. ↵ Maidment ID , Damery S , Campbell N , Seare N , Fox C , Iliffe S , et al. Medication review plus person-centred care: a feasibility study of a pharmacy-health psychology dual intervention to improve care for people living with dementia . BMC Psychiatry . 2018 Oct 19 ; 18 ( 1 ): 340 . OpenUrl PubMed 87. ↵ Maidment ID , Barton G , Campbell N , Shaw R , Seare N , Fox C , et al. MEDREV (pharmacy-health psychology intervention in people living with dementia with behaviour that challenges): the feasibility of measuring clinical outcomes and costs of the intervention . BMC Health Serv Res . 2020 Mar 2 ; 20 ( 1 ): 157 . OpenUrl PubMed 88. ↵ Moore KJ , Candy B , Davis S , Gola A , Harrington J , Kupeli N , et al. Implementing the compassion intervention, a model for integrated care for people with advanced dementia towards the end of life in nursing homes: a naturalistic feasibility study . BMJ Open . 2017 Jun 1 ; 7 ( 6 ): e015515 . OpenUrl Abstract / FREE Full Text 89. ↵ du Toit SHJ , Chan YL , Jessup GM , Weaver J . Peer-enabled staff training in residential care settings as means for promoting person-centred dementia care . Aging Ment Health . 2020 Aug ; 24 ( 8 ): 1278 – 87 . OpenUrl PubMed 90. ↵ NHS England | Workforce, training and education [Internet] . 2023 [cited 2024 Aug 1 ]. The Oliver McGowan Mandatory Training on Learning Disability and Autism . Available from: https://www.hee.nhs.uk/our-work/learning-disability/current-projects/oliver-mcgowan-mandatory-training-learning-disability-autism 91. ↵ Home - A Workforce Strategy for Adult Social Care in England [Internet] . [cited 2024 Jul 22 ]. Available from: https://www.skillsforcare.org.uk/Workforce-Strategy/Home.aspx 92. Cooper C , Vickerstaff V , Barber J , Phillips R , Ogden M , Walters K , et al. A psychosocial goal-setting and manualised support intervention for independence in dementia (NIDUS-Family) versus goal setting and routine care: a single-masked, phase 3, superiority, randomised controlled trial . Lancet Healthy Longev . 2024 Feb ; 5 ( 2 ): e141 – 51 . OpenUrl 93. Cooper C . Feasibility and acceptability of nidus-professional, a training and support intervention for homecare workers caring for clients living with dementia: a cluster-randomised feasibility trial . Int J Geriatr Psychiatry . View the discussion thread. 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Share Systematic policy and evidence review to consider how dementia education and training is best delivered in the social care workforce, and how policy does or can enable its implementation in England Saskia Delray , Sube Banerjee , Sedigheh Zabihi , Madeline Walpert , Karen Harrison-Dening , Charlotte Kenten , Yvonne Birks , Clarissa Giebel , Mohammed Akhlak Rauf , Sally Reynolds , Claudia Cooper medRxiv 2024.08.24.24312532; doi: https://doi.org/10.1101/2024.08.24.24312532 Share This Article: Copy Citation Tools Systematic policy and evidence review to consider how dementia education and training is best delivered in the social care workforce, and how policy does or can enable its implementation in England Saskia Delray , Sube Banerjee , Sedigheh Zabihi , Madeline Walpert , Karen Harrison-Dening , Charlotte Kenten , Yvonne Birks , Clarissa Giebel , Mohammed Akhlak Rauf , Sally Reynolds , Claudia Cooper medRxiv 2024.08.24.24312532; doi: https://doi.org/10.1101/2024.08.24.24312532 Citation Manager Formats BibTeX Bookends EasyBib EndNote (tagged) EndNote 8 (xml) Medlars Mendeley Papers RefWorks Tagged Ref Manager RIS Zotero Tweet Widget Facebook Like Google Plus One Subject Area Psychiatry and Clinical Psychology Subject Areas All Articles Addiction Medicine (574) Allergy and Immunology (865) Anesthesia (304) Cardiovascular Medicine (4460) Dentistry and Oral Medicine (445) Dermatology (383) Emergency Medicine (611) Endocrinology (including Diabetes Mellitus and Metabolic Disease) (1517) Epidemiology (15251) Forensic Medicine (31) Gastroenterology (1132) Genetic and Genomic Medicine (6621) Geriatric Medicine (669) Health Economics (1002) Health Informatics (4564) Health Policy (1372) Health Systems and Quality Improvement (1617) Hematology (544) HIV/AIDS (1272) Infectious Diseases (except HIV/AIDS) (15938) Intensive Care and Critical Care Medicine (1107) Medical Education (624) Medical Ethics (147) Nephrology (670) Neurology (6642) Nursing (346) Nutrition (1001) Obstetrics and Gynecology (1148) Occupational and Environmental Health (957) Oncology (3350) Ophthalmology (981) Orthopedics (369) Otolaryngology (421) Pain Medicine (436) Palliative Medicine (130) Pathology (665) Pediatrics (1698) Pharmacology and Therapeutics (694) Primary Care Research (714) Psychiatry and Clinical Psychology (5464) Public and Global Health (9259) Radiology and Imaging (2212) Rehabilitation Medicine and Physical Therapy (1372) Respiratory Medicine (1198) Rheumatology (598) Sexual and Reproductive Health (716) Sports Medicine (533) Surgery (715) Toxicology (100) Transplantation (289) Urology (265) (function(){function c(){var b=a.contentDocument||a.contentWindow.document;if(b){var d=b.createElement('script');d.innerHTML="window.__CF$cv$params={r:'a038b322be10f047',t:'MTc4MDA5MTI2OQ=='};var a=document.createElement('script');a.src='/cdn-cgi/challenge-platform/scripts/jsd/main.js';document.getElementsByTagName('head')[0].appendChild(a);";b.getElementsByTagName('head')[0].appendChild(d)}}if(document.body){var a=document.createElement('iframe');a.height=1;a.width=1;a.style.position='absolute';a.style.top=0;a.style.left=0;a.style.border='none';a.style.visibility='hidden';document.body.appendChild(a);if('loading'!==document.readyState)c();else if(window.addEventListener)document.addEventListener('DOMContentLoaded',c);else{var e=document.onreadystatechange||function(){};document.onreadystatechange=function(b){e(b);'loading'!==document.readyState&&(document.onreadystatechange=e,c())}}}})();