Browsing by Person "Woolham, John"

Now showing 1 - 7 of 7

Assessment of need and practice for assistive technology and telecare for people with dementia—The ATTILA (Assistive Technology and Telecare to maintain Independent Living At home for people with dementia) trial
(Elsevier, 2019-09-03) Forsyth, Kirsty; Henderson, Catherine; Davis, Lucy; Singh Roy, Anusua; Dunk, Barbara; Curnow, Eleanor; Gathercole, Rebecca; Lam, Natalie; Harper, Emma; Leroi, Iracema; Woolham, John; Fox, Chris; O'Brien, John; Bateman, Andrew; Poland, Fiona; Bentham, Peter; Burns, Alistair; Davies, Anna; Gray, Richard; Bradley, Rosie; Knapp, Martin; Newman, Stanton; McShane, Rupert; Ritchie, Craig; Talbot, Emma; Hooper, Emma; Winson, Rachel; Scutt, Bethany; Ordonez, Victoria; Nunn, Samantha; Lavelle, Grace; Howard, Robert
Introduction The objective of this study was to define current assistive technology and telecare (ATT) practice for people with dementia living at home.
Assistive technology and telecare to maintain independent living at home for people with dementia: The ATTILA RCT
(NIHR, 2021-03) Gathercole, Rebecca; Bradley, Rosie; Harper, Emma; Davies, Lucy; Pank, Lynn; Lam, Natalie; Davies, Anna; Talbot, Emma; Hooper, Emma; Winson, Rachel; Scutt, Bethany; Montano, Victoria Ordonez; Nunn, Samantha; Lavelle, Grace; Lariviere, Matthew; Hirani, Shashivadan; Brini, Stefano; Bateman, Andrew; Bentham, Peter; Burns, Alistair; Dunk, Barbara; Forsyth, Kirsty; Fox, Chris; Henderson, Catherine; Knapp, Martin; Leroi, Iracema; Newman, Stanton; O'Brien, John; Poland, Fiona; Woolham, John; Gray, Richard; Howard, Robert
Assistive technology and telecare have been promoted to manage the risks associated with independent living for people with dementia, but there is limited evidence of their effectiveness. This trial aimed to establish whether or not assistive technology and telecare assessments and interventions extend the time that people with dementia can continue to live independently at home and whether or not they are cost-effective. Caregiver burden, the quality of life of caregivers and of people with dementia and whether or not assistive technology and telecare reduce safety risks were also investigated. This was a pragmatic, randomised controlled trial. Blinding was not undertaken as it was not feasible to do so. All consenting participants were included in an intention-to-treat analysis. This trial was set in 12 councils in England with adult social services responsibilities. Participants were people with dementia living in the community who had an identified need that might benefit from assistive technology and telecare. Participants were randomly assigned to receive either assistive technology and telecare recommended by a health or social care professional to meet their assessed needs (a full assistive technology and telecare package) or a pendant alarm, non-monitored smoke and carbon monoxide detectors and a key safe (a basic assistive technology and telecare package). The primary outcomes were time to admission to care and cost-effectiveness. Secondary outcomes assessed caregivers using the 10-item Center for Epidemiological Studies Depression Scale, the State-Trait Anxiety Inventory 6-item scale and the Zarit Burden Interview. Of 495 participants, 248 were randomised to receive full assistive technology and telecare and 247 received the limited control. Comparing the assistive technology and telecare group with the control group, the hazard ratio for institutionalisation was 0.76 (95% confidence interval 0.58 to 1.01; = 0.054). After adjusting for an imbalance in the baseline activities of daily living score between trial arms, the hazard ratio was 0.84 (95% confidence interval 0.63 to 1.12; = 0.20). At 104 weeks, there were no significant differences between groups in health and social care resource use costs (intervention group - control group difference: mean -£909, 95% confidence interval -£5336 to £3345) or in societal costs (intervention group - control group difference: mean -£3545; 95% confidence interval -£13,914 to £6581). At 104 weeks, based on quality-adjusted life-years derived from the participant-rated EuroQol-5 Dimensions questionnaire, the intervention group had 0.105 (95% confidence interval -0.204 to -0.007) fewer quality-adjusted life-years than the control group. The number of quality-adjusted life-years derived from the proxy-rated EuroQol-5 Dimensions questionnaire did not differ between groups. Caregiver outcomes did not differ between groups over 24 weeks. Compliance with the assigned trial arm was variable, as was the quality of assistive technology and telecare needs assessments. Attrition from assessments led to data loss additional to that attributable to care home admission and censoring events. A full package of assistive technology and telecare did not increase the length of time that participants with dementia remained in the community, and nor did it decrease caregiver burden, depression or anxiety, relative to a basic package of assistive technology and telecare. Use of the full assistive technology and telecare package did not increase participants' health and social care or societal costs. Quality-adjusted life-years based on participants' EuroQol-5 Dimensions questionnaire responses were reduced in the intervention group compared with the control group; groups did not differ in the number of quality-adjusted life-years based on the proxy-rated EuroQol-5 Dimensions questionnaire. Future work could examine whether or not improved assessment that is more personalised to an individual is beneficial. Current Controlled Trials ISRCTN86537017.
Carers’ involvement in telecare provision by local councils for older people in England: Perspectives of council telecare managers and stakeholders
(Cambridge University Press, 2019-10-08) Steils, Nicole; Woolham, John; Fisk, Malcolm; Porteus, Jeremy; Forsyth, Kirsty
This paper explores telecare manager and other ‘stakeholder’ perspectives on the nature, extent and impact of family and other unpaid/informal carers’ involvement in the provision of telecare equipment and services for older people. Data used in the paper are derived from a larger study on telecare provision by local councils in England. The paper aims to add to the growing evidence about carers’ engagement with electronic assistive technology and telecare, and considers this in the context of typologies of professionals’ engagement with carers. How carers are involved in telecare provision is examined primarily from the perspectives of senior managers responsible for telecare services who responded to an online survey and/or were interviewed in 2016 as part of a wider study. The perspectives of three unpaid carers were captured in a separate strand of the main study, which comprised more detailed case study interviews within four selected councils. Thematic and comparative analysis of both qualitative and quantitative survey data revealed the varied involvements and responsibilities that carers assumed during the telecare provision process, the barriers that they needed to overcome and their integration in local council strategies. Findings are discussed in the context of Twigg and Atkin's typology of carer support. They suggest that carers are mainly perceived as ‘resources’ and involvement is largely taken for granted. There are instances in which carers can be seen as ‘co-workers’: this is mainly around responding to alerts generated by the telecare user or by monitored devices, but only in those councils that fund response services. Though some participants felt that telecare devices could replace or ‘supersede’ hands-on care that involved routine monitoring of health and wellbeing, it was also acknowledged that its use might also place new responsibilities on carers. Furthermore, the study found that meeting carers’ own rights as ‘co-clients’ was little acknowledged.
The effectiveness and cost-effectiveness of assistive technology and telecare for independent living in dementia: A randomised controlled trial
(British Geriatrics Society, 2021-01-23) Howard, Robert; Gathercole, Rebecca; Bradley, Rosie; Harper, Emma; Davis, Lucy; Pank, Lynn; Lam, Natalie; Talbot, Emma; Hooper, Emma; Winson, Rachel; Scutt, Bethany; Ordonez Montano, Victoria; Nunn, Samantha; Lavelle, Grace; Bateman, Andrew; Bentham, Peter; Burns, Alistair; Dunk, Barbara; Forsyth, Kirsty; Fox, Chris; Poland, Fiona; Leroi, Iracema; Newman, Stanton; O'Brien, John; Henderson, Catherine; Knapp, Martin; Woolham, John; Gray, Richard
Objectives The use of assistive technology and telecare (ATT) has been promoted to manage risks associated with independent living in people with dementia but with little evidence for effectiveness.
The impact of assistive technology on burden and psychological wellbeing in informal caregivers of people with dementia (ATTILA Study)
(Alzheimer's Association, 2020-10-07) Davies, Anna; Brini, Stefano; Hirani, Shashivadan; Gathercole, Rebecca; Forsyth, Kirsty; Henderson, Catherine; Bradley, Rosie; Davies, Lucy; Dunk, Barbara; Harper, Emma; Lam, Natalie; Pank, Lynn; Leroi, Iracema; Woolham, John; Fox, Chris; O'Brien, John; Bateman, Andrew; Poland, Fiona; Bentham, Pete; Burns, Alistar; Gray, Richard; Knapp, Martin; Talbot, Emma; Hooper, Emma; Winson, Rachel; Scutt, Bethany; Ordonez, Victoria; Nunn, Samantha; Lavelle, Grace; Howard, Robert; Newman, Stanton
INTRODUCTION, Assistive Technology and Telecare (ATT) may alleviate psychological burden in informal caregivers of people with dementia. This study assessed the impact of ATT on informal caregivers’ burden and psychological wellbeing.
Making use of evidence in commissioning practice: Insights into the understanding of a telecare study’s findings
(Policy Press, 2019-12-16) Woolham, John; Steils, Nicole; Forsyth, Kirsty; Fisk, Malcolm; Porteus, Jeremy
Background. This paper discusses findings from a study of English Local Authority (LA) Adult Social Care Departments (ASCDs) that explored how managers use telecare. A decade earlier, a large clinical trial, the ‘Whole System Demonstrator’ project (WSD), funded by the Department of Health (DH) investigated telecare’s effectiveness in promoting and maintaining independence among users. It found no evidence that telecare improved outcomes. Despite these conclusions, the DH did not change its policy or guidance, and LAs did not appear to scale back investment in telecare. Aims and objectives. The present study explores how English ASCDs responded to WSD findings and why investment continued despite evidence from the WSD. Methods. Data were obtained from an online survey sent to all telecare lead managers in England. The survey achieved a final response rate of 75%. Findings. The survey asked questions focused on awareness and use of research in general, and specifically knowledge about the findings of the WSD. Most respondents were highly critical of the WSD methods, and its findings. Discussion. Critical examination of telecare manager views found widespread inaccurate information about the trial methodology and findings, as well as the wider political and policy context that shaped it. Conclusions. The WSD could not explain why telecare did not deliver better outcomes. A more nuanced understanding of the circumstances in which it might achieve good outcomes has received little consideration. LA difficulties in using evidence in telecare commissioning potentially leaves the sector at risk of market capture and supplier induced demand. key messages Social care services in England continue to invest in telecare despite evidence it does not produce better outcomes for older users. Generalizable evidence for telecare effectiveness is not well understood by commissioners/providers. Better use of evidence is needed for telecare to be effective for older people. Without independent evidence there is a risk of ‘market capture’ by manufacturers.
Outcomes for older telecare recipients: The importance of assessments
(SAGE, 2019-10-30) Woolham, John; Steils, Nicole; Fisk, Malcolm; Porteus, Jeremy; Forsyth, Kirsty
Summary This article explores the role of telecare assessment, review and staff training in meeting the needs of older people living at home. Using original empirical data obtained from an online survey of English local authorities it reveals considerable variation in assessment and review practice and in training given to social work and other staff who assess and review, which may impact on outcomes for telecare users. The study findings are situated within an English policy context and earlier findings from a large, government funded randomised controlled trial. This trial concluded that telecare did not lead to better outcomes for users.