Orrell, Martin, Coleston, Donna Maria, O’Raw, Linda, Broome, Emma, Challis, David, Dening, Tom, Boliang, Guo, Hoe, Juanita ORCID: https://orcid.org/0000-0003-4647-8950, Lloyd-Evans, Brynmor, Moniz-Cook, Esme, Opazo Breton, Magdalena, Poland, Fiona, Prothero, David, Redley, Marcus, Stanyon, Miriam, Worden, Angela and Yates, Jennifer (2025) Development of the best practice model to improve crisis management for older people with dementia: the AQUEDUCT mixed methods research programme including RCT. Project Report. NIHR Journals Library, UK.

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Abstract

ackground: In many countries, supporting people with dementia to remain at home is a key priority. However, a crisis can lead to a breakdown of care at home. In England, various multidisciplinary teams have been set up to support people with dementia during a crisis, but little is known about the most effective way of organising these or their impact. Objectives: The study aimed to: 1. Review evidence on best practice in teams managing crisis for people with dementia and develop an evidence-based Resource Kit to improve practice. 2. Conduct a process feasibility study for a randomised controlled trial of the Resource Kit and refine the research procedures and outcome measures based on feedback. 3. Test the Resource Kit with a representative sample of teams across England in a randomised controlled trial examining the impact upon psychiatric hospital admissions and other outcome measures. Method/design: A systematic review of the impact of Teams Managing Crisis in Dementia on outcomes, including hospital admissions, and an online scoping survey of team managers were undertaken to understand current evidence and practice. Qualitative work, including interviews and focus groups, explored the experiences of team staff, people with dementia and their carers during a crisis. A tool of 50 standards to measure best practice in teams was developed and refined by consultations, a consensus workshop and field testing. A Resource Kit, which included the Best Practice Tool and activities to assist teams in meeting the 50 standards, was developed and field tested. A feasibility study refined the research procedures for a subsequent pragmatic randomised controlled trial of the online Resource Kit in teams in England compared to treatment as usual. Setting: The study took place in National Health Service trusts providing mental health crisis services for older people with dementia across England. Participants: Participants were staff members of Teams Managing Crisis in Dementia, and people with dementia and their carers referred to these teams. Intervention: The trial intervention consisted of a Resource Kit containing the Best Practice Tool for teams to evaluate their practice and materials to develop aspects of their practice. Main outcome measures: The trial used psychiatric hospital admissions for people with dementia from teams’ catchment areas, according to postcode, as the primary outcome. Results: The systematic review demonstrated some positive effect of crisis teams on hospital admissions, although there was a need for higher-quality evidence. The online survey of team managers reported considerable variation in ways teams worked. Both highlighted the need for a more standardised approach to managing crises for people with dementia in the community. Qualitative work with staff, people with dementia, carers and other stakeholders indicated that services operated to a variety of models and that there was no clear shared definition of a crisis in dementia care. A Resource Kit was developed containing a Best Practice Tool with 50 standards and materials to guide improvement in practice in specific domains. The feasibility study for the randomised controlled trial of the Resource Kit indicated some sensitivity to change over t ime of the Best Practice Tool scores within teams, and different development choices by teams of domains in the Resource Kit. The primary outcome was identified as psychiatric hospital admissions with quality of life and well-being measures as secondary outcomes, reflecting limitations of data collection imposed by the Severe Acute Respiratory Syndrome Coronavirus 2 pandemic. For the trial, the original target was 30 Teams Managing Crisis in Dementia, with power analysis set at 90%. However, due to the Severe Acute Respiratory Syndrome Coronavirus 2 pandemic, an approved amendment reduced the target to 24 Teams Managing Crisis in Dementia, adjusting the power analysis to 80%. However, only 23 teams were randomised, including 238 of their staff and 75 service users, including people with dementia and their carers. The Resource Kit intervention was well received by teams but did neither reduce hospital admissions nor improve the well-being of people with dementia, their carers or team staff. Limitations: The Best Practice Tool was not tested for psychometric properties due to small numbers of teams involved in field testing. There were limitations associated with the reduced choice of outcome measures for the trial due to the COVID pandemic. Conclusions: Although the results showed no significant difference in admissions to psychiatric hospitals or the other chosen measures, the Resource Kit is valuable for team quality improvement, standardising procedures and offering a comparison tool. The study has also provided an example of how it was possible to undertake research with a hard-toreach population, both during the challenge of a personal crisis and the COVID pandemic. Future work: Future research could address quality improvement in teams using more process-based outcomes, comparable to initiatives such as the Memory Standards National Accreditation Programme in England.

Item Type:	Report (Project Report)
Additional Information:	NIHR Programme Grants for Applied Research Report: Achieving Quality and Effectiveness in Dementia Using Crisis Teams (AQUEDUCT) programme.
Subjects:	Medicine and health > Clinical medicine > Dementia
Related URLs:	https://www.journalslibrary.nihr.ac.uk/p...
Date Deposited:	27 Nov 2025
URI:	https://repository.uwl.ac.uk/id/eprint/14356
Sustainable Development Goals:	Goal 3: Good Health and Well-Being

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