Understanding what is important to older people living with frailty in relation to advance care planning.

Background: Advance care planning (ACP) provides opportunities for people to make decisions about future care. Internationally, the approach to this varies. Older people living with frailty could considerably benefit from discussing and undertaking advance care planning.

A group intervention to improve quality of life for people with advanced dementia living in care homes: the Namaste feasibility cluster RCT.

Background: People with advanced dementia who live and die in nursing homes experience variable quality of life, care and dying. There is a need to identify appropriate, cost-effective interventions that facilitate high-quality end-of-life care provision.

Objectives: To establish the feasibility and acceptability to staff and family of conducting a cluster randomised controlled trial of the Namaste Care intervention for people with advanced dementia in nursing homes.

A collaborative approach in dementia care to improve clinical effectiveness and priorities for research through audit.

Background: To provide appropriate cost-effective care for an ageing population, realignment of care provision to conditions common in advanced age, notably, dementia and multi-morbidities is required. The use of outcome measures in practice may enable this.

Aim: A collaborative baseline audit was undertaken to understand how best to implement outcome measures into services for people with dementia across clinical settings.

Managing health changes for people with a learning disability in a residential care home setting.

Background: People with learning disability (LD) have complex comorbidities that develop at an earlier age than the general population and with which they are now living longer. Identification, assessment and management of these conditions is important but challenging.

Aim: To develop resources with care staff to enable them to recognise and manage changes and decline in the health of a person with a LD.

A four-stage process for intervention description and guide development of a practice-based intervention: refining the Namaste Care intervention implementation specification for people with advanced dementia prior to a feasibility cluster randomised trial.

Background: Some interventions are developed from practice, and implemented before evidence of effect is determined, or the intervention is fully specified. An example is Namaste Care, a multi-component intervention for people with advanced dementia, delivered in care home, community, hospital and hospice settings. This paper describes the development of an intervention description, guide and training package to support implementation of Namaste Care within the context of a feasibility trial.

Improving the approach to future care planning in care homes.

Background:: There is international and national interest in the availability and provision of quality end-of-life care. In the UK this includes the promotion of advance care planning (ACP).

Aims:: To support care home staff to apply national policy on ACP in practice.

Namaste Care in nursing care homes for people with advanced dementia: protocol for a feasibility randomised controlled trial.

Introduction: Many people living with advanced dementia live and die in nursing care homes. The quality of life, care and dying experienced by these people is variable. Namaste Care is a multisensory programme of care developed for people with advanced dementia.

Development and implementation of the Steps to Successful Palliative Care programme in residential care homes for people with a learning disability.

Background:: For health and social care services to meet the needs of a growing and ageing population they need to respond appropriately. This response is only going to be possible if attention is paid to the individuals within it. This includes those people living with a learning disability (LD).

Family perceptions of care at the end of life in UK nursing care homes.

Background: Over a fifth of the population of developed countries die in care homes. While studies are emerging on the outcomes of care in the last few weeks of life, few report on the experience as perceived by the family members.

Methods: As part of a wider study to improve the delivery of end-of-life care, bereaved relatives of residents who had died in a care home/hospital were sent the Family Perception of Care Scale questionnaire to evaluate their experience of care provision for their relative in the last month of life.

Facilitation of an end-of-life care programme into practice within UK nursing care homes: A mixed-methods study.

Background: The predicted demographic changes internationally have implications for the nature of care that older people receive and place of care as they age. Healthcare policy now promotes the implementation of end-of-life care interventions to improve care delivery within different settings. The Gold Standards Framework in Care Homes (GSFCH) programme is one end-of-life care initiative recommended by the English Department of Health.

Developing, implementing and sustaining an end-of-life care programme in residential care homes.

Background: In the UK 15.8% of people aged 85 years and over live in a care home or long-stay hospital setting. With the projection of an ageing population it is realistic to expect that the number of people both living and dying in all care homes will increase.

The challenges of implementing a multi-centre audit of end-of-life care in care homes.

Aims: This article aims to share the experience of a hospice in facilitating a multi-centre audit of end-of-life care in care homes, particularly noting the challenges and enablers of carrying out the audit.

Methods: The audit was a retrospective multi-centre survey of bereaved relatives/next of kin of residents who died in the care home, using an anonymous, validated questionnaire: the Family Perception of Care Scale. Questionnaires were sent 3-months after bereavement.

A practice development initiative supporting care home staff deliver high quality end-of-life care.

Background: The global population is changing with an increasing percentage of the oldest old, many of whom in the UK are looked after in care homes. Care homes now provide care for a fifth of the UK population who die each year. However, most nursing care homes are privately owned and not part of the NHS, which exposes staff to a lack of skills/knowledge in relation to end-of-life care.

The effect of using high facilitation when implementing the Gold Standards Framework in Care Homes programme: a cluster randomised controlled trial.

Background: The provision of quality end-of-life care is increasingly on the national agenda in many countries. In the United Kingdom, the Gold Standards Framework for Care Homes programme has been promoted as a national framework for improving end-of-life care. While its implementation is recommended, there are no national guidelines for facilitators to follow to undertake this role.

Current prevalence of dementia, depression and behavioural problems in the older adult care home sector: the South East London Care Home Survey.

Background: a large and increasing number of older people in the UK are living in care homes. Dementia is a frequent reason underlying admission and determining care needs, but prevalence data are becoming increasingly outdated and reliant on brief screening instruments.

Objective: to describe the prevalence and severity of dementia, depression, behavioural problems and relevant medication use in a representative sample of residential and nursing care home residents.

Advance care planning in care homes: the experience of staff, residents, and family members.

Background: In the UK, implementation of the Gold Standards Framework in Care Homes (GSFCH) programme is being promoted to develop the quality of end-of-life care for frail older people living and dying in care homes. Advance care planning (ACP) discussions are an integral part of this. This study explored experiences of initiating and completing these discussions in homes undertaking the GSFCH.

The provision of care for residents dying in U.K. nursing care homes.

Objectives: to identify the care currently provided to residents dying in U.K. nursing care homes.

The effect of policy on end-of-life care practice within nursing care homes: a systematic review.

Background: The number of older people in the UK is increasing. A significant proportion of end of life care for this population is currently provided and will increasingly be provided within nursing care homes.

Aim: To identify the impact of implementing end of life care policy with regard to the use of the Gold Standards Framework in Care Homes programme, the Liverpool Care Pathway (or an Integrated Care Pathway) and educational/training interventions to support the provision of end of life care within nursing care homes within the UK.

A baseline review of medication provided to older people in nursing care homes in the last month of life.

Aim: Increasing numbers of older people are dying in the nursing care home setting. Little is known about the medication needs of the very old and frail in the last weeks of life and how they might differ from a model of care developed for people dying from cancer.

Method: A baseline review of medication in the last month of life was undertaken to try and establish current practice of prescribing for this population.

Changing practice: use of audit to change oral care practice.

Although oral problems are common in palliative care, oral care can be a neglected area of practice. This article discusses the introduction of an oral care protocol and standard in one palliative care unit. The project used audit tools developed by Lee et al (2001) and involved a survey of the oral care knowledge of nursing and medical staff, and a retrospective survey of current practice using 50 sets of patients' notes.