1. Ritchard Ledgerd Clinical Researcher

2. United KingdomNorway 33,383 occupational therapists3,756 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 government95% work in jobs funded by the government 30 universities offering 60 education programmes 6 universities offering 6 education programmes All programmes WFOT Approved 72% join their national occupational therapy association 91% join their national occupational therapy association 92% female91% female National Health Service (public) no chargeHealth Service no charge Average life expectancy Male =79.5 Female = 82.5 Average life expectancy Male = 79.4 Female = 83.4 Number of people with dementia set to double by 2040

3. General overview of health & social care provision in the UK Community Health Services (Intermediate Care) Hospitals - Physical (Acute) Social Services/Care Including 6 weeks reablement General Practitioners (Primary Care) Community Mental Health Services (Intermediate Care) Hospitals - Psychiatric (Acute)

4. 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

5. 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 stigma  Ensure early diagnosis support and treatment  Develop services to meet peoples needs better 17 objectives

6. 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

7. 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)

8. 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

9. Centre for Evidence Based Medicinewww.cebm.netwww.cebm.net Centre for Health Evidencewww.cche.netwww.cche.net Critical Appraisal Skills Programme http://www.casp-uk.net/http://www.casp-uk.net/ Database of Abstracts of Reviews of Effects(DARE) http://www.crd.york.ac.uk/crdweb/http://www.crd.york.ac.uk/crdweb/ Trip Database http://www.tripdatabase.com/http://www.tripdatabase.com/ Examples of useful websites

10. 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.

11. Dementia Services in the United Kingdom Memory Services Replaced Day Hospital Services Multidisciplinary Diagnosis and Assessment 4-6 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

12. 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

13. Crisis Teams Usually doctors, nurses, occupational therapists and support workers Intensive time limited support at home Functional and organic diagnosis Variation and access Role of the occupational therapist Rapid response Dementia Services in the United Kingdom

14. Community Groups Dementia Services in the United Kingdom

15. 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

16. National research studies

17. 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

18. COTiD-UK Aim 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. Community Occupational Therapy in Dementia - UK Hypotheses: 1.COTiD-UK will significantly improve Activities of Daily Living (ADL) abilities in people with dementia 2.COTiD-UK will significantly improve quality of life of people with dementia and their family carers 3.The Programme will demonstrate cost effectiveness

19. Intervention & Manual Development

20. Next Stages Pilot Study – 3 sites (October 2014 – January 2015) 25 dyads control group 25 dyads in treatment group Randomised Controlled Trial (February 2015 – Dec 2015) 240 dyads in control group 240 in treatment group

21. More information www.ucl.ac.uk/valid