NIHR CLAHRC Cambridgeshire and Peterborough

Establish areas of service design and structure where improvements can be made in terms of provision for young people’s mental health needs during periods of transition.

Develop a training package which changes how foster carers work with young people entering care in terms of identifying and providing for their mental health needs

Old Age & End of Life Care Theme

Dementia and Mental Health in Old Age: current and planned research studies

The Dementia and Mental Health in Old Age research group are currently undertaking and planning the following programmes of research, some in collaboration with other CLAHRC-CP themes and service partners as indicated:

Improving dementia care through evidence based research synthesis:

Systematic reviews of diagnostic test accuracy in dementia

Systematic review of screening in dementia

Systematic review of dementia outcomes re: non-pharmaceutical interventions

Informing service needs assessment, commissioning and development:

Joint Strategic Needs Assessment – Older People and Dementia
(collaboration with the Public Health Theme)
NHS Cambridgeshire’s Adult Health and Well-being team requested CLAHRC-CP input on the best available and forthcoming evidence for the 2010 update of their JSNA for older people. Discussions and sharing of evidence on dementia identification, support needs and treatment options helped inform commissioning.

Older People’s Mental Health services redesign

Dementia Register scoping exercise

Factors associated with people declining ambulance transport to hospital

Deprivation of Liberty Safeguards for people of all ages with mental ill-health or intellectual disability

Implications for policy, planning and practice from population research:

Demonstrating the impact of population research: The case of MRC-CFAS

Informing service planning for an ageing population: implications of research findings from the Cambridge City over-75s Cohort study
Intervention studies in development:

Sharing previous research findings with practitioners, service users and carers is helping develop new applied research projects:

Exercise and activity interventions for people with dementia in the community and their carers

Hip fracture – a trigger for supportive and palliative care assessment for people with dementia

Evaluation of innovations in the acute sector:

Supported home assessment for people with dementia discharged from hospital

Specialist delirium and dementia ward in Addenbrooke’s Hospital

Specialist dementia nurse secondment

Mental health first aid training

CLAHRC PhD Projects:

Anxiety, depression and health services in older people

Behavioural and psychological symptoms of dementia: understanding the course, causes and impact in the population

CLAHRC Fellows Project:

The impact of dementia on ambulance services

Innovations in person-centred care for people with dementia living in care homes

Developing data registration and retrieval to further research and improve patient care

Costs and quality comparisons of two models of service delivery for early diagnosis and care of patients with dementia

The Dementia and Mental Health in Old Age Team currently comprises:
(see people for further details)

Dr Tom Dening **                         Consultant Old Age Psychiatrist, CPFT Medical Director
Dr Jane Fleming ***             Senior Research Associate
Dr Pranathi Ramachandra ** Consultant Old Age Psychiatrist, CPFT Research Lead, CLAHRC Fellow
Dr Ayesha Khan *      Research Associate (with the Public Health Implementation Theme)
Dr Nadja Smailagic *          Research Associate (with the Public Health Implementation Theme)
Alistair Gaskell ***         CLAHRC Fellow
Uju Okereke ***               CLAHRC Fellow
Matthew Prina **                          PhD Student (with the Public Health Implementation Theme)
Rianne van der Linde                PhD Student (with the Public Health Implementation Theme)

End of Life Care Team: current and planned research studies

The CLAHRC team is based in the Institute of Public Health (IPH), University of Cambridge, and has funding until September 2013. Team members funded from sources other than CLAHRC are based in the General Practice Research Unit in the IPH. The group are currently undertaking the following programme of research:

Hospital admissions at the end of life (CLAHRC funded)

Evaluation of a Specialist Palliative Care professional advice line. (CLAHRC funded)

Template for cancer care reviews in primary care. (Macmillan funded)

“Patient choice” at End of Life: An Anthropological Exploration. (CLAHRC funded)

End of Life Care for the Oldest Old (CLAHRC funded)

End of Life Care discussions in heart failure: a systematic review. (CLAHRC funded)

End of Life Care discussions in COPD: a systematic review. (CLAHRC funded)

End of Life Care discussions in cancer: a systematic review. (Deanery funded)

GP and DN educational needs assessment: a questionnaire study (CLAHRC funded)

Analysis of national datasets of admissions close to the end of life. (CLAHRC funded)

PACE study – patients’ Plans And Care Expectations. (Macmillan funded)

CAPE study: Care Pathways at the End of life. (CLAHRC and NIHR RfPB funded)

Artificial nutrition decisions for people at risk of lacking capacity. (CLAHRC funded)

“Just in case” bags: anticipatory prescribing in End of Life Care. (Deanery funded)

Place of death in dementia. (SHA funded)

Medical student education in End of Life Care (Clinical School and PCT FSF funded)

Hospice at Home – a service evaluation (Hospice Charity and PCT FSF funded)

Impact on service, policy and practice

Many of the broad portfolio of projects associated with the Old Age and End of Life Care Theme have close links with stakeholders in service user, carer, practitioner, commissioner and policy sectors. Ensuring that findings from research, evaluation and other collaborative work have impact where most relevant is a priority, as the following examples highlight:

The questionnaire study of Cambridgeshire and Peterborough GPs and CNs produced a report which was disseminated locally. This highlighted educational and training needs among the professions in these areas. This information will be used in the educational initiative recently funded by the Cambridgeshire HIEC and it is understood that discussions have taken place about the results by people within the PCTs involved in training of these professional groups.

The team has been invited to meetings with clinicians and managers within the PCTs to discuss the findings – to disseminate and explain the research. These meetings have also informed the research team of the context of some of the findings.

The audit of hospice advice lines was carried out to inform Cambridgeshire PCT of changes required to the current arrangements for health professionals to obtain advice on end of life care issues. A report outlining the findings was distributed to relevant parties in the PCT and is to be presented to NHS Cambridgeshire’s End of Life Care Stakeholders group.

The National End of Life Care Programme featured publications reporting evidence synthesis results from two reviews conducted by members of the team on the availability of bereavement support and on end of life care discussions in heart failure. For the latter, meetings with the NHS Improvement Agency and the British Heart Foundation were also crucial in achieving wider dissemination.

Researchers, practitioners and service users involved in a wide range of this theme’s dementia-related projects took part in a series of ‘market-place’ workshops at a stake-holder event held in September 2011 “Dementia Research: Knowledge into Care”. The combination of high profile speakers presenting updates on research and practice innovation in the region, smaller group sessions to outline and discuss CLAHRC-linked projects, and opportunities for networking all contributed to those who attended rating the day an excellent way to forward the aims of bridging the translation gaps from research to practice and back.

The End of Life Care Research Team, funded by the NIHR CLAHRC and other sources currently comprises:

Dr Stephen Barclay ** – Principal Investigator, University Lecturer

Dr Jane Fleming *** – Senior Research Associate

Dr Zoe Morris *** – Senior Research Associate

Dr Morag Farquhar ** – Senior Research Associate

Dr Gemma Clarke ** – Research Associate

Sue Boase ** – Research Associate for CAPE study

Clare Crang * – Research Associate for Macmillan PACE study

Fiona Longstaff ** – Research Nurse for CAPE study and Hospice at Home evaluation

Natalie Momen *** – Research Assistant

Rebecca Whyte * – Research Assistant for DIME Medical Student Education study

Erica Borgstrom *** – PhD student