FITS into practice: translating research into practice in reducing the use of anti-psychotic medication for people with dementia living in care homes.

OBJECTIVES: This paper reports on the acceptability and effectiveness of the FITS (Focussed Intervention Training and Support) into Practice Programme. This intervention was scaled up from an earlier cluster randomised-controlled trial that had proven successful in significantly decreasing antipsychotic prescribing in care homes. METHOD: An in depth 10-day education course in person-centred care was delivered over a three-month period, followed by six supervision sessions. Participants were care-home staff designated as Dementia Care Coaches (DCCs) responsible for implementing interventions in 1 or 2 care homes. The course and supervision was provided by educators called Dementia Practice Development Coaches (DPDCs). Effectiveness data included monitoring antipsychotic prescriptions, goal attainment, knowledge, attitudes and implementation questionnaires. Qualitative data included case studies and reflective journals to elucidate issues of implementation. RESULTS: Of the 100 DCCs recruited, 66 DCCs completed the programme. Pre-post questionnaires demonstrated increased knowledge and confidence and improved attitudes to dementia. Twenty per cent of residents were prescribed antipsychotics at baseline which reduced to 14% (31% reduction) with additional dose reductions being reported alongside improved personalised goal attainment. Crucial for FITS into Practice to succeed was the allocation and protection of time for the DCC to attend training and supervision and to carry out implementation tasks in addition to their existing job role. Evaluation data showed that this was a substantial barrier to implementation in a small number of homes. DISCUSSION AND CONCLUSIONS: The FITS into practice programme was well evaluated and resulted in reduction in inappropriate anti-psychotic prescribing. Revisions to the intervention are suggested to maximise successful implementation.

Give people with dementia a voice in discussions about sex.

In 2015, a 78-year-old man in the US was charged with third-degree felony sexual abuse for having sex with his wife who was living in a care home. One of the factors behind the prosecution was that his wife's daughter felt her mother was unable to give consent for sexual activity.

Effects of hyperoxic training on performance and cardiorespiratory response to exercise.

PURPOSE: To determine whether training in a hyperoxic environment would result in greater increases in VO2max and performance at 90% VO2max as compared with training in normoxia. METHODS: In a single blind design nine athletes trained for 6 wk on a cycle ergometer 3 d.wk(-1), 1 h.d(-1) (10 x 4-min intervals, with 2 min of rest between intervals) at 90% HR(max). Training HR range was maintained by adjusting the power output. Subjects were randomly assigned to H (60% O2) or N (21% O2) breathing conditions for training. After 12 wk of detraining, a second 6-wk training protocol was completed with the breathing conditions reversed. VO2max, performance time at 90% VO2max and cardiorespiratory response to a steady-state exercise at 80% VO2max were measured pre- and posttraining. All pre- and posttraining tests were conducted under normoxic conditions. RESULTS: There were no significant differences between pretraining results for any of the parameters. Power output was 8.1% higher while training in H compared with N, to maintain training HR. Both H and N training resulted in increased performance time, with H being greater than N. Although there was a trend for a greater increase in VO2max after H versus N training, this difference was not significant. HR(max) did not change for H or N. HR VE at 80% VO2max decreased posttraining with no differences between H and N. CONCLUSION: The data showed that a higher power output was required to maintain HR during H training. This increased training intensity during H resulted in improved exercise performance whereas cycling at 90% VO2max in room air and may be due to peripheral factors because cardiorespiratory responses were similar.