1. Wide Awake Club: Engaging care home residents with dementia in night-time social activities.
Dr Gillian Ward, Reader in Occupational Therapy and Assistive Technologies, Coventry University
Mr. Ed Russell, Director of Innovation, WCS-Care
Introduction: me
CTEHR Cov Uni
Partnership with WCS in a Data Driven Research and Innovation Project.

2. Presentation aim
To describe this innovative practice development - Wide Awake Club: a night-time activity programme to support occupational engagement of care home residents with dementia and night-time wakefulness
Discuss the impact on well-being of care home residents with dementia and care home staff
Consider the value of the Wide Awake Club for occupational therapy

3. Currently run 13 care homes across Warwickshire, including five which have been recognised as 'outstanding' by the Care Quality Commission (CQC)
11 offer day care, long-term residential and short-term respite care for older people and people living with dementia
2 provide rehabilitation, respite and long-term residential care for people with physical disabilities or long-term conditions
Using the latest innovations, techniques and approaches in the homes their aim is to make “Every day well lived”
Context of the setting Wide Awake club is run by WCS-Care who currently run etc……..
One of these care homes for PWD is Drovers House Rugby

4. Drover’s House Rugby Opened in 2013
Purpose-built specialist dementia care home, provides 75 specialist care home places for older people with Alzheimer's and other forms of dementia. 
6 households of between 10 and 13 people
Each household has its own communal open-plan lounge, dining area and kitchen.
Everyone has their own ensuite room, with a personalised front door, and windows overlooking the surrounding neighbourhood, so people can watch the world going by outside, feeling involved in daily community life.
For couples, a double apartment can be created with a bedroom and private lounge, or adjacent bedrooms are available.
There's always lots happening in each household, including daily Oomph! exercise classes and activities,
Drovers House also has a welcoming cafe where residents can meet family and friends for a drink and some cake, a shop where they can stock up on supplies for their household's kitchen, a hair salon and luxury spa bath area.

5. Dementia and sleep disturbance
Over 850,000 people living with Dementia across the United Kingdom (Mitchell et al 2016).
One third of people with dementia live in care homes (Prince et al 2014).
Sleep disturbance in people with dementia is a common and problematic symptom, often accompanied by confusion, wandering and agitation at night-time.
Current non-pharmacological interventions include light therapy (circadian lighting) and increased physical and social activity. Cochrane systematic review underway to summarise best evidence for efficacy of non- pharmacological interventions for sleep disturbances in people with dementia (Wilfling et al 2015).
Recent systematic review and meta-analysis (Abdelhamid et al 2016) of effectiveness of interventions to support nutritional intake in people with dementia found studies with a strong social element around eating/drinking, although small and of low quality, provided consistent suggestion of improvements in aspects of quality of life.
However there were no interventions to support those “night-owls” who sleep during the day.
Facts about dementia and sleep disturbance, night-time wakefulness
Circadian lighting – increasing exposure to blue light wavelengths during the day to stimulate mood, reaction times and attention and reducing this at night time to mimic our natural circadian rhythm.

6. What happens if you don’t sleep?
Fatigue
Short temper/irritability
Lack of Focus
Poor Concentration
Mood changes
Increased risk of accidents
More prone to illness, serious medical conditions, such as obesity, heart disease, high blood pressure and diabetes.
Everyone’s experienced the fatigue, short temper and lack of focus that often follow a poor night’s sleep.
An occasional night without sleep makes you feel tired and irritable the next day, but it won’t harm your health.
After several sleepless nights, the effects become more serious, making it difficult to concentrate and make decisions. You’ll start to feel down, and may fall asleep during the day. Your risk of injury and accidents at home, work and on the road also increases. Further impacts on the person living with dementia.

7. The Wide Awake Club
Residents who are regularly awake between pm and 7am are invited to take part in Wide Awake Club
Held in communal areas on the ground floor to avoid disturbing other residents on household
Normally attend in their night clothes.
Take part in a range of activities offered (or can watch others) including: chair exercises, quizzes, spa bath, hand massage, arts and crafts, jigsaws and watching TV/ films.
Food and drink available
When residents show signs of sleepiness such as yawning, dozing encouraged and helped to go back to bed
Residents may return to the club on more than one occasion in one night.
Wide Awake Club started in March 2016 at Dovers House, residents who had night-time wakefulness were disturbing other residents, night staff found it difficult to support them individually, they were less wakeful during the day and less able to engage in day-time activities and were also at higher risk of poor nutrition and dehydration as they were asleep and missing drinks or meals.
These residents needed to have their day time needs provided for at night-time - read

8. Wide Awake Club Average Attendance March 2016 – January 2017
Month
Attendees
Notes
March 2016 16
3 Residents usually have a meal and go to bed between
April 2016 14
1 death
May 2016 13
1 new admission attends
1 resident that used to attend nightly now attends approx. 3/7
June 2016
 1 resident that used to attend nightly now attends approx. 3/7
July 2016 10
No new attendees , 3 residents settling in bed prior to shift handover, may occasionally wake , attend and return to bed within 1 hour
August 2016
1 resident no longer attends , however remains in household until identified as being sleepy then encouraged to bed
September 2016 9
2 deaths
1 new admission – attends no later than 01:00
October 2016
Residents are being encouraged to bed as soon as they start to become tired or doze off
November 2016 7
2 residents now settled prior to handover
December 2016 5
2 deaths of regular attendees
January 2017 3
One remains until approx. 12 and then retires for the night.
One resident sleeps in chair however when encouraged to bed, re awakens , appears to like company
The Wide Awake Club was introduced at Drovers House, Rugby to support occupational engagement and well-being in March 2016.
Observations show that after 11 months of delivering the Wide-Awake Club there were 16 residents that started, 2 new admissions, 5 deaths, and only 3 residents who attended at the start of the programme were still regularly awake at night-time.

9. Impacts on staff Changes to traditional night time care role
New skills needed
Confidence and improved job satisfaction.
Change from routine night checks, taking people back to bed.
Positive skill development leading to improved interaction with residents and job satisfaction.

10. Impacts on Residents - Evaluation
Funded Pilot study – New WCS-Care Home, Castel Brook, Kenilworth
(VC Challenge, Data Driven Research and Innovation research programme, Coventry University)
Residents (Pre and post intervention)
Sleep Quality (Emfit QS – under mattress sleep monitor)
Dementia Quality of Life (DEMQOL) (Smith et al 2007)
Behaviour changes (Dementia Care Mapping™)
Fluid and Nutrition intake
Activities engaged in and response to activity (During the Wide Awake Club) – Happiness index
Staff (Pre and post intervention)
Qualitative Interview
Self-report questionnaire (Maslach Burnout Inventory – Human Services Survey (MBI-HSS) (Maslach and Jackson 1996).
Results are purely observational at the moment – about to commence a pilot study to evaluate the WAC.

11. Occupational Therapy and night-time activities
Living Well through Activity in Care Homes toolkit (COT 2015) been designed to equip care homes with ideas and materials in order for them to provide a service focused on residents’ needs, preferences and activity choices. In its Quality Standards on the Mental wellbeing of older people in care homes, the National Institute for Health and Care Excellence (NICE) state that: Older people in care homes are offered opportunities during their day to participate in meaningful activity that promotes their health and wellbeing. For people with night-time wakefulness our night IS their day, Wide Awake Club offers a new tool in the toolkit to support living well in care homes
So what are the implications for occupational therapy?
To summariseThis innovative intervention has been developed within a care home for people with dementia by introducing a night-time activity programme to support occupational engagement and well-being and adds further interventions to the “Living Well Through Activity in Care Homes toolkit” (COT 2015) by exploring night-time occupational interventions to support health and well-being.

12. Tweetable messages
Wide Awake Club provides a night-time activity programme to support occupational engagement and well-being for people with dementia and night-time wakefulness.
Wide Awake Club adds new interventions to the “Living Well Through Activity in Care Homes toolkit”
To summarise

13. References
Abdelhamid A, Bunn D, Copley M, Cowap V, Dickinson A, Gray L, Howe A, Killett A, Lee J, Li F, Poland F, Potter J, Richardson K, Smithard D, Fox C, Hooper L. (2016) Effectiveness of interventions to directly support food and drink intake in people with dementia: systematic review and meta-analysis. BMC Geriatrics [Online] 16:26 DOI: /s
College of Occupational Therapists (2015) Living well through activity in care homes toolkit. [Online] Available at: care-homes-toolkit-0 Accessed
Dementia Care Mapping™ (2017) Accessed
Maslach C and Jackson SE (1996) Maslach Burnout Inventory – Human Services Survey (MBI-HSS) in MBI Manual 3rd ed. Palto Alto CA: Consulting Psychological Press
Mitchell S, Lucas C, Norton M & Phipps L. (2016) Dementia risk reduction: it’s never too early, it’s never too late. Perspectives in Public Health 136(2), 79-80
Prince M, Knapp M, Guerchet M, McCrone P, Prina M, Comas-Herrera A, Wittenber, R, Adelaja B, Hu B, King D, Rehill A and Salimkumar, D. (2014). Dementia UK: Update. London: Alzheimer's Society.
Smith S, Lamping D, Bannerjee S, Harwood R, Foley B, Smith P, Knapp M. (2007). Development of a new measure of health-related quality of life for people with dementia: DEMQOL. Psychological Medicine, 37(5), doi: /S
Wilfling D, Junghans A, Marshall L, Eiseman N, Meyer G, Mohler R, Kope S (2015) Non-pharmacological interventions for sleep disturbances in people with dementia. [Online] Available at: Accessed

14. For further information contact
Dr Gill Ward, Centre for Technology Enabled Health Research
Mr Ed Russell, Director of Innovation, WCS-Care