iWHELD Improves Quality of Life and Well-Being in People With Dementia Living in Nursing Homes

iWHELD may improve quality of life and well-being and can be used with pharmacological treatment for neuropsychiatric symptoms, even during a pandemic, according to a study published in Alzheimer’s and Dementia.

“This study delivers a definitive RCT of the iWHELD program to establish its impact on QoL, agitation, and psychotropic prescribing in nursing home residents with dementia during the COVID-19 pandemic including an evaluation of the impact on individuals who contracted COVID-19,” wrote Joanne McDermid, University of Exeter Medical School, University of Exeter in Exeter, UK, and Institute of Psychiatry, Psychology and Neuroscience, King's College London in London, UK, and coauthors.

iWHELD is a digital program for person-centered care adapted for remote delivery of dementia care in nursing homes during the COVID-19 pandemic. During the 16-week intervention period, the iWHELD intervention significantly improved the quality of life (QoL) of nursing home residents compared with those who received standard treatment. This was evidenced by a significant advantage in the change in QoL for the intervention group compared with the treatments as usual (TAU) group on 2 independent measures of QoL, namely the DEMQOL-Proxy and the EQ-5D-5L. The results of the primary analysis showed that the improvement in QoL was statistically significant for the DEMQOL-Proxy (F=4.3, P=0.04), while the EQ-5D-5L also showed a significant advantage for the intervention group (F=6.5, P=0.01).

The study found no significant difference in the level of agitation or clinically significant agitation between the group that received iWHELD intervention and the group that received TAU. However, the prevalence of clinically significant agitation was 15% lower in the iWHELD group than in the TAU group (37.1% vs. 22.6%). At baseline, there was no difference in the use of psychotropic drugs between the groups (χ2 =1.99, P=0.37), but the iWHELD group had significantly lower use of psychotropics during the follow-up as compared with the TAU group (χ2=4.08, P=0.044).

Participants who contracted COVID-19 during the trial period and were assigned to the iWHELD intervention showed significantly improved quality of life compared with the TAU group. The improvement was measured using EQ-5D-5L and showed a 4.81 (SE 1.30) point benefit with a Cohen's d effect size of 0.27. The frequency of clinically significant agitation was 12% lower at follow-up, as determined by Fisher's exact test (P=0.065). Additionally, participants taking psychotropic medications also experienced benefits from the iWHELD intervention.

“The findings from this trial demonstrate the substantial benefits of iWHELD as an innovative, practical, accessible, and scalable solution to enhance the QoL for residents in nursing home settings,” concluded the study authors.

Reference

McDermid J, Henley W, Corbett A, et al. Impact of the iWHELD digital person-centered care program on quality of life, agitation and psychotropic medications in people with dementia living in nursing homes during the COVID-19 pandemic: A randomized controlled trial. Alzheimers Dement. doi:10.1002/alz.13582