Wellbeing Groups in Dementia Care Services: A Review of Attendee and Carer Satisfaction

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The National Dementia Strategy (Department of Health 2009) states that there are currently 700,000 people in Britain with dementia, with this number expected to double within the next 30 years. With this in mind, the strategy aims to improve the care of people with dementia, with more focus on treatment and management. In addition, the National Institute for Health and Clinical Excellence (NICE) released guidelines calling for improvements in the wellbeing of older adults (NICE 2008, 2006).

The wellbeing groups in Rossendale were planned to enhance the interventions offered by the memory service, developed initially in 2002 following the person-centred approach developed by Tom Kitwood, a leading researcher in dementia care. The wellbeing groups have been running since May 2005 in response to service developments, which included the closure of day hospitals.

Underlying principles of the wellbeing group

Wellbeing in dementia

Kitwood and Bredin (1992) described 12 indicators of wellbeing in dementia:

* The assertion of desire/will

* The ability to experience and express a range of emotions

* Initiation of social contact

* Affectional warmth

* Social sensitivity

* Self-respect

* Acceptance of other people with dementia

* Humour

* Creativity and self-expression

* Showing evident pleasure

* Helpfulness

* Relaxation.

The National Health Service (NHS) Scotland (2006) states that mental wellbeing includes life satisfaction, optimism, self-esteem, mastery and feeling in control, having a purpose in life, and a sense of belonging and support. The United Kingdom (UK) Inquiry into Mental Health and Well-being in Later Life (Age Concern and the Mental Health Foundation 2006) identified five key factors affecting the mental health and wellbeing of older people. These were discrimination, participation in meaningful activity, relationships, physical health and poverty.

Many service users in Rossendale were lacking positive contact that validated them as human beings. Although many had regular contact with their family, they did not have peer support. Community-based day centres provide this contact, but many service users did not feel ready for this. Most of those seen by the memory service were assessed as low in mood, lacking in confidence and experiencing little wellbeing. The wellbeing groups aimed to encourage a sense of wellbeing by providing positive social contact, the opportunity to achieve through the completion of tasks and the opportunity to engage in meaningful activity, and encouraging a sense of belonging through interaction with others with similar difficulties.

Wilcock (1993, p17) stated: 'The need for an individual to engage in purposeful occupation is innate and is related to health and survival.' Chung (2004) noted that although people with dementia experienced deteriorating cognitive abilities, their innate need for activity participation remained. The UK Inquiry into Mental Health and Well-being in Later Life (Age Concern and the Mental Health Foundation 2006) stated that self-help and peer support were necessary when supporting people with mental health problems. Brooker and Duce (2000) observed that meeting in groups could fulfil the basic need for belonging.

Despite the inherent benefits of activity, it should be noted that for individuals with dementia, their declining cognitive functions often hinder them from meaningful participation in activities (Baum and Edwards 1993). People with dementia are often excluded from group activities, which may provide opportunities for occupational and social activity. The skilled structuring of an activity group can help to compensate for these disabilities, which can be an important factor in improving self-esteem and belonging (David 1991).

Group aims and sessions

The initial group aims were:

* Confidence building

* Resocialisation

* Increasing social skills

* Regaining identity and role

* Reskilling

* Exploring new or old hobbies

* Increasing motivation

* Encouraging active participation

* Allowing successful achievements

* Increasing alertness

* Increasing wellbeing

* Promoting awareness of surroundings. …