MARQUE: Developing an evidence-based intervention to improve agitation for people with dementia in care homes

The MARQUE (Managing Agitation and Raising Quality of Life) study aimed to improve understanding of agitation in care homes, and the quality of life of people with dementia, through an evidence-based training intervention for care home staff. This cluster-randomised control trial, led by researchers at UCL, ran across 10 care homes in England. They found that this intervention improved quality of life, and was feasible and cost-effective for this purpose. 

The MARQUE intervention consists of a number of components including a game to get to know residents’ preferences and interests (Call-to-Mind); a technique to investigate causes of residents’ agitation, propose solutions and record outcomes of those interventions (called Describe, Investigate, Create, Evaluate or DICE); a focus on introducing activities the residents enjoyed; improved communication between staff; and relaxation techniques for staff.

This project aimed to develop this study further, to find out if improvements from the intervention were sustainable over a longer-term period. It aimed to find out whether there was continued implementation of the intervention strategies that staff had learned and, therefore, the intervention had long term effects to increase quality of life. 

Researchers conducted qualitative, face-to-face interviews with care home staff from the original study, 2 years on. Twenty-eight staff participated from across 7 of the 10 care homes. The staff interviewed varied across roles including carers, managers, nurses and activity coordinators.

The intervention was originally intended to be tested across a wider group of care homes, but the COVID-19 pandemic made this impossible. The research team hopes that, with the easing of COVID restrictions, the planned roll-out can restart.

Researchers found that all homes had continued with at least one component of the intervention.

Only one home was still using the full intervention, but results were patchy as many of the staff members who were trained in the MARQUEE technique had left. Overall, the game to get to know residents’ preferences (Call-to-Mind) was the most used intervention, and four of the six homes were still playing it. 

Staff felt their working lives and the culture of the home had improved as a result. 

Researchers found three themes in the responses from staff. They described improved communication between staff, more respect for junior colleagues, and an increased willingness to try new strategies. One nurse said: "We used to wait for somebody coming from ..outside.. tell us to do 1,2,3. But now I think the studies have opened our mind to say, okay, you can do this yourself".

The interviews illustrated the original study's findings that MARQUE training improved the quality of life of residents living with dementia, and is likely to improve it in the long-term.

The study showed that MARQUE empowered staff at all levels to manage agitation and interact more successfully with care home residents. This is likely to improve quality of life not just for residents, but for the staff themselves

This is a small study, but it suggests the MARQUE intervention could be rolled out more widely.

University College London

Camden and Islington NHS Foundation Trust

Brighton and Sussex Medical School and Sussex Partnership, NHS Foundation Trust

National Institute for Health Research (NIHR)

Economic and Social Research Council (ESRC)

NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) North Thames (now 'ARC North Thames')

UCLH NIHR Biomedical Research Centre