The STAR programme was developed by Dr Linda Teri and colleagues at the University of Washington, USA^(1). The programme focuses on the values, dignity and rights of the person with dementia and the strengths of staff members. It was taught by a variety of health and social care professionals including psychologists, occupational therapists and trainee nurses. STAR is an eight week training programme of two half day workshops and 4 individual sessions. The workshops include a variety of activities such as lectures, group discussion, case studies and videos.

The programme covers the following skills and topics:

• understanding dementia as an illness and the way it affects people and families
• communication skills including listening with respect to people with dementia and their families
• managing behaviour that challenges and identifying signs of anxiety and depression
• understanding why the person with dementia has challenging behaviour, exploring different factors which may contribute to this behaviour and how to work with the person to find effective solutions. The programme calls this identifying activators, behaviours and consequences (ABCs) of behavioural distress
• understanding the influence that the environment can have on behaviour. For example changes in staff or surroundings, noise, being uncomfortable, not having any personal space
• identifying and planning activities for people with dementia to enjoy. The programme calls these pleasant events.

In the UK an estimated 285,000 people with dementia live in care homes⁽²⁾, this is 67% of the total number of adults who live in care homes⁽³⁾. Depression and anxiety are common in people with dementia and their behaviour can change as their condition progresses. The National Dementia Strategy for England ⁽⁴⁾ recommends that specialist dementia care training should be available for all care home staff. However we don’t know how many care home staff have the opportunity to attend specialist training and there is no information on which of the training programmes work best.

Two out of the three studies we looked at for this summary found that the STAR programme helps to reduce depression in some people with dementia living in care homes. However the results need to be interpreted cautiously as both studies were small (less than 65 people with dementia in total took part in them) and only one was a randomised control trial (RCT).

The first was a small RCT in the USA carried out by the team that developed STAR ⁽¹⁾. The study involved 25 staff and 31 people with dementia from four care homes. The care homes were divided into two groups, Staff in the first group were trained using the STAR programme and the second group received usual care home training.

People with dementia were assessed before the training started and again eight weeks after the training had finished: The assessments covered:

• signs of anxiety and depression
• memory and thinking skills
• challenging or unusual behaviour.

Staff were asked about their job satisfaction and if they felt confident that they had the skills they needed to work with people with dementia.

The research found that the anxiety and depression improved among people with dementia when staff had completed the STAR training programme, and there were fewer reports of challenging behaviour among people with dementia. In the care homes where staff did not receive STAR training these symptoms either stayed the same or became worse.

There was no difference in job satisfaction and confidence between the two groups of staff.

The other two small studies, one in the UK and the other in Brazil, looked at the difference the STAR training programme made. However, they did not compare their results with those of care homes where staff only received their usual care home training.

The UK study ⁽⁶⁾. found that, compared to before the training, the people with dementia were less depressed and there were fewer reports of challenging behavior after staff completed the training.

The study in Brazil ⁽⁷⁾ did not find that STAR training made a difference, although there were slightly fewer reports of challenging behaviour, the quality of life of the people with dementia was lower after staff received training. Because the study did not compare the results to those of people in care homes where the staff had not received the training, it is not possible to tell whether some of the changes observed would have happened irrespective of the STAR training.