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de Souto Barreto P, Demougeot L, Pillard F, Lapeyre-Mestre M, Rolland Y. Exercise training for managing behavioral and psychological symptoms in people with dementia: A systematic review and meta-analysis. Ageing Res Rev 2015; 24:274-85. [PMID: 26369357 DOI: 10.1016/j.arr.2015.09.001] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 08/20/2015] [Accepted: 09/09/2015] [Indexed: 12/11/2022]
Abstract
This systematic review and meta-analysis of randomized controlled trials assessed the effects of exercise on behavioral and psychological symptoms of dementia (BPSD, including depression) in people with dementia (PWD). Secondary outcomes for the effects of exercise were mortality and antipsychotic use. Twenty studies were included in this review (n=18 in the meta-analysis). Most studies used a multicomponent exercise training (n=13) as intervention; the control group was often a usual care (n=10) or a socially-active (n=8) group. Exercise did not reduce global levels of BPSD (n=4. Weighted mean difference -3.884; 95% CI -8.969-1.201; I(2)=69.4%). Exercise significantly reduced depression levels in PWD (n=7). Standardized mean difference -0.306; 95% CI -0.571 to -0.041; I(2)=46.8%); similar patterns were obtained in sensitivity analysis performed among studies with: institutionalized people (p=0.038), multicomponent training (p=0.056), social control group (p=0.08), and low risk of attrition bias (p=0.11). Exploratory analysis showed that the principal BPSD (other than depression) positively affected by exercise was aberrant motor behavior. Exercise had no effect on mortality. Data on antipsychotics were scarce. In conclusion, exercise reduces depression levels in PWD. Future studies should examine whether exercise reduces the use (and doses) of antipsychotics and other drugs often used to manage BPSD.
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Holle D, Krüger C, Halek M, Sirsch E, Bartholomeyczik S. Experiences of nursing staff using dementia-specific case conferences in nursing homes. Am J Alzheimers Dis Other Demen 2015; 30:228-37. [PMID: 25260597 PMCID: PMC10852842 DOI: 10.1177/1533317514552320] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Dementia specific-case conferences with the Innovative dementia oriented assessment tool (CC-IdA) could be an important tool with which to analyze and manage challenging behavior. The study gives an insight into nursing staff' experiences using CC-IdA in dementia care. METHODS Qualitative interviews were conducted with 18 nursing teams from 12 nursing homes alongside a quasi-experimental study. In addition, observational field notes were taken. Interviews and observational field notes were analyzed using the thematic content analysis. RESULTS CC-IdA contributed to a reflective handling of challenging behavior, to changes in the communication with residents and to the identification of potentially triggers of challenging behavior. Factors influencing the implementation of CC-IdA were among others a lack of moderation skills, limited knowledge of dementia, a lack of biographical information and a lack of involvement by other professionals. CONCLUSIONS CC-IdA represents an important tool in the management of challenging behavior of people with dementia. For the successful implementation of these case conferences, both structural and personal resources are needed.
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Affiliation(s)
- Daniela Holle
- German Center for Neurodegenerative Diseases (DZNE), Witten, Germany School of Nursing Science, Witten/Herdecke University, Witten, Germany
| | - Cornelia Krüger
- School of Nursing Science, Witten/Herdecke University, Witten, Germany Medical Advisory Service of Compulsory Health Insurance Funds, Munich, Germany
| | - Margareta Halek
- German Center for Neurodegenerative Diseases (DZNE), Witten, Germany School of Nursing Science, Witten/Herdecke University, Witten, Germany
| | - Erika Sirsch
- German Center for Neurodegenerative Diseases (DZNE), Witten, Germany
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Pélissier C, Fontana L, Fort E, Vohito M, Sellier B, Perrier C, Glerant V, Couprie F, Agard JP, Charbotel B. Impaired mental well-being and psychosocial risk: a cross-sectional study in female nursing home direct staff. BMJ Open 2015; 5:e007190. [PMID: 25829371 PMCID: PMC4386217 DOI: 10.1136/bmjopen-2014-007190] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES The present study sought to quantify the impaired mental well-being and psychosocial stress experienced by nursing home staff and to determine the relationship between impaired mental well-being assessed on the 12-item General Health Questionnaire (GHQ-12) and exposure to psychosocial stress assessed on Siegrist's effort/reward and overcommitment model. METHODS A transverse study was conducted in France on 2471 female employees in 105 nursing homes for the elderly. Personal and occupational data were collected by questionnaire for 668 housekeepers, 1454 nursing assistants and 349 nurses. RESULTS 36.8% of participants (n=896) showed impaired mental well-being, 42.7% (n=1039) overcommitment and 9% (n=224) effort/reward imbalance. Overcommitment (prevalence ratio (PR)=1.27; 95% CI (1.21 to 1.34)) and effort-reward imbalance (PR=1.19; 95% CI (1.12 to 1.27)) were significantly associated with presence of impaired mental well-being after adjustment for personal factors (age and private life events). Taking effort and reward levels into account, the frequency of impaired mental well-being was highest in case of exposure to great extrinsic effort and low rewards of any type: esteem, PR=3.53, 95% CI (3.06 to 4.08); earnings, PR=3.48, 95% CI (2.99 to 4.06); or job security, PR=3.30, 95% CI (2.88 to 3.78). Participants in situations of overcommitment and of effort/reward imbalance were at the highest risk of impaired mental well-being: PR=3.86, 95% CI (3.42 to 4.35). CONCLUSIONS Several changes in nursing home organisation can be suggested to reduce staff exposure to factors of psychosocial stress. Qualitative studies of the relation between impaired mental well-being and psychosocial stress in nursing home staff could guide prevention of impaired mental well-being at work.
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Affiliation(s)
- C Pélissier
- Université Lyon 1, UMRESTTE (IFSTTAR/UCLB joint unit), Domaine Rockefeller, Lyon, France
- Service de Santé au Travail, CHU de Saint-Etienne, Saint-Etienne, France
| | - L Fontana
- Université Lyon 1, UMRESTTE (IFSTTAR/UCLB joint unit), Domaine Rockefeller, Lyon, France
- Service de Santé au Travail, CHU de Saint-Etienne, Saint-Etienne, France
| | - E Fort
- Université Lyon 1, UMRESTTE (IFSTTAR/UCLB joint unit), Domaine Rockefeller, Lyon, France
| | - M Vohito
- AST Grand Lyon, Villeurbanne, Cedex, France
| | | | - C Perrier
- AST Grand Lyon, Villeurbanne, Cedex, France
| | | | - F Couprie
- AST Grand Lyon, Villeurbanne, Cedex, France
| | | | - B Charbotel
- Université Lyon 1, UMRESTTE (IFSTTAR/UCLB joint unit), Domaine Rockefeller, Lyon, France
- Hospices Civils de Lyon, Service des Maladies Professionnelles, Centre Hospitalier Lyon Sud, Pierre Bénite, France
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Coming to grips with challenging behaviour: A cluster randomised controlled trial on the effects of a new care programme for challenging behaviour on burnout, job satisfaction and job demands of care staff on dementia special care units. Int J Nurs Stud 2015; 52:68-74. [DOI: 10.1016/j.ijnurstu.2014.10.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Revised: 09/10/2014] [Accepted: 10/03/2014] [Indexed: 11/24/2022]
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Holle D, Roes M, Buscher I, Reuther S, Müller R, Halek M. Process evaluation of the implementation of dementia-specific case conferences in nursing homes (FallDem): study protocol for a randomized controlled trial. Trials 2014; 15:485. [PMID: 25496425 PMCID: PMC4295267 DOI: 10.1186/1745-6215-15-485] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Accepted: 12/01/2014] [Indexed: 11/29/2022] Open
Abstract
Background Challenging behaviors exhibited by individuals with dementia might result from an unmet need that they cannot communicate directly due to cognitive restrictions. A dementia-specific case conference represents a promising means of analyzing and exploring these unmet needs. The ongoing FallDem study is a stepped-wedged, cluster-randomized trial evaluating the effects of two different types of dementia-specific case conferences on the challenging behaviors of nursing home residents. This study protocol describes the process evaluation that is conducted, along with the FallDem study. The goal of the process evaluation is to explain potential discrepancies between expected and observed outcomes, and to provide insights into implementation processes and recruitment strategies, as well as the contexts and contextual factors that promote or inhibit the implementation of dementia-specific case conferences. Methods/Design The process evaluation will use a mixed-method design comprising longitudinal elements, in which quantitative and qualitative data will be gathered. Qualitative data will be analyzed using content analysis, documentary analysis and a documentary method. Quantitative data (standardized questionnaires) will be analyzed using descriptive statistics. Both types of data will complement one another and provide a more comprehensive picture of the different objects under investigation. Discussion The process evaluation will allow for a comprehensive understanding of the changing processes and mechanisms underlying the ‘black box’ of the complex intervention of the FallDem study. These findings will provide practical knowledge regarding issues related to the implementation of dementia-specific case conferences in nursing homes. Trial registration Current Controlled Trials identifier: ISRCTN20203855, registered on 10th July 2013.
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Affiliation(s)
- Daniela Holle
- German Center for Neurodegenerative Diseases (DZNE), Stockumer Str, 12, 58453 Witten, Germany.
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Marx KA, Stanley IH, Van Haitsma K, Moody J, Alonzi D, Hansen BR, Gitlin LN. Knowing Versus Doing: Education and Training Needs of Staff in a Chronic Care Hospital Unit for Individuals With Dementia. J Gerontol Nurs 2014; 40:26-34; quiz 36-7. [DOI: 10.3928/00989134-20140905-01] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 07/28/2014] [Indexed: 11/20/2022]
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de Souto Barreto P, Lapeyre-Mestre M, Vellas B, Rolland Y. From rural to urban areas: differences in behavioural and psychological symptoms of dementia in nursing home residents according to geographical location. Psychogeriatrics 2014; 14:229-34. [PMID: 25495084 DOI: 10.1111/psyg.12063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Revised: 07/18/2014] [Accepted: 08/05/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND We determined whether the prevalence of behavioural and psychological symptoms of dementia (BPSD) in institutionalized older adults differed according to the geographical location of different facilities. METHODS This cross-sectional study covered 175 nursing homes (NH) in France (n = 6275; age, 86.0 ± 8.2 years; women, 73.7%). Information on NH residents' health status and NH structure and internal organization were recorded by the NH staff. Each participant was coded for the presence or absence of the following BPSD: aggressive, screaming, and wandering behaviours. NH were geographically defined as rural (<2000 inhabitants), low urban (2000 ≤ inhabitants < 10 000), intermediate urban (10 000 ≤ inhabitants < 100 000), or high urban (inhabitants ≥ 100 000). RESULTS Adjusted binary logistic regressions showed that, compared with residents living in rural NH, those living in NH located in high-urban areas had a significantly higher risk of aggressiveness (odds ratio = 1.33; 95% confidence interval = 1.06-1.67) and screaming (odds ratio = 1.43; 95% confidence interval = 1.05-1.95). The likelihood of aggressiveness was also higher in residents living in NH located in intermediate-urban areas (odds ratio = 1.36; 95% confidence interval = 1.13-1.65). CONCLUSIONS Rurality seems to play a positive role in the expression of BPSD. If this hypothesis were confirmed, it would encourage NH staff to develop activities that explore rural potentials for the management of BPSD.
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Affiliation(s)
- Philipe de Souto Barreto
- Gérontopôle of Toulouse, Institute of Ageing, University Hospital of Toulouse (CHU Toulouse), Toulouse, France; UMR7268 Aix-Marseille University Biocultural Anthropology Laboratory, Marseille, France
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Palm R, Bartholomeyczik S, Roes M, Holle B. Structural characteristics of specialised living units for people with dementia: a cross-sectional study in German nursing homes. Int J Ment Health Syst 2014; 8:39. [PMID: 25360154 PMCID: PMC4213458 DOI: 10.1186/1752-4458-8-39] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 10/12/2014] [Indexed: 11/30/2022] Open
Abstract
Background Living units (LU) specialised for people with dementia are an important feature of nursing homes. Little is known about their structural characteristics, and an international definition is lacking. This study explored characteristics of the environment and staff from defined LU types to identify differences between them. Design Cross-sectional study comparing five types of LUs. LUs were defined based on their living concept (segregated and integrated), size (small and large scale), and funding (extra funded and not extra funded). Differences were identified using descriptive statistics, Chi-Square resp. Kruskal-Wallis-Test and post-hoc analysis with Bonferroni corrections. Results In total, 103 LUs from 51 nursing homes participated: 63 integrated and 40 segregated LUs; 48 integrated and 31 segregated LUs were large. Sixteen large segregated LUs were extra funded. Regarding the environment, a distinctive feature of small LUs was a higher percentage of single rooms. Small integrated LUs provided and served meals more in a homelike manner than other LUs. LUs did not differ in their interior and access for the residents to use outdoor areas. Regarding the staff, small LUs provided more staff, but they were not exclusively assigned to the LUs. Large segregated LUs with additional funding provided more registered nurses and nurses with a special qualification per resident than the other large LUs. Conclusion Nursing homes implemented different features in their specialised LUs. Because single room availability, homelike provision of meals, staff quantity, quality and continuity may influence residents’ outcomes, it is necessary to investigate whether differences are apparent in future evaluation studies of specialised LUs for people with dementia.
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Affiliation(s)
- Rebecca Palm
- German Centre for Neurodegenerative Diseases, Stockumer Str. 12, 58453 Witten, Germany ; Faculty of Health, School of Nursing Science, Witten/Herdecke University (UW/H), Stockumer Str. 12, 58453 Witten, Germany
| | - Sabine Bartholomeyczik
- Faculty of Health, School of Nursing Science, Witten/Herdecke University (UW/H), Stockumer Str. 12, 58453 Witten, Germany
| | - Martina Roes
- German Centre for Neurodegenerative Diseases, Stockumer Str. 12, 58453 Witten, Germany ; Faculty of Health, School of Nursing Science, Witten/Herdecke University (UW/H), Stockumer Str. 12, 58453 Witten, Germany
| | - Bernhard Holle
- German Centre for Neurodegenerative Diseases, Stockumer Str. 12, 58453 Witten, Germany ; Faculty of Health, School of Nursing Science, Witten/Herdecke University (UW/H), Stockumer Str. 12, 58453 Witten, Germany
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Zwijsen SA, Smalbrugge M, Eefsting JA, Gerritsen DL, Hertogh CMPM, Pot AM. Grip on challenging behavior: process evaluation of the implementation of a care program. Trials 2014; 15:302. [PMID: 25059544 PMCID: PMC4132912 DOI: 10.1186/1745-6215-15-302] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Accepted: 07/14/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Grip on Challenging Behavior care program for managing challenging behavior was implemented in the dementia special care units of 17 Dutch nursing homes. A process evaluation of the implementation of the care program was performed to determine the quality of the implementation and the lessons to be learned for future implementation. METHODS The care program was implemented according to a stepped wedge design. First-order data (data on recruitment, reach, relevance and feasibility) were used to determine the validity of the study, and second-order data (intervention quality and the barriers and facilitators for implementing the care program) were used to describe the implementation process. Two structured questionnaires were administered to care staff and key stakeholders and semi-structured interviews were held in the units. RESULTS University affiliated and non-affiliated nursing homes from different parts of the Netherlands participated. The resident participation rate was over 95% and the participation rate for the training sessions was 82%. Respondents considered the care program relevant and feasible. The degree of implementation was not optimal. The barriers and facilitators in implementing the care program could be divided into three categories: organizational aspects, culture on the unit and aspects of the care program itself. CONCLUSIONS The recruitment, reach, relevance and feasibility are sufficient to allow for analysis and generalization of the effects of the care program, but the degree of implementation should be taken into account in further analysis. Future projects that involve implementation should consider the specific features of the organization and the cultural orientation of the unit to better adapt to specific needs. TRIAL REGISTRATION The Netherlands National Trial register under number NTR2141 registered on 11 December 2009. Randomization took place in November 2010, and the first intervention group started using the intervention in February 2011.
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Affiliation(s)
- Sandra A Zwijsen
- Department of General Practice and Elderly Care Medicine/EMGO + Institute for Health and Care Research, VU Medical Center, Amsterdam, the Netherlands.
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The satisfaction with the quality of dementia care and the health, burnout and work ability of nurses: A longitudinal analysis of 50 German nursing homes. Geriatr Nurs 2014; 35:42-6. [DOI: 10.1016/j.gerinurse.2013.09.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Revised: 09/09/2013] [Accepted: 09/16/2013] [Indexed: 11/18/2022]
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de Souto Barreto P, Lapeyre-Mestre M, Vellas B, Rolland Y. Potential underuse of analgesics for recognized pain in nursing home residents with dementia: A cross-sectional study. Pain 2013; 154:2427-2431. [DOI: 10.1016/j.pain.2013.07.017] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Revised: 07/11/2013] [Accepted: 07/15/2013] [Indexed: 11/30/2022]
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