1
|
Cheng YT, Xin GK, Wang YL, Tan FY, Yuan L, Zhang Y, Liu Y, Ni CP. The current status of apathy in patients with dementia and its factors: A systematic review. Geriatr Nurs 2024; 58:290-297. [PMID: 38848610 DOI: 10.1016/j.gerinurse.2024.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 05/14/2024] [Accepted: 05/22/2024] [Indexed: 06/09/2024]
Abstract
OBJECTIVE To systematically evaluate the current status of apathy in dementia patients and its associated factors. METHODS We searched Chinese and English databases to collect studies on the associated factors of apathy in patients with dementia from inception to March 14, 2023. Two researchers independently screened the literature, evaluated the quality, and extracted the data RESULTS: A total of 20 studies were included, and the incidence of apathy in patients with dementia ranged from 21 % to 90 %. According to the model of apathy proposed by Massimo in 2018, the associated factors were divided into individual factors for dementia patients, caregiver factors, and environmental factors. The individual factors of apathy in patients with dementia mainly include demographic characteristics, the severity of cognitive impairment, a combination of other behavioral and psychological symptoms of dementia, acute medical problems or adverse drug reactions, unmet needs, and malnutrition. Caregiver factors mainly include emotional expressions of hostility or criticism towards dementia patients and caregivers' expectations for a better life in the future. Environmental factors mainly include too high or too low stimulation and a lack of daytime activities CONCLUSIONS: Existing studies have shown that the incidence of apathy in dementia patients is high and is affected by multi-dimensional factors. There are more studies on individual factors in dementia patients and fewer studies on caregivers and environmental factors. In the future, a large number of high-quality studies are needed to demonstrate the mechanism of apathy in dementia patients and to find more related factors.
Collapse
Affiliation(s)
- Yue-Tong Cheng
- Department of Nursing, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China; School of Nursing, China Medical University, Shenyang, Liaoning Province, PR China
| | - Gong-Kai Xin
- School of Nursing, China Medical University, Shenyang, Liaoning Province, PR China
| | - Ye-Lv Wang
- School of Nursing, China Medical University, Shenyang, Liaoning Province, PR China
| | - Feng-Ying Tan
- School of Nursing, China Medical University, Shenyang, Liaoning Province, PR China
| | - Lei Yuan
- School of Nursing, China Medical University, Shenyang, Liaoning Province, PR China
| | - Yu Zhang
- School of Nursing, China Medical University, Shenyang, Liaoning Province, PR China; Department of Nephrology, The Fourth Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, PR China
| | - Yu Liu
- School of Nursing, China Medical University, Shenyang, Liaoning Province, PR China
| | - Cui-Ping Ni
- School of Nursing, China Medical University, Shenyang, Liaoning Province, PR China.
| |
Collapse
|
2
|
Abowari-Sapeh ME, Ackah JA, Murphy JL, Akudjedu TN. Towards an improved dementia care experience in clinical radiography practice: A state-of-the-art review. J Med Imaging Radiat Sci 2024; 55:307-319. [PMID: 38365469 DOI: 10.1016/j.jmir.2024.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 11/24/2023] [Accepted: 01/25/2024] [Indexed: 02/18/2024]
Abstract
INTRODUCTION The increasing global incidence rate of dementia and associated co/multimorbidity has consequently led to a rise in the number of people with dementia (PwD) requiring clinical radiography care services. This review aims to explore and integrate findings from diverse settings with a focus on the experiences of PwD and stakeholders, towards the development of a holistic approach for dementia care and management within the context of radiography services. METHOD An electronic search was performed across the following databases: PUBMED, CINAHL, Medline, SCOPUS, and ScienceDirect for articles published from January 2009 and June 2023. Articles were included if they fulfilled a predefined criteria mainly focused on experiences of PwD and/or other stakeholders when using the radiography services. Data obtained from the included studies were analysed using a result-based convergent synthesis. RESULT Eleven studies from diverse settings met the inclusion criteria. A mix of both positive and negative experiences of PwD and stakeholders were reported following visits to radiology and radiotherapy departments were highlighted across settings. The findings were themed around the need for: person-centred care, effective communication, attitudinal changes of staff, specialised and improved clinical environment and inclusion of caregivers for the care of PwD. DISCUSSION This study emphasise the critical importance of adopting holistic approaches to caring for PwD. This involves adopting a person-centred approach, actively involving caregivers, effective communication, and adequate training for radiographers to provide quality services, all in dementia-friendly environments. CONCLUSION The experiences of various stakeholders highlight the need for a more holistic approach and strategy for the care and management of PwD within the context of the radiography services. This calls for an urgent need for a comprehensive strategy that includes awareness creation of staff to enhance the quality of care and the overall experience for PwD using the radiography services.
Collapse
Affiliation(s)
- Mendes E Abowari-Sapeh
- Department of Medical Science & Public Health, Faculty of Health & Social Sciences, Institute of Medical Imaging and Visualisation, Bournemouth Gateway Building, Bournemouth University, 10 St Pauls' Lane, BH8 8GP, UK; Oncology Department, Research & Development Unit, Royal Cornwall Hospital, Truro, UK
| | - Joseph A Ackah
- Department of Medical Science & Public Health, Faculty of Health & Social Sciences, Institute of Medical Imaging and Visualisation, Bournemouth Gateway Building, Bournemouth University, 10 St Pauls' Lane, BH8 8GP, UK
| | - Jane L Murphy
- Faculty of Health and Social Sciences, Ageing and Dementia Research Centre, Bournemouth University, UK
| | - Theophilus N Akudjedu
- Department of Medical Science & Public Health, Faculty of Health & Social Sciences, Institute of Medical Imaging and Visualisation, Bournemouth Gateway Building, Bournemouth University, 10 St Pauls' Lane, BH8 8GP, UK.
| |
Collapse
|
3
|
Tasseron-Dries PEM, Smaling HJA, Nakanishi M, Achterberg WP, van der Steen JT. What are best practices for involving family caregivers in interventions aimed at responsive behaviour stemming from unmet needs of people with dementia in nursing homes: a scoping review. BMJ Open 2023; 13:e071804. [PMID: 38149428 PMCID: PMC10711828 DOI: 10.1136/bmjopen-2023-071804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 11/03/2023] [Indexed: 12/28/2023] Open
Abstract
OBJECTIVES This study aimed to determine best practices for involving family caregivers in interventions aimed at preventing and reducing responsive behaviour stemming from unmet needs, including pain. DESIGN Scoping review, reported according to the Preferred Reporting Items for Systematic Reviews, Meta-Analyses extension for Scoping Reviews reporting guideline. DATA SOURCES PubMed, Embase, Emcare, Web of Science, COCHRANE Library, PsycINFO, Academic Search Premier and Cinahl searched up to 23 July 2023. ELIGIBILITY CRITERIA Studies reporting on family involvement in interventions for nursing home residents with dementia were included. DATA EXTRACTION AND SYNTHESIS Two researchers independently extracted the data, followed by a content analysis. RESULTS Of the 1486 records screened, 20 studies were included. Family caregivers were involved in interventions aimed at planning care, life review (eg, documentation of life experiences of their relative), and selecting activities for their relative. Family caregivers preferred an active role in developing optimal care for their relative. Drivers of success and barriers to family involvement centred around three themes: (1) communication between all involved; (2) prerequisites (organisational and other conditions) and (3) personal circumstances (family's coping and skills). CONCLUSION Best practices for involving family caregivers in interventions aimed at addressing responsive behaviour in residents with dementia concerned those interventions in which family caregivers were given an important role in managing responsive behaviour. This means that, in order to achieve an active role of family caregivers in the whole care process, their needs must be taken into account. TRIAL REGISTRATION NUMBER The protocol of the review was regisered at OSF; https://osf.io/twcfq.
Collapse
Affiliation(s)
- Petra E M Tasseron-Dries
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
- Stichting Warande (Nursing Home Organization), Zeist, The Netherlands
- University Network of the Care Sector South Holland, Leiden University Medical Center, Leiden, The Netherlands
| | - Hanneke J A Smaling
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
- University Network of the Care Sector South Holland, Leiden University Medical Center, Leiden, The Netherlands
| | - Miharu Nakanishi
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
- Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Wilco P Achterberg
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
- University Network of the Care Sector South Holland, Leiden University Medical Center, Leiden, The Netherlands
| | - Jenny T van der Steen
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
- Primary and Community Care, and Radboudumc Alzheimer Center, Radboud university medical center, Nijmegen, The Netherlands
| |
Collapse
|
4
|
Vuic B, Konjevod M, Tudor L, Milos T, Nikolac Perkovic M, Nedic Erjavec G, Pivac N, Uzun S, Mimica N, Svob Strac D. Tailoring the therapeutic interventions for behavioral and psychological symptoms of dementia. Expert Rev Neurother 2022; 22:707-720. [PMID: 35950234 DOI: 10.1080/14737175.2022.2112668] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Behavioral and psychological symptoms of dementia (BPSD) are symptoms of non-cognitive nature, which frequently develop during the course and different stages of dementia. The diagnosis of BPSD is complex due to symptom variety, and relies on detailed clinical evaluation and medical history. Accurate assessment of BPSD is crucial in order to tailor therapeutic intervention (non-pharmacological and pharmacological) for each individual and monitor patient response to therapy. AREAS COVERED This review encompasses the epidemiology, classification, assessment and etiology of BPSD, as well as their impact on caregiver distress, and gives an overview of current and emerging non-pharmacological and pharmacological therapeutic options, as well as potential BPSD biomarkers, in order to provide a framework for improving BPSD diagnosis and developing novel, targeted and specific therapeutic strategies for BPSD. EXPERT OPINION Due to the large heterogeneity of BPSD and of the fact that drugs available only alleviate symptoms, finding an adequate treatment is very challenging and often involves a polytherapeutic approach. Non-pharmacologic interventions have shown promising results in improving BPSD, however further research is needed to confirm their beneficial effects. Thus, the modification of pre-existancing as well as the development of novel pharmacologic and non-pharmacologic solutions should be considered for BPSD therapy.
Collapse
Affiliation(s)
- Barbara Vuic
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Ruder Boskovic Institute, Bijenicka cesta 54, 10000 Zagreb, Croatia
| | - Marcela Konjevod
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Ruder Boskovic Institute, Bijenicka cesta 54, 10000 Zagreb, Croatia
| | - Lucija Tudor
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Ruder Boskovic Institute, Bijenicka cesta 54, 10000 Zagreb, Croatia
| | - Tina Milos
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Ruder Boskovic Institute, Bijenicka cesta 54, 10000 Zagreb, Croatia
| | - Matea Nikolac Perkovic
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Ruder Boskovic Institute, Bijenicka cesta 54, 10000 Zagreb, Croatia
| | - Gordana Nedic Erjavec
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Ruder Boskovic Institute, Bijenicka cesta 54, 10000 Zagreb, Croatia
| | - Nela Pivac
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Ruder Boskovic Institute, Bijenicka cesta 54, 10000 Zagreb, Croatia
| | - Suzana Uzun
- Department for Biological Psychiatry and Psychogeriatry, University Hospital Vrapce, 10 000 Zagreb, Croatia
| | - Ninoslav Mimica
- Department for Biological Psychiatry and Psychogeriatry, University Hospital Vrapce, 10 000 Zagreb, Croatia
| | - Dubravka Svob Strac
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Ruder Boskovic Institute, Bijenicka cesta 54, 10000 Zagreb, Croatia
| |
Collapse
|
5
|
Tan EY, de Vugt ME, Deckers K, Schols JM, Verhey FR. Interaction of caregiver-expressed emotions and neuropsychiatric symptoms in persons with dementia: a longitudinal cohort study. BMJ Open 2021; 11:e046869. [PMID: 34588239 PMCID: PMC8480002 DOI: 10.1136/bmjopen-2020-046869] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Neuropsychiatric symptoms (NPS) have a major impact in persons with dementia (PwD). The interaction between the caregiver and the person with dementia may be related to the emergence of NPS. The concept of expressed emotion (EE) is used to capture this dyadic interaction. The aim of the present study is to examine longitudinally the association between EE in caregivers and NPS in PwD living at home. DESIGN A longitudinal cohort study with 2 years of follow-up. SETTING PwD and their informal caregivers living at home in the south of the Netherlands. PARTICIPANTS 112 dyads of PwD and their caregivers from the MAAstricht Study of BEhavior in Dementia. MAIN OUTCOME MEASURES EE was measured at baseline with the Five-Minute Speech Sample and was used to classify caregivers in a low-EE or high-EE group. Associations between EE and neuropsychiatric subsyndromes (hyperactivity, mood and psychosis) measured with the Neuropsychiatric Inventory (NPI) were analysed over time. RESULTS Seventy-six (67.9%) caregivers were classified in the low-EE group and 36 (32.1%) in the high-EE group. There was no difference between the EE groups in mean NPI scores over time. In the high-EE group, hyperactivity occurred more frequently than in the low-EE group at baseline (p=0.013) and at the other time points, but the mean difference was not always significant. There were no differences for the mood and psychosis subsyndromes. PwD with caregivers scoring high on the EE subcategory critical comments had an increased risk of institutionalisation (OR 6.07 (95% CI 1.14 to 32.14, p=0.034)) in comparison with caregivers scoring low on critical comments. CONCLUSIONS High EE in informal caregivers is associated with hyperactivity symptoms in PwD. This association is likely to be bidirectional. Future studies investigating this association and possible interventions to reduce EE are needed.
Collapse
Affiliation(s)
- Eva Yl Tan
- Alzheimer Centre Limburg, School for Mental Health and Neuroscience, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
- Reinier van Arkel Group, s-Hertogenbosch, Netherlands
| | - Marjolein E de Vugt
- Alzheimer Centre Limburg, School for Mental Health and Neuroscience, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Kay Deckers
- Alzheimer Centre Limburg, School for Mental Health and Neuroscience, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Jos Mga Schols
- Department of General Practice, School for Public Health and Primary Care (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Frans Rj Verhey
- Alzheimer Centre Limburg, School for Mental Health and Neuroscience, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| |
Collapse
|
6
|
Chaudhury H, Murray K, Seetharaman K. Special Care Units. ENCYCLOPEDIA OF GERONTOLOGY AND POPULATION AGING 2021:4722-4728. [DOI: 10.1007/978-3-030-22009-9_855] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/19/2023]
|
7
|
Practical nursing recommendations for palliative care for people with dementia living in long-term care facilities during the COVID-19 pandemic: A rapid scoping review. Int J Nurs Stud 2021; 113:103781. [PMID: 33080475 PMCID: PMC7526658 DOI: 10.1016/j.ijnurstu.2020.103781] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 09/22/2020] [Accepted: 09/24/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND The acute nature of COVID-19 and its effects on society in terms of social distancing and quarantine regulations affect the provision of palliative care for people with dementia who live in long-term care facilities. The current COVID-19 pandemic poses a challenge to nursing staff, who are in a key position to provide high-quality palliative care for people with dementia and their families. OBJECTIVE To formulate practice recommendations for nursing staff with regard to providing palliative dementia care in times of COVID-19. DESIGN AND METHOD A rapid scoping review following guidelines from the Joanna Briggs Institute. Eligible papers focused on COVID-19 in combination with palliative care for older people or people with dementia and informed practical nursing recommendations for long-term care facilities. After data extraction, we formulated recommendations covering essential domains in palliative care adapted from the National Consensus Project's Clinical Practice Guidelines for Quality Palliative Care. DATA SOURCES We searched the bibliographic databases of PubMed, CINAHL and PsycINFO for academic publications. We searched for grey literature using the search engine Google. Moreover, we included relevant letters and editorials, guidelines, web articles and policy papers published by knowledge and professional institutes or associations in dementia and palliative care. RESULTS In total, 23 documents (7 (special) articles in peer-reviewed journals, 6 guides, 4 letters to editors, 2 web articles (blogs), 2 reports, a correspondence paper and a position paper) were included. The highest number of papers informed recommendations under the domains 'advance care planning' and 'psychological aspects of care'. The lowest number of papers informed the domains 'ethical care', 'care of the dying', 'spiritual care' and 'bereavement care'. We found no papers that informed the 'cultural aspects of care' domain. CONCLUSION Literature that focuses specifically on palliative care for people with dementia in long-term care facilities during the COVID-19 pandemic is still largely lacking. Particular challenges that need addressing involve care of the dying and the bereaved, and ethical, cultural and spiritual aspects of care. Moreover, we must acknowledge grief and moral distress among nursing staff. Nursing leadership is needed to safeguard the quality of care and nursing staff should work together within an interprofessional care team to initiate advance care planning conversations in a timely manner, to review and document advance care plans, and to adapt goals of care as they may change due to the COVID-19 situation. Tweetable abstract: The current COVID-19 pandemic affects people living with dementia, their families and their professional caregivers. This rapid scoping review searched for academic and grey literature to formulate practical recommendations for nursing staff working in long-term care facilities on how to provide palliative care for people with dementia in times of COVID-19. There is a particular need for grief and bereavement support and we must acknowledge grief and moral distress among nursing staff. This review exposes practice and knowledge gaps in the response to COVID-19 that reflect the longstanding neglect and weaknesses of palliative care in the long-term care sector. Nursing leadership is needed to safeguard the quality of palliative care, interprofessional collaboration and peer support among nursing staff.
Collapse
|
8
|
Smith SJ, Griffiths AW, Creese B, Sass C, Surr CA. A biopsychosocial interpretation of the Neuropsychiatric Inventory - Nursing Home assessment: reconceptualising psychiatric symptom attributions. BJPsych Open 2020; 6:e137. [PMID: 33153507 PMCID: PMC7745231 DOI: 10.1192/bjo.2020.113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The Neuropsychiatric Inventory (NPI) is predicated on the assumption that psychiatric symptoms are manifestations of disease. Biopsychosocial theories suggest behavioural changes viewed as psychiatric may also arise as a result of external behavioural triggers. Knowing the causes of psychiatric symptoms is important since the treatment and management of symptoms relies on this understanding. AIMS This study sought to understand the causes of psychiatric symptoms recorded in care home settings by investigating qualitatively described symptoms in Neuropsychiatric Inventory-Nursing Home (NPI-NH) interviews. METHOD The current study examined the NPI-NH interviews of 725 participants across 50 care homes. The qualitatively described symptoms from each of the 12 subscales of the NPI were extracted: 347 interviews included at least one qualitatively described symptom (n = 651 descriptions). A biopsychosocial algorithm developed following a process of independent researcher coding (n = 3) was applied to the symptom descriptions. This determined whether the description had predominantly psychiatric features, or features that were cognitive or attributable to other causes (i.e. issues with orientation and memory; expressions of need; poor care and communication; or understandable reactions). RESULTS Our findings suggest that the majority (over 80%) of descriptions described symptoms with features that could be attributable to cognitive changes and external triggers (such as poor care and communication). CONCLUSIONS The finding suggest that in its current form the NPI-NH may over attribute the incidence of psychiatric symptoms in care homes by overlooking triggers for behavioural changes. Measures of psychiatric symptoms should determine the causes of behavioural changes in order to guide treatments more effectively.
Collapse
Affiliation(s)
- Sarah J Smith
- Centre for Dementia Research, Leeds Beckett University, UK
| | | | - Byron Creese
- College of Medicine and Health, University of Exeter Medical School, UK
| | - Cara Sass
- Centre for Dementia Research, Leeds Beckett University, UK
| | - Claire A Surr
- Centre for Dementia Research, Leeds Beckett University, UK
| |
Collapse
|
9
|
Kutschar P, Berger S, Brandauer A, Freywald N, Osterbrink J, Seidenspinner D, Gnass I. Nursing Education Intervention Effects on Pain Intensity of Nursing Home Residents with Different Levels of Cognitive Impairment: A Cluster-Randomized Controlled Trial. J Pain Res 2020; 13:633-648. [PMID: 32273749 PMCID: PMC7105359 DOI: 10.2147/jpr.s237056] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 03/07/2020] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Pain management in nursing homes is challenging and pain prevalence remains high. The objective of this study was to improve the pain situation of nursing home residents following a nursing-related educational intervention within a cluster-randomized controlled trial (2016-2018). PARTICIPANTS Clusters were nursing homes from one nursing home operator in Bavaria, Germany. Nursing home residents who were permanently registered in the facilities, at least 60 years of age, and who themselves or their legal guardians provided informed consent were included. INTERVENTION In addition to the implementation of pain nurses and pain care assistants, staff of the intervention group received an educational intervention in pain management, containing classroom (quality circles) and web-based training for nurses. METHODS Based on the Mini-Mental State Examination (MMSE), residents were either interviewed (MMSE 10-30) using self-report instruments or observed (MMSE 0-9) by proxy assessment. The primary outcome in residents able to self-report was maximum pain intensity according to Brief Pain Inventory (BPI); in those not able to self-report treatment-relevant pain above cut-off (≥2) on the Pain Assessment in Advanced Dementia (PAINAD). RESULTS Out of 20 randomly selected clusters, 9 nursing homes from the control, and 6 nursing homes from the intervention group participated. Multilevel linear (n=347 residents, MMSE 10-30) and logistic regression (n=222 residents, MMSE 0-9) analyses were conducted. Maximum pain intensity was higher after intervention (B=1.32, p<0.01), decreased with a better quality of life (B=-0.07, p<0.001), and was lower when dementia diagnoses were present (B=-1.12, p<0.01). PAINAD scores before and after intervention did not differ significantly (OR=0.89, p=0.724), but chances to exhibit treatment-related pain were higher with decreasing MMSE (OR=0.94, p<0.05). CONCLUSION While no significant positive intervention effect was measured, findings suggest nurses' raised awareness towards pain management. Overall results indicate that large-scale educational interventions seem to be less effective in complex nursing home settings without also including specific individual-based intervention measures.
Collapse
Affiliation(s)
- P Kutschar
- Institute of Nursing Science and Practice, Paracelsus Medical University, Salzburg, Austria
| | - S Berger
- Institute of Nursing Science and Practice, Paracelsus Medical University, Salzburg, Austria
| | - A Brandauer
- Institute of Nursing Science and Practice, Paracelsus Medical University, Salzburg, Austria
| | - N Freywald
- Institute of Nursing Science and Practice, Paracelsus Medical University, Salzburg, Austria
| | - J Osterbrink
- Institute of Nursing Science and Practice, Paracelsus Medical University, Salzburg, Austria
- Brooks College of Health, University of North Florida, Jacksonville, FL, USA
| | - D Seidenspinner
- Nursing Science and Practice Development, University Hospital of Munich-Großhadern (LMU), Munich, Germany
| | - I Gnass
- Institute of Nursing Science and Practice, Paracelsus Medical University, Salzburg, Austria
| |
Collapse
|
10
|
Resnick B, Galik E, Kolanowski A, VanHaitsma K, Boltz M, Zhu S, Ellis J, Behrens L, Eshraghi K. Gender differences in presentation and management of behavioral and psychological symptoms associated with dementia among nursing home residents with moderate to severe dementia. J Women Aging 2020; 33:635-652. [PMID: 32142386 DOI: 10.1080/08952841.2020.1735925] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Lack of identification and management of behavioral and psychological symptoms of dementia (BPSD) can negatively impact female residents. The purpose of this secondary data analysis was to explore gender differences in presentation and management of BPSD and quality of interactions between residents and staff. A total of 553 residents from 55 nursing homes were included. Males exhibited more apathy and sexually inappropriate behavior and females exhibited more anxiety and sadness. Anxiety and sexually inappropriate behavior were more likely to be addressed in care plans for males than females. There was no difference in how staff interacted with males or females.
Collapse
Affiliation(s)
- Barbara Resnick
- School of Nursing, University of Maryland, Baltimore, Maryland, USA
| | - Elizabeth Galik
- School of Nursing, University of Maryland, Baltimore, Maryland, USA
| | - Ann Kolanowski
- College of Nursing, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Kimberly VanHaitsma
- College of Nursing, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Marie Boltz
- College of Nursing, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Shijun Zhu
- School of Nursing, University of Maryland, Baltimore, Maryland, USA
| | - Jeanette Ellis
- School of Nursing, University of Maryland, Baltimore, Maryland, USA
| | - Liza Behrens
- College of Nursing, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Karen Eshraghi
- College of Nursing, Pennsylvania State University, University Park, Pennsylvania, USA
| |
Collapse
|
11
|
Strøm BS, Engedal K, Rokstad AM. Engagement in Everyday Activities among People Living in Indian Nursing Homes: The Association with Person-Centredness. Dement Geriatr Cogn Dis Extra 2020; 10:13-26. [PMID: 32158463 PMCID: PMC7011750 DOI: 10.1159/000505396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 12/10/2019] [Indexed: 02/03/2023] Open
Abstract
Introduction It has been reported that residents living in nursing homes are often inactive and lonely and are offered a limited number of activities. However, high engagement in activities has been reported to improve residents' quality of life and engagement in personalized activities can even reduce agitation and enhance positive mood. Information regarding occupational patterns and purpose in life is well established in Western countries. However, we know next to nothing about how people living in Indian nursing homes spend their days. Objective To explore the participation in everyday activities among older people in Indian nursing homes and the extent to which engagement in activities is associated with person-centred care. Methods The study was conducted in 6 nursing homes in India, comprising 147 residents. In all, 23 nursing staff took part and completed a 26-item questionnaire about resident activities based on the Multi-Dimensional Dementia Assessment Scale and the Person-Directed Care Questionnaire. Person-centredness was measured with the Person-Centred Care Assessment Tool. Results We found low participation in everyday activities among the residents. Participation in religious activities was the most frequent, whereas the least used activities were excursions, participating in cultural activities, taking part in educational programmes, visiting a restaurant and going to the cinema. A significant positive association was found between person-centred care and participation in religious activities, engagement in an activity programme and physical activity. Conclusions The most frequently attended activity was religious activities. Person-centred care was associated with participation in religious activities, engagement in an activity programme, physical activity, spending time in the garden and playing and listening to music.
Collapse
Affiliation(s)
| | - Knut Engedal
- Norwegian Advisory Unit for Aging and Health, Vestfold Hospital HF, Tønsberg, Norway.,Department of Geriatrics, Oslo University Hospital, Tønsberg, Norway
| | - Anne Marie Rokstad
- Norwegian Advisory Unit for Aging and Health, Vestfold Hospital HF, Tønsberg, Norway.,Faculty of Health Science and Social Care, Molde University College, Molde, Norway
| |
Collapse
|
12
|
Makimoto K, Kang Y, Kobayashi S, Liao XY, Panuthai S, Sung HC, Suzuki M, Terada S, Yamakawa M. Prevalence of behavioural and psychological symptoms of dementia in cognitively impaired elderly residents of long-term care facilities in East Asia: a cross-sectional study. Psychogeriatrics 2019; 19:171-180. [PMID: 30394003 DOI: 10.1111/psyg.12380] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 07/31/2018] [Accepted: 08/27/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The aim of this study was to compare the prevalence of behavioural and psychological symptoms of dementia (BPSD) in cognitively impaired elderly residents of long-term care facilities in East Asia and to explore the factors associated with these patterns. METHODS This was a cross-sectional survey of BPSD in cognitively impaired elderly residents of long-term care facilities in Japan, South Korea, China, Taiwan, and Thailand. The Mini-Mental State Examination, Clinical Dementia Rating (CDR), and Neuropsychiatric Inventory, Nursing Home version (NPI-NH), were used to assess cognitive status, dementia severity, and BPSD, respectively. NPI-NH subscale severity scores were multiplied by frequency scores to obtain the subscale scores and aggregated into two groups based on score (clinically insignificant = 1- 3; clinically significant ≥4). RESULTS Data from 662 people were analyzed. Median age, median Mini-Mental State Examination scores, and median CDR scores differed significantly among the seven study sites. The prevalence of BPSD varied from 64% in Taiwan to 100% in dementia care units in Japan, and the median total NPI-NH scores ranged from 2 in Taiwan to 14 in dementia care units in Japan. After stratification of the sample by dementia severity and clinical significance of NPI-NH scores, differences in the prevalence of clinically significant BPSD were mostly observed among facilities dedicated to dementia patients in the CDR 1 group. In the CDR 3 group, the prevalence of some clinically significant BPSD, such as apathy, was high even among study sites with low median total NPI-NH scores. CONCLUSIONS Our findings may suggest referral and selection biases in the study sites. Future prospective studies are needed to address the impact of environmental and care factors on the occurrence of BPSD in Asian countries.
Collapse
Affiliation(s)
- Kiyoko Makimoto
- Department of Health Sciences, Graduate School of Medicine, Osaka University, Osaka, Japan.,Department of Nursing, School of Nursing and Rehabilitation, Konan Women's University, Kobe, Japan
| | - Younhee Kang
- College of Nursing, Ewha Womans University, Seoul, South Korea
| | | | - Xiao-Yan Liao
- Department of Nursing, Nanfang Hospital, Guangzhou, China
| | | | - Huei-Chuan Sung
- Graduate Institute of Long-term Care, Tzu Chi University of Science and Technology, Hualien, Taiwan
| | - Mizue Suzuki
- Department of Nursing, School of Medicine, Hamamatsu University, Shizuoka, Japan
| | - Saya Terada
- Department of Health Sciences, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Miyae Yamakawa
- Department of Health Sciences, Graduate School of Medicine, Osaka University, Osaka, Japan
| |
Collapse
|
13
|
Chaudhury H, Murray K, Seetharaman K. Special Care Units. ENCYCLOPEDIA OF GERONTOLOGY AND POPULATION AGING 2019:1-7. [DOI: 10.1007/978-3-319-69892-2_855-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 06/20/2019] [Indexed: 07/19/2023]
|
14
|
Helvik AS, Selbæk G, Šaltytė Benth J, Røen I, Bergh S. The course of neuropsychiatric symptoms in nursing home residents from admission to 30-month follow-up. PLoS One 2018; 13:e0206147. [PMID: 30335840 PMCID: PMC6193723 DOI: 10.1371/journal.pone.0206147] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 10/08/2018] [Indexed: 12/27/2022] Open
Abstract
Aim The aim of this study was to describe the prevalence and persistence of clinically significant neuropsychiatric symptoms (NPS) in nursing home residents with dementia, and to study the association between severity of dementia and specific neuropsychiatric sub-syndromes over time. Methods In total, 583 residents with dementia were included at admission to a nursing home and followed with biannual assessments until death, or to 30-month follow-up. At the end of the 30-month follow-up, 305 participants had died and 57 had left the study for other reasons, leaving 221 residents in the study. We collected data on demographics, cognition, severity of dementia, NPS, personal activities of daily living (P-ADL), physical health, medication and type of nursing home unit. NPS was assessed using the Neuropsychiatric Inventory (NPI), the Nursing Home version. Results The prevalence and persistence at two consecutive time-points of clinically significant NPS was high during the study period. The mean NPI agitation sub-syndrome score increased during the study period, while the NPI affective and psychosis sub-syndrome scores remained unchanged. More severe dementia was associated with higher NPI agitation, psychosis and affective sub-syndrome scores. The association remained unchanged over time for agitation and psychosis. For the NPI affective sub-syndrome, the association was stronger at the beginning, and declined towards the end of the study period. Conclusion The findings of high prevalence and persistence at two consecutive time points of clinically significant NPS over time, and the associations between severity of dementia and NPI sub-syndromes shed light on the burden and care needs of nursing home residents with dementia after admission to nursing home care. This information is of interest to health care planners and providers to enable them to increase the quality of care for nursing home residents.
Collapse
Affiliation(s)
- Anne-Sofie Helvik
- General Practice Research Unit, Department of Public Health and Nursing, Faculty of Medicine and health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Health Trust, Tønsberg, Norway
- St Olavs University Hospital, Trondheim, Norway
- * E-mail:
| | - Geir Selbæk
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Health Trust, Tønsberg, Norway
- Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Jūratė Šaltytė Benth
- Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway
- Institute of Clinical Medicine, Campus Ahus, University of Oslo, Oslo, Norway
- HØKH, Research Centre, Akershus University Hospital, Lørenskog, Norway
| | - Irene Røen
- Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway
| | - Sverre Bergh
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Health Trust, Tønsberg, Norway
- Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway
| |
Collapse
|
15
|
Davies SJC, Burhan AM, Kim D, Gerretsen P, Graff-Guerrero A, Woo VL, Kumar S, Colman S, Pollock BG, Mulsant BH, Rajji TK. Sequential drug treatment algorithm for agitation and aggression in Alzheimer's and mixed dementia. J Psychopharmacol 2018; 32:509-523. [PMID: 29338602 PMCID: PMC5944080 DOI: 10.1177/0269881117744996] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Behavioural and psychological symptoms of dementia (BPSD) include agitation and aggression in people with dementia. BPSD is common on inpatient psychogeriatric units and may prevent individuals from living at home or in residential/nursing home settings. Several drugs and non-pharmacological treatments have been shown to be effective in reducing behavioural and psychological symptoms of dementia. Algorithmic treatment may address the challenge of synthesizing this evidence-based knowledge. METHODS A multidisciplinary team created evidence-based algorithms for the treatment of behavioural and psychological symptoms of dementia. We present drug treatment algorithms for agitation and aggression associated with Alzheimer's and mixed Alzheimer's/vascular dementia. Drugs were appraised by psychiatrists based on strength of evidence of efficacy, time to onset of clinical effect, tolerability, ease of use, and efficacy for indications other than behavioural and psychological symptoms of dementia. RESULTS After baseline assessment and discontinuation of potentially exacerbating medications, sequential trials are recommended with risperidone, aripiprazole or quetiapine, carbamazepine, citalopram, gabapentin, and prazosin. Titration schedules are proposed, with adjustments for frailty. Additional guidance is given on use of electroconvulsive therapy, optimization of existing cholinesterase inhibitors/memantine, and use of pro re nata medications. CONCLUSION This algorithm-based approach for drug treatment of agitation/aggression in Alzheimer's/mixed dementia has been implemented in several Canadian Hospital Inpatient Units. Impact should be assessed in future research.
Collapse
Affiliation(s)
- Simon JC Davies
- Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, ON, Canada
- Dementia Integrated Pathway Working Group, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Amer M Burhan
- Dementia Integrated Pathway Working Group, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Geriatric Psychiatry, Western University, London, ON, Canada
| | - Donna Kim
- Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, ON, Canada
- Dementia Integrated Pathway Working Group, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Philip Gerretsen
- Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, ON, Canada
- Dementia Integrated Pathway Working Group, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Multimodal Imaging Group, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Ariel Graff-Guerrero
- Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, ON, Canada
- Dementia Integrated Pathway Working Group, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Multimodal Imaging Group, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Vincent L Woo
- Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, ON, Canada
- Dementia Integrated Pathway Working Group, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Sanjeev Kumar
- Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, ON, Canada
- Dementia Integrated Pathway Working Group, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Sarah Colman
- Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, ON, Canada
- Dementia Integrated Pathway Working Group, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Bruce G Pollock
- Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, ON, Canada
- Dementia Integrated Pathway Working Group, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Benoit H Mulsant
- Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, ON, Canada
- Dementia Integrated Pathway Working Group, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Tarek K Rajji
- Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, ON, Canada
- Dementia Integrated Pathway Working Group, Centre for Addiction and Mental Health, Toronto, ON, Canada
| |
Collapse
|
16
|
Massimo L, Kales HC, Kolanowski A. State of the Science: Apathy As a Model for Investigating Behavioral and Psychological Symptoms in Dementia. J Am Geriatr Soc 2018; 66 Suppl 1:S4-S12. [PMID: 29659001 PMCID: PMC5905718 DOI: 10.1111/jgs.15343] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 01/26/2018] [Accepted: 02/05/2018] [Indexed: 12/01/2022]
Abstract
Apathy is one of the most common and pervasive of the behavioral and psychological symptoms of dementia (BPSDs). Apathy has profound consequences for morbidity, mortality, and caregiver burden. Treatment of apathy has been hindered because of poor understanding of the mechanisms underlying this heterogeneous syndrome. Research has demonstrated that apathy is associated with disruption of the frontal-striatal system in individuals with neurodegenerative disease. As with other BPSDs, these neural mechanisms alone do not completely account for the syndrome; individual, caregiver, and environmental factors also contribute to apathy. In this article, we modify a current conceptual model of the factors contributing to BPSDs to examine determinants of apathy. This integrative model provides a more complete and theoretically informed understanding of apathy, allowing for greater insight into potential targets for research, intervention, and care. We end by proposing an agenda for moving the science of BPSDs in general, and apathy in particular, forward.
Collapse
Affiliation(s)
- Lauren Massimo
- College of Nursing, Pennsylvania State University, University Park, Pennsylvania
- Frontotemporal Degeneration Center, Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Helen C Kales
- Program for Positive Aging, Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
| | - Ann Kolanowski
- College of Nursing, Pennsylvania State University, University Park, Pennsylvania
| |
Collapse
|
17
|
Auer S, Linsmayer E, Beránková A, Pascher P, Firlinger B, Prischl D, Ratajczak P, Span E, Holmerova I. DEMDATA: The Austrian-Czech institutional long term care project - design and protocol of a two-centre cross sectional study. BMC Health Serv Res 2017; 17:296. [PMID: 28427396 PMCID: PMC5397749 DOI: 10.1186/s12913-017-2244-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 04/11/2017] [Indexed: 11/21/2022] Open
Abstract
Background The organization of long-term care is one of the main challenges of public health and health policies in Europe and worldwide, especially in terms of care concepts for people with dementia. In Austria and the Czech Republic the majority of elderly institutionalized persons with dementia are cared for in nursing homes. It is however unclear, how many persons living in nursing homes in Austria and in the Czech Republic are suffering from cognitive impairment and dementia. In addition, basic information on the nutritional status, the status of mobility and the medication prescription patterns are often missing. To facilitate new effective and evidenced based care concepts, basic epidemiological data are in urgent need. Thus, DEMDATA was initiated to provide important basic data on persons living in nursing homes in Austria and the Czech Republic for future care planning. Methods DEMDATA is a multicentre mixed methods cross-sectional study. Stratified and randomly drawn nursing homes in Austria and the Czech Republic are surveyed. The study protocol used in both study centres assesses four different domains: a) Resident, b) Care team, c) Relative and d) Environmental Factors. Resident’s data include among others health status, cognition, dementia, mobility, nutrition, behavioural symptoms, pain intensity and quality of life. A minimum of 500 residents per country are included into the study (N = 1000 residents). The care team is asked about the use of the person-centred care and their burden. The relatives are asked about the number of visits and proxy-rate the quality of life of their family member. All staff employed in the nursing homes, all residents and relatives can voluntary take part in the study. The environmental factors include among others the organisational category of the nursing home, number of residents, number of rooms, social activities and the care concept. The project started in March 2016 and will be concluded in February 2018. Discussion DEMDATA will provide important epidemiological data on four different nursing home domains in Austria and the Czech Republic, with a focus on the prevalence of dementia in this population. Thereby supplying decision and policy makers with important foundation for future care planning.
Collapse
Affiliation(s)
- Stefanie Auer
- Department for Clinical Neuroscience and Preventive Medicine, Danube University Krems, Dr.-Karl-Dorrek-Straße 30, 3500, Krems, Austria. .,MAS Alzheimerhilfe, Bad Ischl, Austria.
| | | | - Anna Beránková
- Faculty of Humanities, Charles University, Prague, Czech Republic
| | - Patrick Pascher
- Department for Clinical Neuroscience and Preventive Medicine, Danube University Krems, Dr.-Karl-Dorrek-Straße 30, 3500, Krems, Austria.,MAS Alzheimerhilfe, Bad Ischl, Austria
| | - Bernadette Firlinger
- Department for Clinical Neuroscience and Preventive Medicine, Danube University Krems, Dr.-Karl-Dorrek-Straße 30, 3500, Krems, Austria
| | | | - Paulina Ratajczak
- Department for Clinical Neuroscience and Preventive Medicine, Danube University Krems, Dr.-Karl-Dorrek-Straße 30, 3500, Krems, Austria
| | | | - Iva Holmerova
- Faculty of Humanities, Charles University, Prague, Czech Republic
| |
Collapse
|
18
|
Helvik AS, Engedal K, Wu B, Benth JŠ, Corazzini K, Røen I, Selbæk G. Severity of Neuropsychiatric Symptoms in Nursing Home Residents. Dement Geriatr Cogn Dis Extra 2016; 6:28-42. [PMID: 26933438 PMCID: PMC4772643 DOI: 10.1159/000442250] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
We aimed at assessing time shift in the severity of neuropsychiatric symptoms (NPS) in nursing home residents between 2004/2005 and 2010/2011 and associations between NPS and socio-demographic variables, physical health status, dementia severity, and the use of psychotropic drugs. The Neuropsychiatric Inventory Nursing Home Version was used in 2004/2005 (n = 1,163) and 2010/2011 (n = 1,858). Linear mixed model analysis was applied. There was no time shift in the severity of apathy, psychosis, and affective symptoms, but agitation did exhibit a time shift. Agitation was less severe in 2010/2011 than in 2004/2005 in residents with a Clinical Dementia Rating (CDR) sum of boxes score ≤4, and more severe in residents with a CDR sum of boxes score >16. Higher CDR sum of boxes scores and use of psychotropic medication were associated with more severe apathy, agitation, psychosis, and affective symptoms. Poor physical health was associated with more severe apathy, psychosis, and affective symptoms. Women had more severe agitation and less severe affective symptoms than men. A longer stay in a nursing home was associated with more severe agitation and less severe affective symptoms. In conclusion, agitation was less severe in 2010/2011 than in 2004/2005 among nursing home residents with a milder degree of dementia, and more severe in residents with severe dementia.
Collapse
Affiliation(s)
- Anne-Sofie Helvik
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Norway; St. Olav's University Hospital, Trondheim, Norway; Norwegian National Advisory Unit on Aging and Health, Vestfold Health Trust, Tønsberg, Norway
| | - Knut Engedal
- Norwegian National Advisory Unit on Aging and Health, Vestfold Health Trust, Tønsberg, Norway
| | - Bei Wu
- Duke Center for the Study of Aging and Human Development, Duke University School of Nursing, Durham, N.C., USA; Duke Global Health Institute, Durham, N.C., USA
| | - Jūratė Šaltytė Benth
- Institute of Clinical Medicine, Campus Ahus, Norway; HØKH, Research Centre, Akershus University Hospital, Lørenskog, Norway; Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway
| | - Kirsten Corazzini
- Duke Center for the Study of Aging and Human Development, Duke University School of Nursing, Durham, N.C., USA
| | - Irene Røen
- Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway
| | - Geir Selbæk
- Norwegian National Advisory Unit on Aging and Health, Vestfold Health Trust, Tønsberg, Norway; Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway; Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway
| |
Collapse
|
19
|
Ferreira AR, Martins S, Ribeiro O, Fernandes L. Validity and reliability of the European portuguese version of neuropsychiatric inventory in an institutionalized sample. J Clin Med Res 2014; 7:21-8. [PMID: 25368697 PMCID: PMC4217749 DOI: 10.14740/jocmr1959w] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2014] [Indexed: 11/11/2022] Open
Abstract
Background Neuropsychiatric symptoms are very common in dementia and have been associated with patient and caregiver distress, increased risk of institutionalization and higher costs of care. In this context, the neuropsychiatric inventory (NPI) is the most widely used comprehensive tool designed to measure neuropsychiatric Symptoms in geriatric patients with dementia. The aim of this study was to present the validity and reliability of the European Portuguese version of NPI. Methods A cross-sectional study was carried out with a convenience sample of institutionalized patients (≥ 50 years old) in three nursing homes in Portugal. All patients were also assessed with mini-mental state examination (MMSE) (cognition), geriatric depression scale (GDS) (depression) and adults and older adults functional assessment inventory (IAFAI) (functionality). NPI was administered to a formal caregiver, usually from the clinical staff. Inter-rater and test-retest reliability were assessed in a subsample of 25 randomly selected subjects. Results The sample included 166 elderly, with a mean age of 80.9 (standard deviation: 10.2) years. Three out of the NPI behavioral items had negative correlations with MMSE: delusions (rs = -0.177, P = 0.024), disinhibition (rs = -0.174, P = 0.026) and aberrant motor activity (rs = -0.182, P = 0.020). The NPI subsection of depression/dysphoria correlated positively with GDS total score (rs = 0.166, P = 0.038). NPI showed good internal consistency (overall α = 0.766; frequency α = 0.737; severity α = 0.734). The inter-rater reliability was excellent (intraclass correlation coefficient (ICC): 1.00, 95% confidence interval (CI) 1.00 - 1.00), as well as test-retest reliability (ICC: 0.91, 95% CI 0.80 - 0.96). Conclusion The results found for convergent validity, inter-rater and test-retest reliability, showed that this version appears to be a valid and reliable instrument for evaluation of neuropsychiatric symptoms in institutionalized elderly.
Collapse
Affiliation(s)
- Ana Rita Ferreira
- Faculty of Medicine, University of Porto, Al. Hernani Monteiro, 4200-319 Porto, Portugal
| | - Sonia Martins
- Research and Education Unit on Aging (UNIFAI), University of Porto, Rua Jorge de Viterbo Ferreira, no. 228, 4050-313 Porto, Portugal
| | - Orquidea Ribeiro
- Department of Health Information and Decision Sciences (CIDES) and CINTESIS, Faculty of Medicine, University of Porto, Al. Hernani Monteiro, 4200-319 Porto, Portugal
| | - Lia Fernandes
- UNIFAI/CINTESIS Research Unit, Faculty of Medicine, University of Porto. Clinic of Psychiatry and Mental Health, CHSJ, Porto, Al. Hernani Monteiro, 4200-319 Porto, Portugal
| |
Collapse
|
20
|
van der Spek K, Gerritsen DL, Smalbrugge M, Nelissen-Vrancken MHJMG, Wetzels RB, Smeets CHW, Zuidema SU, Koopmans RTCM. PROPER I: frequency and appropriateness of psychotropic drugs use in nursing home patients and its associations: a study protocol. BMC Psychiatry 2013; 13:307. [PMID: 24238392 PMCID: PMC3840691 DOI: 10.1186/1471-244x-13-307] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Accepted: 11/13/2013] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Nursing home patients with dementia use psychotropic drugs longer and more frequently than recommended by guidelines implying psychotropic drugs are not always prescribed appropriately. These drugs can have many side effects and effectiveness is limited. Psychotropic drug use between nursing home units varies and is not solely related to the severity of neuropsychiatric symptoms. There is growing evidence indicating that psychotropic drug use is associated with environmental factors, suggesting that the prescription of psychotropic drugs is not only related to (objective) patient factors. However, other factors related to the patient, elderly care physician, nurse and the physical environment are only partially identified. Using a mixed method of qualitative and quantitative research, this study aims to understand the nature of psychotropic drug use and its underlying factors by identifying: 1) frequency and appropriateness of psychotropic drug use for neuropsychiatric symptoms in nursing home patients with dementia, 2) factors associated with (appropriateness of) psychotropic drug use. METHODS A cross-sectional mixed methods study. For the quantitative study, patients with dementia (n = 540), nursing staff and elderly care physicians of 36 Dementia Special Care Units of 12 nursing homes throughout the Netherlands will be recruited. Six nursing homes with high average rates and six with low average rates of psychotropic drug use, based on a national survey about frequency of psychotropic drug use on units, will be included. Psychotropic drugs include antipsychotics, anxiolytics, hypnotics, antidepressants, anticonvulsants and anti-dementia drugs. Appropriateness will be measured by an instrument based on the Medication Appropriateness Index and current guidelines for treatment of neuropsychiatric symptoms. Factors associated to psychotropic drug use, related to the patient, elderly care physician, nurse and physical environment, will be explored using multilevel regression analyses. For the qualitative study, in depth interviews with staff will be held and analyzed to identify and explore other unknown factors. DISCUSSION This study will provide insight into factors that are associated with the frequency and appropriateness of psychotropic drug use for neuropsychiatric symptoms. Understanding psychotropic drug use and its associations may contribute to better dementia care.
Collapse
Affiliation(s)
- Klaas van der Spek
- Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboudumc, Huispost 117 ELG, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Debby L Gerritsen
- Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboudumc, Huispost 117 ELG, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Martin Smalbrugge
- Department of General Practice and Elderly Care Medicine/EMGO + Institute for Health and Care Research, VU Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands
| | | | - Roland B Wetzels
- Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboudumc, Huispost 117 ELG, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Claudia HW Smeets
- Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboudumc, Huispost 117 ELG, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Sytse U Zuidema
- Department of General Practice, University of Groningen, University Medical Center Groningen, HPC FA21, PO Box 196, 9700 AD Groningen, The Netherlands
| | - Raymond TCM Koopmans
- Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboudumc, Huispost 117 ELG, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| |
Collapse
|
21
|
Kok JS, Berg IJ, Scherder EJA. Special care units and traditional care in dementia: relationship with behavior, cognition, functional status and quality of life - a review. Dement Geriatr Cogn Dis Extra 2013; 3:360-75. [PMID: 24403908 PMCID: PMC3884203 DOI: 10.1159/000353441] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background Special care facilities for patients with dementia gain increasing attention. However, an overview of studies examining the differences between care facilities with respect to their effects on behavior, cognition, functional status and quality of life is lacking. Results Our literature search resulted in 32 studies published until October 2012. Overall, patients with dementia who lived at special care units (SCUs) showed a significantly more challenging behavior, more agitation/aggression, more depression and anxiety, more cases of global cognitive impairment and a better psychosocial functioning. There was a tendency towards a better functional status in specialized care facilities, and a better quality of life was found in favor of the SCU group compared to the traditional nursing home (n-SCU) group. Longitudinal studies showed an increased number of neuropsychiatric cases, more patients displaying deteriorating behavior and resistance to care as well as less decline in activities of daily living (ADL) in the SCU group compared to the n-SCU group. Patients in small-scale, homelike SCUs showed more agitation and less ADL decline compared to SCU patients. Conclusion This review shows that the patient characteristics in SCU and n-SCU settings and, to a minor extent, in SCU and small-scale, homelike SCU settings are different. Over time, there are differences between n-SCU, SCU and small-scale, homelike SCU facilities for some variables.
Collapse
Affiliation(s)
- Jeroen S Kok
- Lentis/Dignis, Mental Health Care Institute, Zuidlaren, The Netherlands
| | - Ina J Berg
- Lentis/Dignis, Mental Health Care Institute, Zuidlaren, The Netherlands
| | - Erik J A Scherder
- Department of Clinical Neuropsychology, VU University Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
22
|
Zubritsky C, Abbott KM, Hirschman KB, Bowles KH, Foust JB, Naylor MD. Health-related quality of life: expanding a conceptual framework to include older adults who receive long-term services and supports. THE GERONTOLOGIST 2012; 53:205-10. [PMID: 22859435 DOI: 10.1093/geront/gns093] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
For older adults receiving long-term services and supports (LTSS), health-related quality of life (HRQoL) has emerged as a critical construct to examine because of its focus on components of well-being, which are affected by progressive changes in health status, health care, and social support. HRQoL is a health-focused quality of life (QOL) concept that encompasses aspects of QOL that affect health such as function, physical, and emotional health. Examining existing theoretical constructs and indicators of HRQoL among LTSS recipients led us to posit a revised conceptual framework for studying HRQoL among LTSS recipients. We adapted the Wilson and Cleary HRQoL model by expanding function to specifically include cognition, adding behavior and LTSS environmental characteristics in order to create a more robust HRQoL conceptual framework for older adults receiving LTSS. This refined conceptual model allows for the measurement of a mix of structural, process, and outcome measures. Continued development of a multidimensional conceptual framework with specific HRQoL measures that account for the unique characteristics of older adults receiving LTSS will contribute significantly to LTSS research, policy, and planning efforts.
Collapse
Affiliation(s)
- Cynthia Zubritsky
- Center for Mental Health Policy and Services Research, Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA
| | | | | | | | | | | |
Collapse
|
23
|
Cerejeira J, Lagarto L, Mukaetova-Ladinska EB. Behavioral and psychological symptoms of dementia. Front Neurol 2012; 3:73. [PMID: 22586419 PMCID: PMC3345875 DOI: 10.3389/fneur.2012.00073] [Citation(s) in RCA: 643] [Impact Index Per Article: 53.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Accepted: 04/13/2012] [Indexed: 12/17/2022] Open
Abstract
Behavioral and psychological symptoms of dementia (BPSD), also known as neuropsychiatric symptoms, represent a heterogeneous group of non-cognitive symptoms and behaviors occurring in subjects with dementia. BPSD constitute a major component of the dementia syndrome irrespective of its subtype. They are as clinically relevant as cognitive symptoms as they strongly correlate with the degree of functional and cognitive impairment. BPSD include agitation, aberrant motor behavior, anxiety, elation, irritability, depression, apathy, disinhibition, delusions, hallucinations, and sleep or appetite changes. It is estimated that BPSD affect up to 90% of all dementia subjects over the course of their illness, and is independently associated with poor outcomes, including distress among patients and caregivers, long-term hospitalization, misuse of medication, and increased health care costs. Although these symptoms can be present individually it is more common that various psychopathological features co-occur simultaneously in the same patient. Thus, categorization of BPSD in clusters taking into account their natural course, prognosis, and treatment response may be useful in the clinical practice. The pathogenesis of BPSD has not been clearly delineated but it is probably the result of a complex interplay of psychological, social, and biological factors. Recent studies have emphasized the role of neurochemical, neuropathological, and genetic factors underlying the clinical manifestations of BPSD. A high degree of clinical expertise is crucial to appropriately recognize and manage the neuropsychiatric symptoms in a patient with dementia. Combination of non-pharmacological and careful use of pharmacological interventions is the recommended therapeutic for managing BPSD. Given the modest efficacy of current strategies, there is an urgent need to identify novel pharmacological targets and develop new non-pharmacological approaches to improve the adverse outcomes associated with BPSD.
Collapse
Affiliation(s)
- J Cerejeira
- Serviço de Psiquiatria, Centro Hospitalar Psiquiátrico de Coimbra Coimbra, Portugal
| | | | | |
Collapse
|
24
|
Zwijsen SA, Smalbrugge M, Zuidema SU, Koopmans RTCM, Bosmans JE, van Tulder MW, Eefsting JA, Gerritsen DL, Pot AM. Grip on challenging behaviour: a multidisciplinary care programme for managing behavioural problems in nursing home residents with dementia. Study protocol. BMC Health Serv Res 2011; 11:41. [PMID: 21338502 PMCID: PMC3051882 DOI: 10.1186/1472-6963-11-41] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2010] [Accepted: 02/21/2011] [Indexed: 11/25/2022] Open
Abstract
Background Behavioural problems are common in nursing home residents with dementia and they often are burdensome for both residents and nursing staff. In this study, the effectiveness and cost-effectiveness of a new care programme for managing behavioural problems will be evaluated. Methods/Design The care programme is based on Dutch national guidelines. It will consist of four steps: detection, analysis, treatment and evaluation. A stepped wedge design will be used. A total of 14 dementia special care units will implement the care programme. The primary outcome is behavioural problems. Secondary outcomes will include quality of life, prescription rate of antipsychotics, use of physical restraints and workload and job satisfaction of nursing staff. The effect of the care programme will be estimated using multilevel linear regression analysis. An economic evaluation from a societal perspective will also be carried out. Discussion The care programme is expected to be cost-effective and effective in decreasing behavioural problems, workload of nursing staff and in increasing quality of life of residents. Trial registration The Netherlands National Trial Register (NTR). Trial number: NTR 2141
Collapse
Affiliation(s)
- Sandra A Zwijsen
- Department of Nursing Home Medicine/EMGO + Institute for Health and Care Research, VU Medical Center, Amsterdam, The Netherlands.
| | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Abstract
BACKGROUND A large and growing number of people with dementia are being cared for in long-term care. The empirical literature on the design of environments for people with dementia contains findings that can be helpful in the design of these environments. A schema developed by Marshall in 2001 provides a means of reviewing the literature against a set of recommendations. The aims of this paper are to assess the strength of the evidence for these recommendations and to identify those recommendations that could be used as the basis for guidelines to assist in the design of long term care facilities for people with dementia. METHODS The literature was searched for articles published after 1980, evaluating an intervention utilizing the physical environment, focused on the care of people with dementia and incorporating a control group, pre-test-post-test, cross sectional or survey design. A total of 156 articles were identified as relevant and subjected to an evaluation of their methodological strength. Of these, 57 articles were identified as being sufficiently strong to be reviewed. RESULTS Designers may confidently use unobtrusive safety measures; vary ambience, size and shape of spaces; provide single rooms; maximize visual access; and control levels of stimulation. There is less agreement on the usefulness of signage, homelikeness, provision for engagement in ordinary activities, small size and the provision of outside space. CONCLUSIONS There is sufficient evidence available to come to a consensus on guiding principles for the design of long term environments for people with dementia.
Collapse
|