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Cohen-Mansfield J. A Paradigm Shift in Caregiver Preparation: From Information Provision to Enhanced Collaborative Care-element Optimization (ECCO). J Am Med Dir Assoc 2024; 25:387-389. [PMID: 38284962 DOI: 10.1016/j.jamda.2023.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 11/13/2023] [Indexed: 01/30/2024]
Affiliation(s)
- Jiska Cohen-Mansfield
- Department of Health Promotion, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Minerva Center for Interdisciplinary Study of End of Life, Tel Aviv University, Tel Aviv, Israel; Igor Orenstein Chair for the Study of Geriatrics, Tel Aviv University, Tel Aviv, Israel.
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Lorusso L, Bosch S, Park NK, Shorr R, Conroy M, Ahrentzen S, Freytes M. Investigating the Feasibility of Multisensory Environments to Improve the Assisted Bathing Experience for Veterans With Dementia: A Clinical Trial. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2021; 15:180-195. [PMID: 34763558 DOI: 10.1177/19375867211053861] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES This evidence-based design clinical trial assessed the feasibility of a multisensory environment (MSE) using aromatherapy, color-changing lights, and music as a behavioral intervention to calm Veterans with dementia during assisted bathing to improve the patient experience. BACKGROUND The number of Veterans with dementia is growing rapidly, along with the associated debilitating behavior challenges. The severity of these distressed behaviors that predominantly occur at bath time often necessitates costly, dangerous sedatives. Feasibility studies of nonpharmacological behavioral interventions during bathing for people with dementia are urgently needed, and research supports MSE as a viable solution. METHOD Using an A-B, multiple baselines across participants design, this study tracked operational behaviors of four Veterans with dementia during bathing without and with an MSE intervention. Sessions were provided and recorded by a dedicated team of five nurses, so the study team could analyze the Veterans' operational behaviors to understand the impact of individualized MSE during both baseline and intervention phases. RESULTS The results support the feasibility of MSE as a helpful, nonpharmacological behavioral intervention for Veterans with dementia during bathing. All participants experienced an overall increase in duration of positive operational behaviors and an overall decrease in duration of negative operational behaviors. CONCLUSIONS Healthcare environments are integral components in dementia care and the use of MSE within the bathing setting appears to improve not only operational behaviors but the overall bathing experience.
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Affiliation(s)
| | | | | | - Ronald Shorr
- Geriatric Research Education and Clinical Center, University of Florida, Gainesville, FL, USA
| | | | | | - Magaly Freytes
- Center of Innovation on Disability & Rehabilitation Research, Gainesville, FL, USA
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3
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Modification of bed bathing procedure based on the left-hand and right-hand chart to improve work efficiency. ENFERMERIA CLINICA 2020. [DOI: 10.1016/j.enfcli.2020.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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4
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Lorusso L, Park NK, Bosch S, Fretes IM, Shorr R, Conroy M, Ahrentzen S. Sensory Environments for Behavioral Health in Dementia: Diffusion of an Environmental Innovation at the Veterans Health Administration. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2020; 13:44-56. [PMID: 32552109 PMCID: PMC7519577 DOI: 10.1177/1937586720922852] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To evaluate the diffusion of multisensory environments (MSEs) as an innovation at the Veterans Health Administration (VHA) and gather feedback regarding staff perceptions of barriers to uptake and effectiveness of MSEs for Veterans with dementia. BACKGROUND Responding to the need for nonpharmacological behavioral interventions, VHA funded the first MSE for Veterans with dementia in 2010. The room incorporated LED color-changing lights, bubble tubes, vibroacoustic furniture, music, and aromatherapy, and the success of this patient-centered sensory room fueled national rollouts in 2013 and 2015. METHOD A qualitative interview approach was used. Thirty-two staff members participated from 12 of the 53 sites producing 21 individual interviews and 1 group interview with 11 participants. Results were analyzed by a team of eight researchers using the rapid qualitative inquiry method to identify common themes and major insights. RESULTS Important insights emerged with regard to staff members' perceptions about the effectiveness of MSE therapy as well as barriers to uptake and suggested strategies for overcoming those barriers (e.g., empowering a champion, developing a clear maintenance plan). CONCLUSIONS The findings from this research indicate MSEs are perceived as effective in improving behavior for Veterans with dementia and represent an innovation that has been well-diffused within the VHA, with great potential for future clinical applications.
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Affiliation(s)
| | - Nam-Kyu Park
- College of Design, Construction and Planning, University of Florida, Gainesville, FL, USA
| | - Sheila Bosch
- College of Design, Construction and Planning, University of Florida, Gainesville, FL, USA
| | - I. Magaly Fretes
- Center of Innovation on Disability and Rehabilitation Research, U.S. Veterans Health System, USA
| | - Ronald Shorr
- Geriatric Research Education and Clinical Center, U.S. Veterans Health Administration, USA
- University of Florida, Gainesville, FL, USA
| | | | - Sherry Ahrentzen
- College of Design, Construction and Planning, University of Florida, Gainesville, FL, USA
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Taira K, Itatani T, Kamide K, Ito M. [Investigation of the actual conditions of users of a home-visiting bathing service based on the long-term care insurance care ranking and factors affecting the judgment of bathing possibility]. Nihon Ronen Igakkai Zasshi 2019; 56:51-58. [PMID: 30760683 DOI: 10.3143/geriatrics.56.51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIM In home-visiting bathing services (HVBs), a nurse's role is to evaluate the vital signs, judge bathing possibilities and provide treatment before/after bathing. There are no guidelines regarding specific physical criteria for judging the bathing possibility. However, the body condition of HVB users during bathing has not been investigated. Thus, the present study aimed to clarify users' actual conditions and the factors related to the judgment of the possibility of bathing. METHODS An anonymous self-administered questionnaire survey of HVBs users was conducted by Company-A, which provides HVBs. Six hundred sixty responses were collected (response rate: 40.1%).We described the conditions of HVB users and used chi-squared tests and logistic regression analyses to confirm the factors, including the certified Long-term Care Insurance (LTCI) care rank, past medical history and physical conditions that were associated with aborted HVB experiences. RESULTS The mean age of the care-recipients was 82.1±12.1 and 93.3% of the recipients had severe conditions, including conditions necessitation the use of medical equipment, pressure ulcers, and contracture. The logistic regression analysis showed that the LTCI-certified-care-rank, the presence of pain, and the need for treatment before bathing were significant factors. CONCLUSIONS This study showed that users of HVBs not only had high LTCI-certified-care ranks, but that they also required pain management and pre-bathing treatment.
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Affiliation(s)
- Kazuya Taira
- Shiga University of Medical Science, Faculty of Nursing, Department of Public Health Nursing
| | - Tomoya Itatani
- Kanazawa University, Institute of Medical, Pharmaceutical and Health Sciences, Faculty of Health Science, Division of Nursing
| | - Kei Kamide
- Osaka University, Graduate School of Medicine, Division of Health Sciences
| | - Mikiko Ito
- Shiga University of Medical Science, Faculty of Nursing, Department of Public Health Nursing
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Mouriz R, Caamaño Ponte J, García Tuñas L, Dosil C, Facal D. Dementia and Challenging Behaviors in Gerontological Centers. A Case Report. Geriatrics (Basel) 2019; 4:E15. [PMID: 31023983 PMCID: PMC6473795 DOI: 10.3390/geriatrics4010015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 01/13/2019] [Accepted: 01/21/2019] [Indexed: 11/17/2022] Open
Abstract
Among the main challenges in geriatric and gerontological centers, we consider, central, the individualized attention to those elderly persons with challenging behaviors, to the extent that it is possible to design preventive strategies that delay cognitive deterioration and minimize consequences of behavior disorders. The first step will be to develop the correct interpretation of symptoms and deficits as a guarantee of a correct diagnosis which, in addition to not always being easy, has to be adapted to the progression of the disease. We present the case of a 68-year-old institutionalized individual, with an initial diagnosis of diffuse Lewy bodies dementia, analyzing his cognitive and behavioral evolution, and the pharmacological and non-pharmacological approach to the case.
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Affiliation(s)
- Romina Mouriz
- Gerontological Therapeutic Complex "A Veiga", Serge Lucense, Pobra de San Xiao, Láncara, 27360 Lugo, Spain.
- Department of Developmental Psychology, University of Santiago de Compostel, Santiago de Compostela, 15782 Galicia, Spain.
| | - José Caamaño Ponte
- Gerontological Therapeutic Complex "A Veiga", Serge Lucense, Pobra de San Xiao, Láncara, 27360 Lugo, Spain.
| | - Laura García Tuñas
- Gerontological Therapeutic Complex "A Veiga", Serge Lucense, Pobra de San Xiao, Láncara, 27360 Lugo, Spain.
| | - Carlos Dosil
- Gerontological Therapeutic Complex "A Veiga", Serge Lucense, Pobra de San Xiao, Láncara, 27360 Lugo, Spain.
- Department of Developmental Psychology, University of Santiago de Compostel, Santiago de Compostela, 15782 Galicia, Spain.
| | - David Facal
- Department of Developmental Psychology, University of Santiago de Compostel, Santiago de Compostela, 15782 Galicia, Spain.
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Henriques LVL, Dourado MDARF, Melo RCCPD, Tanaka LH. Implementation of the Humanitude Care Methodology: contribution to the quality of health care. Rev Lat Am Enfermagem 2019; 27:e3123. [PMID: 30698221 PMCID: PMC6336364 DOI: 10.1590/1518-8345.2430-3123] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 10/28/2018] [Indexed: 11/26/2022] Open
Abstract
Objective: to evaluate the contribution of the implementation of the Humanitude Care
Methodology to the quality of health care in a Continuing Care Unit. Method: an action-research study with a non-probability convenience sampling,
involving 34 health professionals from one unit in Portugal. Data was
collected through a questionnaire and an observation worksheet for the
Structured Sequence of Humanitude Care Procedures. We used data content
analysis with the Statistical Package for Social Science, version 17.0. Results: health professionals demonstrated difficulties to provide care for people who
are agitated, confused, disoriented, aggressive and who refuse care, and to
communicate with patients who do not communicate verbally. The professionals
valued the accomplishment of the stages of the observation worksheet. There
were discrepancies between the perception of accomplishment and the actual
practice. Throughout the implementation of the methodology, there was an
increase in the practical application of the procedures, with positive
repercussion for the patients and for the professionals. Conclusion: the results allowed to perceive the contribution of the process of
implementation of the methodology, through the positive transformations in
health care delivery.
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Affiliation(s)
| | | | | | - Luiza Hiromi Tanaka
- Universidade Federal São Paulo, Escola Paulista de Enfermagem, São Paulo, SP, Brazil
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8
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Lorusso LN, Bosch SJ. Impact of Multisensory Environments on Behavior for People With Dementia: A Systematic Literature Review. THE GERONTOLOGIST 2019; 58:e168-e179. [PMID: 28201710 DOI: 10.1093/geront/gnw168] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Indexed: 11/13/2022] Open
Abstract
Purpose of the Study Behavioral and psychological symptoms of dementia (BPSD) affect quality of life for people with dementia. Nonpharmacological interventions are the preferred first line of treatment, and it is theorized that BPSD are directly influenced by sensory imbalance and improved by sensory equilibrium. The purpose of this article is to investigate the evidence regarding the use of multisensory environments (MSEs) as treatment for BPSD. Design and Methods A systematic literature review was performed using the PICO framework within PsycINFO, Web of Science, ERIC, PubMED, and Cinahl databases, as well as additional hand-searched documents. Included articles were published during 1990 to 2015 and report empirical studies of MSE BPSD interventions that include furniture, fixtures, and equipment to provide visual, auditory, tactile, and olfactory stimulation. Desired elements include ergonomic vibroacoustic furniture, bubble tubes, color-changing lights, and fiber optics. Results Twelve articles met the inclusion criteria for review. Evidence supports the positive impact of sensory stimulation as a nonpharmacological behavioral treatment for dementia. Many studies investigated both behavior and mood, and several investigated biomedical parameters including heart rate and cognition. Significant differences were not found in the between-group studies when MSE was compared with other one-to-one interventions. Results on long-term effects were mixed. Variations can be seen in terms of research methods, types of environmental interventions, duration, and specific characteristics of participants, thus confounding the reliability of findings. Implications Key findings and directions for future research are discussed including primary outcomes, study design, environmental intervention types, and relevant assessment tools.
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Affiliation(s)
- Lesa N Lorusso
- Department of Interior Design, College of Design, Construction and Planning, University of Florida, Gainesville
| | - Sheila J Bosch
- Department of Interior Design, College of Design, Construction and Planning, University of Florida, Gainesville
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MCGRATH RYANP, VINCENT BRENDAM, LEE IMIN, KRAEMER WILLIAMJ, PETERSON MARKD. Handgrip Strength, Function, and Mortality in Older Adults: A Time-varying Approach. Med Sci Sports Exerc 2018; 50:2259-2266. [DOI: 10.1249/mss.0000000000001683] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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10
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Hung L, Au-Yeung A, Helmer C, Ip A, Elijah L, Wilkins-Ho M, Chaudhury H. Feasibility and acceptability of an iPad intervention to support dementia care in the hospital setting. Contemp Nurse 2018; 54:350-361. [PMID: 30068237 DOI: 10.1080/10376178.2018.1505436] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Staying in the hospital can be a very stressful experience for older people with dementia. A familiar face and reassuring voice of a family member or friend can offer a sense of safety and comfort. AIMS To explore the feasibility and acceptability of using an iPad Simulated Presence Therapy intervention with hospitalized older people with dementia. DESIGN We used a mixed-method design, incorporated video-ethnographic methods, video-recorded observations, and staff interviews. METHODS Four people with dementia from an older adult mental health hospital unit in British Columbia, Canada participated in two weeks of iPad Simulated Presence Therapy intervention. The intervention involved the older person watching a one-minute video prepared by their family prior to receiving care. The video included a reassuring, comforting and supportive message to be played to the older adult with dementia while staff perform a specific care task. The care interactions with the iPad intervention were video-recorded. Staff interviews were conducted to elicit perceived enabling factors and barriers to use the iPad intervention in their practice. Using an inductive and deductive approach, we applied a qualitative thematic analysis to identify themes in our data set. RESULTS We identified four themes: (a) positive responses, (b) person-centred care, (c) video content, and (d) technical skills. CONCLUSION The iPad delivered Simulated Presence Therapy is an acceptable and feasible means of supporting the care of older people with dementia in the hospital setting. Considerations for future research and clinical practice are presented.
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Affiliation(s)
- Lillian Hung
- a Older Adult Tertiary Mental Health , Vancouver Coastal Health , Vancouver , Canada.,b Department of Gerontology , Simon Fraser University , Vancouver , Canada
| | - Andy Au-Yeung
- a Older Adult Tertiary Mental Health , Vancouver Coastal Health , Vancouver , Canada
| | - Corrina Helmer
- a Older Adult Tertiary Mental Health , Vancouver Coastal Health , Vancouver , Canada
| | - Alice Ip
- a Older Adult Tertiary Mental Health , Vancouver Coastal Health , Vancouver , Canada
| | - Levi Elijah
- a Older Adult Tertiary Mental Health , Vancouver Coastal Health , Vancouver , Canada
| | - Michael Wilkins-Ho
- a Older Adult Tertiary Mental Health , Vancouver Coastal Health , Vancouver , Canada
| | - Habib Chaudhury
- b Department of Gerontology , Simon Fraser University , Vancouver , Canada
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11
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Marquardt G, Bueter K, Motzek T. Impact of the design of the built environment on people with dementia: an evidence-based review. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2018; 8:127-57. [PMID: 25816188 DOI: 10.1177/193758671400800111] [Citation(s) in RCA: 104] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE In this review the impact of the design of the built environment on people with dementia in long-term care settings is systematically analyzed and summarized. Architects and designers will be provided with credible evidence on which they can confidently base their design decisions. Researchers will be able to determine which environmental aspects have been well investigated and where there are gaps in the current state of the research. BACKGROUND A great number of studies have established a relationship between the design of the physical environment of long-term care settings and outcomes of people with dementia. However, the methods employed are heterogeneous and the results are often conflicting. Consequently, the process of integrating the best evidence available into architectural designs may be hindered. METHODS A systematic literature search was conducted reviewing studies that meet certain inclusion criteria. Using an evidence-based approach, the methodical quality of the studies was rated. RESULTS One hundred sixty-nine studies were found. They were thematically summarized into four main categories: basic design decisions, environmental attributes, ambience, and environmental information. The effectiveness of the interventions on the behavior, cognition, function, well being, social abilities, orientation, and care outcomes on people with dementia was illustrated by matrices. CONCLUSIONS Results of this review indicate that, with the exception of cognition, specific design interventions are beneficial to the outcomes of people with dementia. Overall, the field of environmental design for people with dementia is well researched in many aspects and only few gaps in knowledge were identified.
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Levy-Storms L, Harris LM, Chen X. A Video-Based Intervention on and Evaluation of Nursing Aides' Therapeutic Communication and Residents' Agitation During Mealtime in a Dementia Care Unit. J Nutr Gerontol Geriatr 2016; 35:267-281. [PMID: 27897609 DOI: 10.1080/21551197.2016.1238430] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The researchers conducted a communication training intervention for certified nursing assistants (CNAs). The intervention aimed at improving CNAs' therapeutic techniques for relating to agitated residents during care. This study focused on an in-depth evaluation of mealtime interactions using videos. Sixteen CNAs and 16 residents living with dementia from one long-term care facility were videotaped during mealtime interactions before and after a therapeutic communication training program. Mixed-effect Poisson regression revealed no effect of the intervention as a whole on residents' refusals, but the intervention did improve CNAs' communication. Additional analyses using specific CNAs' therapeutic communication behaviors indicated a significant negative association with refusals at post-test but not pretest. The findings suggest some communication mechanisms for how the intervention positively influenced residents' refusals.
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Affiliation(s)
- Lené Levy-Storms
- a Departments of Social Welfare and Medicine/Geriatrics , University of California , Los Angeles , California , USA
| | - Lesley M Harris
- b Kent School of Social Work , University of Louisville , Louisville , Kentucky , USA
| | - Xiao Chen
- c Center for Health Policy , University of California , Los Angeles , California , USA
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13
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Mlinac ME, Feng MC. Assessment of Activities of Daily Living, Self-Care, and Independence. Arch Clin Neuropsychol 2016; 31:506-16. [PMID: 27475282 DOI: 10.1093/arclin/acw049] [Citation(s) in RCA: 365] [Impact Index Per Article: 45.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2016] [Indexed: 11/15/2022] Open
Abstract
Activities of daily living (ADL) comprise the basic actions that involve caring for one's self and body, including personal care, mobility, and eating. In this review article, we (1) review useful clinical tools including a discussion on ways to approach ADL assessment across settings, (2) highlight relevant literature evaluating the relationship between cognitive functioning and ADLs, (3) discuss other biopsychosocial factors affecting ADL performance, (4) provide clinical recommendations for enhancing ADL capacity with an emphasis on self-care tasks (eating, grooming, dressing, bathing and toileting), and (5) identify interventions that treatment providers can implement to reduce the burden of ADL care.
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Affiliation(s)
- Michelle E Mlinac
- VA Boston Healthcare System, Harvard Medical School, Boston, MA, USA
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Impact of caregivers' behaviors on resistiveness to care and collaboration in persons with dementia in the context of hygienic care: an interactional perspective. Int Psychogeriatr 2015; 27:1861-73. [PMID: 26165352 DOI: 10.1017/s104161021500099x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The role played by various physical and verbal behaviors of professional caregivers in the onset of resistiveness to care (RTC) and collaborative behaviors of nursing home residents with dementia was assessed in a daily hygienic care routine context. METHODS Two hundred and forty hygienic care routines, observed in eight nursing home residents, were analyzed with a video-assisted systematic observation methodology and a sequential statistical analysis strategy. RESULTS Caregiver and care recipient behaviors are interdependent in the hygienic care routine context. Physical instrumental behavior, neutral, negative and positive statements, positive and negative instructions, and verbal distraction emitted by caregivers are significantly and moderately associated with the onset of RTC in persons with dementia (PWD), but the strength of relationships observed depends on the care recipient's behavior prior to the caregiver's action. Positive instructions are moderately associated with the onset of collaboration in residents with preserved language abilities. However, for residents with severe language impairment, these same instructions were linked to RTC behaviors. CONCLUSIONS Although antecedents to RTC can be identified, the risk that caregiver behaviors trigger resistive responses is higher when care recipients are already exhibiting RTC, and is low when no particular behavior or collaboration is shown. Antecedents to collaboration are also identified and discussed. Although different caregiver behaviors may be more or less likely to elicit resistiveness or collaboration, it is the pre-existing state of the care recipient that will determine its reaction to the caregiver's behavior. Clinical implications emerging from these influential findings are elaborated.
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Bathing in residential care: understanding the experiences of residents and their care providers. QUALITY IN AGEING AND OLDER ADULTS 2015. [DOI: 10.1108/qaoa-12-2013-0034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– The purpose of this paper is to understand how changes in an older adult’s physical capacity alter their bathing preferences, how the care environment incorporates residents’ values and beliefs around bathing to fulfil these changing care needs, and how institutional factors, such as staff scheduling and communication processes, influence Resident Care Aides’ (RCAs) bathing practices.
Design/methodology/approach
– A multiple methods approach involving surveys and interviews with residents and RCAs in a Canadian residential care facility. This paper draws mostly from the semi-structured, qualitative interviews with older adult residents (n=9; Mini Mental Status Exam (MMSE) scores
>
15) and RCAs (n=10) on two nursing units offering different bathing options.
Findings
– Decreasing energy levels and physical decline were commonly cited reasons for residents’ changing bathing preferences. Residents were overall very appreciative of the bathing care they received in residential care, and identified the weekly tub bath as an anticipated encounter where they experienced a valued social interaction with their assigned RCA. While identifying bathing as an occasionally stressful aspect of their work, RCAs also described the bathing experience as an intimate bonding activity. The study identified bathing as an important activity in residential care.
Originality/value
– Previous studies have focused on moderate to severely cognitively impaired older adults’ and their demonstration of agitated behaviours during bathing. Most participants in this study had only minor cognitive impairment, as measured by MMSE scores (average score=20.6); therefore, this study provides insight into the experiences and needs of older adults whose perspective is not generally reflected in the literature.
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Ostaszkiewicz J, Lakhan P, O'Connell B, Hawkins M. Ongoing challenges responding to behavioural and psychological symptoms of dementia. Int Nurs Rev 2015; 62:506-16. [PMID: 25711925 DOI: 10.1111/inr.12180] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Mid- to late-stage dementia is often characterized by behavioural and psychological symptoms, including, but not limited to physical and verbal aggression. INTRODUCTION Although there is a considerable research about the prevalence, aetiology, and management of behavioural and psychological symptoms of dementia, there is limited research about the experience of caring for people with such symptoms in long-term aged care facilities. AIM The aims of the study were to describe: (i) nurses' experiences of caring for people with behavioural and psychological symptoms of dementia in long-term aged care facilities, and (ii) strategies nurses used to deal with these symptoms. METHODS A qualitative exploratory and descriptive design, involving focus group interviews with 30 nurses from three long-term aged care units in Australia. The transcripts were analysed using inductive content analysis. RESULTS The findings revealed five interrelated themes: (i) working under difficult conditions, (ii) behavioural and psychological symptoms of dementia: an everyday encounter, (iii) making sense of behavioural and psychological symptoms of dementia, (iv) attempting to manage behavioural and psychological symptoms of dementia, and (v) feeling undervalued. CONCLUSION This study highlighted the difficult conditions under which nurses worked and the complexity of caring for individuals who have behavioural and psychological symptoms of dementia. IMPLICATIONS FOR NURSING AND HEALTH POLICY Organizational efforts to enhance the quality of care for individuals with behavioural and psychological symptoms of dementia in long-term aged care facilities should extend beyond staff education to heed nurses' concerns about organizational barriers to interpersonal care.
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Affiliation(s)
- J Ostaszkiewicz
- Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Deakin University, Melbourne, Vic., Australia
| | - P Lakhan
- Centre for Research in Geriatric Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - B O'Connell
- Faculty of Nursing, University of Manitoba, Winnipeg, Manitoba, Canada
| | - M Hawkins
- School of Nursing and Midwifery, Deakin University, Melbourne, Vic., Australia
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Howarth A, Sells D, Mackenzie L, Hope A. Are we forcing people with dementia to receive care? Int J Geriatr Psychiatry 2014; 29:768-70. [PMID: 24905887 DOI: 10.1002/gps.4112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Revised: 02/13/2014] [Accepted: 03/04/2014] [Indexed: 11/07/2022]
Affiliation(s)
- Alan Howarth
- Northumberland Challenging Behaviour Service, St George's Park, Morpeth, UK
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Konno R, Kang HS, Makimoto K. A best-evidence review of intervention studies for minimizing resistance-to-care behaviours for older adults with dementia in nursing homes. J Adv Nurs 2014; 70:2167-80. [PMID: 24738712 DOI: 10.1111/jan.12432] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2014] [Indexed: 12/21/2022]
Abstract
AIM To conduct a best-evidence review of non-pharmacological interventions for resistance-to-care behaviours of nursing home residents with dementia in a personal-care context. BACKGROUND Resistance to care is a major source of staff burnout in nursing homes and it is also a safety issue for the staff. DESIGN Best-evidence review. DATA SOURCES We searched for non-pharmacological intervention studies published from 1990-2012, written in English. REVIEW METHODS The search identified 19 intervention studies that examined the effects of interventions to reduce the resistance-to-care behaviours of nursing home residents with dementia in a personal-care context. These 19 papers met the quality assessment requirements of the critical appraisal criteria for experimental studies, which were published by the Joanna Briggs Institute. RESULTS Only three studies were RCTs and the rest were quasi-experimental. The sample size ranged from 7-127. Nine music interventions, such as pre-recorded music played to a group or playing a resident's preferred music, during his or her personal care, resulted in significant reductions in resistance-to-care behaviours. Resistance-to-care behaviours also were significantly reduced in three of four bathing interventions that focused on person-centred care. In the ability-focused interventions, only two out of five studies reported significant reductions in resistance-to-care behaviours. CONCLUSION Non-pharmacological interventions are options to consider to reduce resistance-to-care behaviours in older people with dementia, even though the evidence level is low, given the lack of alternatives. More randomized controlled trials are recommended to confirm the effects of non-pharmacological interventions during personal care.
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Affiliation(s)
- Rie Konno
- Division of Health Sciences, Osaka University Graduate School of Medicine, Osaka University, Japan
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19
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Gallagher M, Hall GR, Butcher HK. Bathing Persons With Alzheimer’s Disease and Related Dementias. J Gerontol Nurs 2014; 40:14-20. [DOI: 10.3928/00989134-20131220-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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20
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Desrosiers J, Viau-Guay A, Bellemare M, Trudel L, Feillou I, Guyon AC. Relationship-based care and behaviours of residents in long-term care facilities. Curr Gerontol Geriatr Res 2014; 2014:949180. [PMID: 24523731 PMCID: PMC3913456 DOI: 10.1155/2014/949180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Revised: 12/04/2013] [Accepted: 12/10/2013] [Indexed: 11/17/2022] Open
Abstract
Introduction. In long-term care (LTC), person-centred approaches are encouraged. One such approach, relationship-based care (RBC), aims among other things to reduce residents' agitated behaviours. RBC has been used in numerous Quebec LTC facilities over the past decade but it has never been studied. Objective. Explore correlations between use of RBC by trained caregivers and the frequency of agitated and positive behaviours of residents with cognitive impairments. Methods. Two independent raters observed fourteen caregiver/resident dyads in two LTC facilities during assistance with hygiene and dressing. Checklists were used to quantify caregivers' RBC use and residents' agitated and positive behaviours. Results. Scores for RBC use were high, suggesting good application of the approach by caregivers. Correlation analyses showed that offering residents realistic choices and talking to them during care were associated with both positive and agitated behaviours (P from 0.03 to 0.003). However, many other components of RBC were not associated with residents' behaviours during care. Conclusions. There were only a few quantitative links between the RBC checklist items and the frequency of agitated or positive behaviours. Other studies with a more rigorous research design are needed to better understand the impact of relationship-based care on residents' behaviours.
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Affiliation(s)
- Johanne Desrosiers
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001 12th Avenue North Sherbrooke, Sherbrooke, QC, Canada J1H 5N4
- Research Centre on Aging, CSSS-IUGS, Sherbrooke, QC, Canada
| | - Anabelle Viau-Guay
- Département d'études sur l'Enseignement et l'Apprentissage, Université Laval, QC, Canada
- Centre de Recherche et d'Intervention sur la Réussite Scolaire (CRIRES), QC, Canada
| | - Marie Bellemare
- Département des Relations Industrielles, Université Laval, QC, Canada
- Chaire de Recherche en Gestion de la Santé et de la sécurité du travail, Université Laval, QC, Canada
| | - Louis Trudel
- Chaire de Recherche en Gestion de la Santé et de la sécurité du travail, Université Laval, QC, Canada
- Département de Réadaptation, Université Laval, QC, Canada
| | - Isabelle Feillou
- Département des Relations Industrielles, Université Laval, QC, Canada
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21
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Cohen-Mansfield J. Nonpharmacologic Treatment of Behavioral Disorders in Dementia. Curr Treat Options Neurol 2013; 15:765-85. [DOI: 10.1007/s11940-013-0257-2] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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22
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Whall AL, Kim H, Colling KB, Hong GR, DeCicco B, Antonakos C. Measurement of aggressive behaviors in dementia: comparison of the physical aggression subscales of the Cohen-Mansfield Agitation Inventory and the Ryden Aggression Scale. Res Gerontol Nurs 2013; 6:171-7. [PMID: 23550812 DOI: 10.3928/19404921-20130321-01] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2012] [Accepted: 03/18/2013] [Indexed: 11/20/2022]
Abstract
One of the central issues in the development of research-based interventions for aggressive behavior (AB) in late-stage dementia is the provision of precise measurement of the major dependent variable, in this case, AB levels. To advance the nursing goal of evidence-based practice, this article presents the characteristics of two research instruments: the Cohen-Mansfield Agitation Inventory (CMAI) aggressive behavior subscale (CMAI-ABS) and the Ryden Aggression Scale (RAS) physically aggressive behavior subscale (RAS-PABS). A total of 282 shower bath events (which are most associated with AB) were observed for 107 nursing home residents with dementia in nine randomly selected nursing homes. Then, we compared the psychometric properties of the CMAI-ABS and the RAS-PABS. Moderate to substantial agreements between the two instruments were identified using Cohen's Kappa. A similar percentage of AB was found on both subscales. Similar items on both subscales, such as hitting and pushing, were moderately correlated. Overall, the study results support that the CMAI-ABS and RAS-PABS measure a single but multifaceted construct-physically aggressive behavior in dementia.
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Affiliation(s)
- Ann L Whall
- Oakland University, School of Nursing, Rochester, MI 48309, USA.
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23
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Young HM, Sikma SK, Reinhard SC, McCormick WC, Cartwright JC. Strategies to promote safe medication administration in assisted living settings. Res Gerontol Nurs 2013; 6:161-70. [PMID: 23350535 DOI: 10.3928/19404921-20130122-01] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Accepted: 01/10/2013] [Indexed: 11/20/2022]
Abstract
Assisted living (AL) provides lower cost, less institutional environments than skilled nursing facilities, yet less professional oversight, despite the high prevalence of chronic conditions among residents. Unlicensed staff administer large quantities of medications daily, and medication management is one of the three top quality issues in AL, with error rates ranging from 10% to 40%. This qualitative study described AL provider views on medication safety and strategies used to promote safety in medication administration. The sample included 96 participants representing all parties involved in medication administration (i.e., medication aides, administrators, RNs, consulting pharmacists, primary care providers) in 12 AL settings in three states. Core themes were the importance of medication safety, unique contextual factors in AL, and strategies used to promote medication safety. This study has implications for research on interventions to improve medication safety at the individual, facility, and policy levels.
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Affiliation(s)
- Heather M Young
- Betty Irene Moore School of Nursing, University of California Davis, Sacramento, CA 95817, USA.
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24
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Person-centered care training in long-term care settings: usefulness and facility of transfer into practice. Can J Aging 2013; 32:57-72. [PMID: 23339880 DOI: 10.1017/s0714980812000426] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The person-centered approach is increasingly recommended in long-term care facilities to increase quality of care. In Quebec, Canada,. caregivers were specifically trained in "relationship-based care. "This study analyzed caregivers' assessment of this approach's usefulness and their capacity, after training, to apply it to care practices. Questionnaires with open-ended questions were administered to caregivers (n= 392) one month after training. Caregivers' answers were categorized using a qualitative approach. Respondents perceive some features of this approach are beyond their reach or in opposition to their beliefs. They reported feeling pressure related to time constraints, their peers and the families of residents. These results indicate that training itself is insufficient to transform practice. Institutions wishing to implement such an approach must also act upon the beliefs of individuals, as well as upon work situations.
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25
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Advances in Alzheimer’s Disease Research: Implications for Family Caregiving. CAREGIVING FOR ALZHEIMER’S DISEASE AND RELATED DISORDERS 2013. [DOI: 10.1007/978-1-4614-5335-2_12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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26
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Lopes JL, Nogueira-Martins LA, de Barros AL. Bed and shower baths: comparing the perceptions of patients with acute myocardial infarction. J Clin Nurs 2012. [PMID: 23186061 DOI: 10.1111/j.1365-2702.2012.04320.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To compare the perceptions of patients with acute myocardial infarction concerning bed and shower baths and evaluate how antecedent variables influence their perceptions. BACKGROUND Professionals are often oblivious to the fact that, when performing a bed bath, they are manipulating someone else's body and invading someone's privacy and intimacy. This lack of awareness may trigger various responses in patients, such as dissatisfaction and anxiety. Several studies assessing the perceptions of patients when receiving a bed bath, and most are qualitative. Thus, there is a need to quantify these perceptions. DESIGN The research was a crossover study. METHODS The sample consisted of 71 patients with acute myocardial infarction, admitted to coronary units. Patients were evaluated on two occasions: after their second bed bath and after their second shower bath. A Semantic Differential Scale was constructed and validated prior to data collection. RESULTS The perception of patients receiving shower baths was significantly more positive than those of patients receiving bed baths (<0·0001). The only variable that interfered with the general perception of patients was prior hospitalisation (p = 0·0468). Patients who previously experienced a hospitalisation had a less positive perception, concerning both the bed and shower baths, than those who were hospitalised for the first time. CONCLUSION The perceptions of patients receiving bed baths were less positive than those of patients receiving shower baths. RELEVANCE TO CLINICAL PRACTICE The perceptions of patients receiving baths are very important to guiding nursing care and developing strategies to minimise patient dissatisfaction.
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Affiliation(s)
- Juliana L Lopes
- Nursing Department, Federal University of São Paulo, and Clinical Nurse, Heart Institute, São Paulo, Brazil.
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27
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Bhat R, Rockwood K. Psychiatric complications of dementia. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2011; 56:398-407. [PMID: 21835103 DOI: 10.1177/070674371105600703] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Our paper describes the neuropsychiatric signs and symptoms of late-life disorders of cognitive impairment. Late-life cognitive disorders are associated with psychiatric symptoms in various ways-from apparent risk factors to pathognomonic features of particular dementias. They contribute greatly to the burden of illness, both in people with dementia, and in those who care for them. Here we consider specific dementia symptoms in relation to dementing illnesses and to the stages of dementia. Recognizing that no one drug is likely to successfully treat all dementia symptoms, we argue for a syndromic approach, which can lead to appropriately targeted therapy.
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Affiliation(s)
- Ravi Bhat
- Rural Health Academic Centre, The University of Melbourne, Shepparton, Victoria, Australia
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28
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Bracke M. Review of wallowing in pigs: Description of the behaviour and its motivational basis. Appl Anim Behav Sci 2011. [DOI: 10.1016/j.applanim.2011.01.002] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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29
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O'Connor CM, Smith R, Nott MT, Lorang C, Mathews RM. Using video simulated presence to reduce resistance to care and increase participation of adults with dementia. Am J Alzheimers Dis Other Demen 2011; 26:317-25. [PMID: 21624886 PMCID: PMC10845485 DOI: 10.1177/1533317511410558] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2024]
Abstract
BACKGROUND Cognitive and functional decline in dementia generally impairs performance of basic care activities. Staff assistance during these activities frequently results in confusion, anxiety, and distress, expressed through resistance to care (RTC). METHODS A single-system ABA withdrawal design (n = 1) evaluated the effect of video-simulated presence (VSP) for decreasing RTC and increasing participation. A family member pre-recorded videos for use during episodes of RTC, in which the family member spoke directly to the participant to encourage participation. RESULTS Introduction of the VSP significantly reduced RTC during the basic care tasks of feeding and talking medication. This effect was reversed when the intervention was withdrawn. Participation increased following VSP, demonstrating clear trends toward clinical significance. CONCLUSIONS This person-centered intervention, based on VSP of a family member, provides encouraging results for reducing RTC and increasing participation of adults with dementia in basic care tasks.
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Affiliation(s)
- C M O'Connor
- University of Sydney, New South Wales, Australia.
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30
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Lin PC, Lin LC, Shyu YIL, Hua MS. Predictors of pain in nursing home residents with dementia: a cross-sectional study. J Clin Nurs 2011; 20:1849-57. [PMID: 21592246 DOI: 10.1111/j.1365-2702.2010.03695.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM The aim of this study was to investigate the association between care activities and pain and restraint and pain in residents with dementia. BACKGROUND If pain in people with dementia is not identified or alleviated in a timely manner, it could lead to an adverse effect on their physical, mental, social health and quality of life. Care activities and restraint might cause pain, but little is known as to whether they are true risk-factors of pain in people with dementia. DESIGN A cross-sectional research design was employed. METHODS One hundred and twelve people with dementia were chosen from two nursing homes located in northern Taiwan. The demographic and clinical data collected included diagnoses, analgesics, restraints, recent falls, etc. The severity of dementia was assessed using the Clinical Dementia Rating Scale. The researchers observed every participant immediately following instances of routine care and then recorded the level of pain using the Chinese version of the Pain Assessment in Advanced Dementia scale. RESULTS About 36·6% of the participants had a Chinese version of the Pain Assessment in Advanced Dementia scale score above two points and an overall mean score of 1·50 (SD 1·81) with a range from 0-8. Only one resident with dementia received regular analgesic. Pain level in residents with dementia that needed assisted care was higher than in residents who were able to move about freely. It showed a positive correlation between level of pain and the severity of dementia among residents. The major predictors for pain in residents with dementia included restraint, assisted bathing and assisted transfer. CONCLUSION The findings confirm the association between care activities and pain and between restraint and pain in residents with dementia. RELEVANCE TO CLINICAL PRACTICE Formal caregivers need to minimise the triggering of pain when they assist residents' daily activities and avoid unnecessary restraints, while offering personalised, conventional nursing care to residents with late-stage dementia.
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Affiliation(s)
- Pei-Chao Lin
- College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
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31
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Hammar LM, Emami A, Engström G, Götell E. Finding the key to communion - Caregivers’ experience of ‘music therapeutic caregiving’ in dementia care: A qualitative analysis. DEMENTIA 2011. [DOI: 10.1177/1471301210392994] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
‘Music therapeutic caregiving’ (MTC), when caregivers sing for or together with persons with dementia (PWDs) during caring situations, has been suggested as a way to reduce PWDs’ behavioral and psychological symptoms of dementia (BPSD). An intervention was designed to elucidate what influences MTC might have on PWDs and their caregivers. The aim was to describe professional caregiverś experiences of caring for PWDs during morning care situations without and with MTC. Group interviews were conducted, and a qualitative content analysis was performed. Two themes were revealed. The first (without MTC), Struggling for care in communion, encompassed four sub-themes: Hampered communication; Physical and mental struggle with aggression; Struggling with ethical demands; and The reward — consolation and love. The second theme (with MTC), Consolidating care in communion, encompassed two sub-themes: awakening cooperation, and feeling of well-being. The authors conclude that MTC could be used to help caregivers provide improved care.
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Affiliation(s)
| | | | | | - Eva Götell
- Mälardalen University and Karolinska Institute, Sweden
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32
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Rosen T, Lachs MS, Bharucha AJ, Stevens SM, Teresi JA, Nebres F, Pillemer K. Resident-to-resident aggression in long-term care facilities: insights from focus groups of nursing home residents and staff. J Am Geriatr Soc 2008; 56:1398-408. [PMID: 18637979 DOI: 10.1111/j.1532-5415.2008.01808.x] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To more fully characterize the spectrum of resident-to-resident aggression (RRA). DESIGN A focus group study of nursing home staff members and residents who could reliably self-report. SETTING A large, urban, long-term care facility. PARTICIPANTS Seven residents and 96 staff members from multiple clinical and nonclinical occupational groups. MEASUREMENTS Sixteen focus groups were conducted. Content was analyzed using nVivo 7 software for qualitative data. RESULTS Thirty-five different types of physical, verbal, and sexual RRA were described, with screaming or yelling being the most common. Calling out and making noise were the most frequent of 29 antecedents identified as instigating episodes of RRA. RRA was most frequent in dining and residents' rooms, and in the afternoon, although it occurred regularly throughout the facility at all times. Although no proven strategies exist to manage RRA, staff described 25 self-initiated techniques to address the problem. CONCLUSION RRA is a ubiquitous phenomenon in nursing home settings, with important consequences for affected individuals and facilities. Further epidemiological research is necessary to more fully describe the phenomenon and identify risk factors and preventative strategies.
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Affiliation(s)
- Tony Rosen
- Division of Geriatric Medicine and Gerontology, Weill Medical College, Cornell University, New York, New York, USA
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33
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Rosen T, Pillemer K, Lachs M. Resident-to-Resident Aggression in Long-Term Care Facilities: An Understudied Problem. AGGRESSION AND VIOLENT BEHAVIOR 2008; 13:77-87. [PMID: 19750126 PMCID: PMC2741635 DOI: 10.1016/j.avb.2007.12.001] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Resident-to-resident aggression (RRA) between long-term care residents includes negative and aggressive physical, sexual, or verbal interactions that in a community setting would likely be construed as unwelcome and have high potential to cause physical or psychological distress in the recipient. Although this problem potentially has high incidence and prevalence and serious consequences for aggressors and victims, it has received little direct attention from researchers to date. This article reviews the limited available literature on this topic as well as relevant research from related areas including: resident violence toward nursing home staff, aggressive behaviors by elderly persons, and community elder abuse. We present hypothesized risk factors for aggressor, victim, and nursing home environment, including issues surrounding cognitive impairment. We discuss methodological challenges to studying RRA and offer suggestions for future research. Finally, we describe the importance of designing effective interventions, despite the lack currently available, and suggest potential areas of future research.
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Affiliation(s)
- Tony Rosen
- Division of Geriatric Medicine and Gerontology Weill Cornell Medical College, Cornell University New York, New York
| | - Karl Pillemer
- Department of Human Development Cornell University, Ithaca, New York
| | - Mark Lachs
- Division of Geriatric Medicine and Gerontology Weill Cornell Medical College, Cornell University New York, New York
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