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McPherson R, Resnick B, Wallace BH. Differences in Staff-Resident Care Interactions by Nursing Home Racial Composition: a Preliminary Analysis. J Racial Ethn Health Disparities 2024; 11:2055-2063. [PMID: 37314689 DOI: 10.1007/s40615-023-01673-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/28/2023] [Accepted: 06/05/2023] [Indexed: 06/15/2023]
Abstract
Limited research has examined racial differences in the quality of staff-resident care interactions in long-term care settings. The quality of care interactions can significantly affect resident quality of life and psychological well-being among nursing home residents living with dementia. Limited research has assessed racial or facility differences in the quality of care interactions. The purpose of the present study was to determine if there were differences in the quality of care interactions among nursing home residents with dementia between Maryland nursing home facilities with and without Black residents. It was hypothesized that after controlling for age, cognition, comorbidities, and function, the quality of care interactions would be better in facilities with Black residents versus those in which there were only White residents. Baseline data from the Evidence Integration Triangle for Behavioral and Psychological Symptoms of Dementia (EIT-4-BPSD) intervention study was used and included 276 residents. The results indicated that facilities in Maryland with Black residents had a 0.27 increase (b = 0.27, p < .05) in the quality of care interaction score compared to facilities without Black residents. The findings from this study will be used to inform future interventions to aid in reducing quality of care disparities in nursing home facilities with and without Black nursing home residents. Future work should continue to examine staff, resident, and facility characteristics associated with the quality of care interactions to improve quality of life among all nursing home residents regardless of race or ethnicity.
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Affiliation(s)
- Rachel McPherson
- School of Nursing, University of Maryland Baltimore, Baltimore, MD, USA.
| | - Barbara Resnick
- School of Nursing, University of Maryland Baltimore, Baltimore, MD, USA
| | - Brandy Harris Wallace
- Department of Sociology, Anthropology, and Public Health, University of Maryland Baltimore County, Baltimore, MD, USA
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Passos L, Tavares J, Batchelor M, Figueiredo D. Interventions to address mealtime support needs in dementia: A scoping review. PLoS One 2024; 19:e0300987. [PMID: 38527044 PMCID: PMC10962800 DOI: 10.1371/journal.pone.0300987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 03/06/2024] [Indexed: 03/27/2024] Open
Abstract
The decrease in cognitive and physical ability among people with dementia can significantly affect eating performance, resulting in mealtime support needs that could lead to inadequate oral intake, weight loss, malnutrition, and reduced functionality in activities of daily living. This scoping review aimed to identify and summarize available research literature on mealtime interventions for people with dementia, and their impact on older people with dementia living in a residential care setting, care staff, and care context/environment. A scoping review of available research published in English, French, Portuguese, or Spanish, was conducted according to the methodology established by The Joanna Briggs Institute. The search was conducted between November 2022 and February 2023 in the following databases: MEDLINE, Web of Science, Scopus, CINAHL Complete, and SciELO. A total of 275 articles were retrieved, of which 33 studies were selected according to inclusion criteria. The interventions were classified into four general categories: environmental, mealtime assistance, staff training, and multicomponent. Most studies demonstrated effectiveness in increasing oral intake and improving behaviors such as agitation and aggression in people with dementia. The impact of interventions on care staff was linked to greater knowledge and attitudes towards mealtime support needs. There is a lack of reporting on the impact of interventions on the care context/environment. Most interventions examined the effects exclusively on residents, focusing on their oral intake and behavioral patterns, particularly agitation among individuals with dementia. However, it is crucial to conduct studies that evaluate the impact on administrators, to comprehend the viewpoints of various hierarchical levels within an organization regarding challenges associated with mealtime. The findings of this scoping review can support the development of new supportive programs, or strategies to improve mealtime experience with positive impact according to the reality and needs of each person or institution.
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Affiliation(s)
- Lígia Passos
- Center for Health Technology and Services Research (CINTESIS@RISE), Department of Education and Psychology, University of Aveiro, Aveiro, Portugal
- Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal
| | - João Tavares
- Center for Health Technology and Services Research (CINTESIS@RISE), School of Health Sciences, University of Aveiro, Aveiro, Portugal
| | - Melissa Batchelor
- School of Nursing, George Washington University, Washington, DC, United States of America
| | - Daniela Figueiredo
- Center for Health Technology and Services Research (CINTESIS@RISE), School of Health Sciences, University of Aveiro, Aveiro, Portugal
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Kashibayashi T, Kanemoto H, Takahashi R, Fujito R, Chadani Y, Tagai K, Shinagawa S, Ishii K, Ikeda M, Kazui H. Neural Basis of Agitated Behaviors in Patients with Amnestic Mild Cognitive Impairment and Alzheimer's Disease. J Alzheimers Dis 2024; 100:1399-1406. [PMID: 39093072 DOI: 10.3233/jad-240256] [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] [Indexed: 08/04/2024]
Abstract
Background Aggression, a common symptom of Alzheimer's disease (AD), can impose a significant burden on caregivers, necessitating early institutionalization. Objective The current study examined the neural basis of aggression and its expression mechanism, to advance the development of effective treatment strategies for aggression in patients with AD. Methods The study sample included 257 patients; 180 were diagnosed with AD and 77 with amnestic mild cognitive impairment (aMCI). Factor analysis of the neuropsychiatric inventory (NPI) aggression scores was performed, and the correlation between each factor and cerebral blood flow (CBF) was examined via diagnosis of AD or aMCI using statistical parametric mapping. Results Refusal of care was correlated with reduced CBF in the right hippocampus of patients with AD while no specific related regions could be identified in patients with aMCI. Violent behavior was associated with decreased CBF in the right temporal pole and medial frontal lobe of patients with AD and aMCI. Conclusions These findings suggest that aggression, measured using NPI includes two distinct symptoms, refusal of care and violent behavior, having different underlying neural bases.
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Affiliation(s)
- Tetsuo Kashibayashi
- Dementia-related Disease Medical Center, Hyogo Prefectural Rehabilitation Hospital at Nishi-Harima, Tatsuno, Japan
| | - Hideki Kanemoto
- Department of Psychiatry, Graduate School of Medicine, Osaka University, Suita, Japan
- Health and Counseling Center, Osaka University, Toyonaka, Japan
| | - Ryuichi Takahashi
- Dementia-related Disease Medical Center, Hyogo Prefectural Rehabilitation Hospital at Nishi-Harima, Tatsuno, Japan
| | - Ryoko Fujito
- Department of Neuropsychiatry, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Yoshihiro Chadani
- Department of Neuropsychiatry, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Kenji Tagai
- Department of Psychiatry, School of Medicine, Jikei University, Tokyo, Japan
| | | | - Kazunari Ishii
- Department of Radiology, Faculty of Medicine, Kindai University, Osakasayama, Japan
| | - Manabu Ikeda
- Department of Psychiatry, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Hiroaki Kazui
- Department of Neuropsychiatry, Kochi Medical School, Kochi University, Nankoku, Japan
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Moermans VRA, Hamers JPH, Verbeek H, de Casterlé BD, Milisen K, Bleijlevens MHC. District nurses' experiences with involuntary treatment in dementia care at home: a qualitative descriptive study. BMC Nurs 2023; 22:394. [PMID: 37853344 PMCID: PMC10585764 DOI: 10.1186/s12912-023-01553-w] [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: 01/13/2023] [Accepted: 10/05/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Research shows that half of person(s) living with dementia (PLWD) receive care which they resist and/or have not given consent to, defined as involuntary treatment. District nurses play a key role in providing this care. Knowledge about how district nurses experience involuntary treatment is lacking. Therefore, the aim of this study was to describe the experiences of district nurses who used involuntary treatment for PLWD at home. METHODS A qualitative descriptive design using semi-structured interviews. Sixteen district nurses with experience in involuntary treatment for PLWD were recruited through purposive sampling. Data were analysed using the Qualitative Analysis Guide of Leuven. RESULTS District nurses' experiences with involuntary treatment were influenced by their involvement in the decision-making process. When they were involved, they considered involuntary treatment use to be appropriate care. However, at the moment that involuntary treatment use was started, district nurses were worried that its use was unjust since they wished to respect the wishes of the PLWD. Eventually, district nurses found, from a professional perspective, that involuntary treatment use was necessary, and that safety outweighed the autonomy of the PLWD. District nurses experienced dealing with this dilemma as stressful, due to conflicting values. If district nurses were not involved in the decision-making process regarding the use of involuntary treatment, family caregivers generally decided on its use. Often, district nurses perceived this request as inappropriate dementia care and they first tried to create a dialogue with the family caregivers to reach a compromise. However, in most cases, family caregivers stood by their request and the district nurse still provided involuntary treatment and found this difficult to tolerate. CONCLUSIONS Our results show that district nurses experience involuntary treatment use as stressful due to dealing with obverse values of safety versus autonomy. To prevent involuntary treatment use and obverse values, we need to increase their ethical awareness, communication skills, knowledge and skills with person-centred care so they can deal with situations that can evolve into involuntary treatment use in a person-centred manner.
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Affiliation(s)
- Vincent R A Moermans
- Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Duboisdomein 30, Maastricht, 6229 GT, The Netherlands.
- Department of Nursing, White Yellow Cross Limburg, Genk, Belgium.
- Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands.
| | - Jan P H Hamers
- Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Duboisdomein 30, Maastricht, 6229 GT, The Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands
| | - Hilde Verbeek
- Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Duboisdomein 30, Maastricht, 6229 GT, The Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands
| | | | - Koen Milisen
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium
- Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Michel H C Bleijlevens
- Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Duboisdomein 30, Maastricht, 6229 GT, The Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands
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Leng M, Sun Y, Li C, Han S, Wang Z. Usability Evaluation of a Knowledge Graph-Based Dementia Care Intelligent Recommender System: Mixed Methods Study. J Med Internet Res 2023; 25:e45788. [PMID: 37751241 PMCID: PMC10565620 DOI: 10.2196/45788] [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: 01/17/2023] [Revised: 04/21/2023] [Accepted: 08/25/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND Knowledge graph-based recommender systems offer the possibility of meeting the personalized needs of people with dementia and their caregivers. However, the usability of such a recommender system remains unknown. OBJECTIVE This study aimed to evaluate the usability of a knowledge graph-based dementia care intelligent recommender system (DCIRS). METHODS We used a convergent mixed methods design to conduct the usability evaluation, including the collection of quantitative and qualitative data. Participants were recruited through social media advertisements. After 2 weeks of DCIRS use, feedback was collected with the Computer System Usability Questionnaire and semistructured interviews. Descriptive statistics were used to describe sociodemographic characteristics and questionnaire scores. Qualitative data were analyzed systematically using inductive thematic analysis. RESULTS A total of 56 caregivers were recruited. Quantitative data suggested that the DCIRS was easy for caregivers to use, and the mean questionnaire score was 2.14. Qualitative data showed that caregivers generally believed that the content of the DCIRS was professional, easy to understand, and instructive, and could meet users' personalized needs; they were willing to continue to use it. However, the DCIRS also had some shortcomings. Functions that enable interactions between professionals and caregivers and that provide caregiver support and resource recommendations might be added to improve the system's usability. CONCLUSIONS The recommender system provides a solution to meet the personalized needs of people with dementia and their caregivers and has the potential to substantially improve health outcomes. The next step will be to optimize and update the recommender system based on caregivers' suggestions and evaluate the effect of the application.
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Affiliation(s)
- Minmin Leng
- Department of Nursing, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- School of Nursing, Peking University, Beijing, China
| | - Yue Sun
- School of Nursing, Peking University, Beijing, China
| | - Ce Li
- Department of Cardiac Adult Postoperative Surgical Recovery Room, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Shuyu Han
- School of Nursing, Peking University, Beijing, China
| | - Zhiwen Wang
- School of Nursing, Peking University, Beijing, China
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Backhouse T, Khondoker M, Killett A, Mioshi E. Most Common Refusals of Personal Care in Advanced Dementia: Psychometric Properties of the Refusal of Care Informant Scale. THE GERONTOLOGIST 2023; 63:1330-1340. [PMID: 35583309 PMCID: PMC10474588 DOI: 10.1093/geront/gnac066] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Refusals of care in dementia can be a source of distress for people with dementia and their caregivers. Informant-based measures to examine refusals of care are limited and often measure other behaviors such as agitation. We aimed to assess the validity and reliability of the newly developed, 14-item, Refusal of Care Informant Scale (RoCIS) and then use the scale to verify the most common refusal behaviors. RESEARCH DESIGN AND METHODS Data from 129 dyads were analyzed. Dyad was defined as a person with advanced dementia either living in a care home or supported in their own home and their caregiver. Data about the person with dementia were gathered using informant-based questionnaires. The psychometric properties of the RoCIS were investigated using Rasch analysis to determine validity and reliability. RESULTS Following Rasch analysis, the item "upset" was removed from the RoCIS. The reduced 13-item RoCIS is unidimensional and achieved a reliability index of 0.85 (Cronbach's alpha 0.88). Sixty-eight percent of people with dementia had refused care in the last month, with "verbally refused" the most common type of refusal behavior. People in the "very severe/profound" stage of dementia showed more refusal behaviors than those in the "severe" stage. DISCUSSION AND IMPLICATIONS Results provide initial evidence that the RoCIS is a valid and reliable informant-based scale measuring refusals of care in advanced dementia. Results indicate a need to develop new approaches and techniques to make assistance with personal care more acceptable to people with dementia.
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Affiliation(s)
- Tamara Backhouse
- School of Health Sciences, University of East Anglia, Norwich, Norfolk, UK
| | - Mizanur Khondoker
- Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK
| | - Anne Killett
- School of Health Sciences, University of East Anglia, Norwich, Norfolk, UK
| | - Eneida Mioshi
- School of Health Sciences, University of East Anglia, Norwich, Norfolk, UK
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7
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Cremer S, Vluggen S, Man-Van-Ginkel JMD, Metzelthin SF, Zwakhalen SM, Bleijlevens MHC. Effective nursing interventions in ADL care affecting independence and comfort - a systematic review. Geriatr Nurs 2023; 52:73-90. [PMID: 37269607 DOI: 10.1016/j.gerinurse.2023.04.015] [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: 01/27/2023] [Revised: 04/21/2023] [Accepted: 04/25/2023] [Indexed: 06/05/2023]
Abstract
Despite its frequent provision, evidence of nursing interventions in Activities of Daily Living (ADL) remains unclear. Hence, we addressed the research question: What are the effects of ADL nursing interventions on independence and comfort in adults across all care settings? We conducted a systematic review of randomized controlled trials and quasi-experimental studies described in systematic reviews. In three databases, we searched for systematic reviews that we used as a portal to select (quasi) experimental studies. After narratively summarizing the studies on characteristics, effects, and interventions, we assessed the risk of bias. Among the 31 included studies, 14 studies evaluated independence, 14 studies measured comfort, and three studies assessed both outcomes. Seven interventions significantly improved independence and seven interventions significantly improved comfort. The studies varied highly in intervention components, outcome measures, and quality. Evidence on ADL nursing interventions affecting independence and comfort remains fragmented and inconclusive, limiting guidance for nursing professionals.
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Affiliation(s)
- S Cremer
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands; Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands.
| | - S Vluggen
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands; Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
| | - J M de Man-Van-Ginkel
- Department of Gerontology and Geriatrics, Nursing Science, Leiden University Medical Centre, Postzone C-07-Q, Postbus 9600, Leiden, RC 2300, The Netherlands
| | - S F Metzelthin
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands; Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
| | - S M Zwakhalen
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands; Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
| | - M H C Bleijlevens
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands; Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
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8
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Complementary and integrative medicines for behavioral and psychological symptoms of dementia: Overview of systematic reviews. Explore (NY) 2023; 19:176-194. [PMID: 35973932 DOI: 10.1016/j.explore.2022.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 08/09/2022] [Accepted: 08/09/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Behavioral and psychological symptoms of dementia (BPSDs) are major contributing factors to disease burden in dementia patients. Complementary and integrative medicine (CIM) has received attention in the management of dementia in patients with BPSDs. This overview aimed to comprehensively and critically review previous systematic reviews (SRs) of CIM modalities for BPSD management. METHODS Thirteen databases were searched in November 2021 to identify SRs on CIM for BPSDs. The methodological quality of the included studies was assessed using A MeaSurement Tool to Assess systematic Reviews 2. RESULTS Among 38 SRs, aromatherapy was the most commonly studied intervention, followed by herbal medicine (HM), acupuncture/acupressure, mindfulness-based interventions, relaxation, and Taichi. Half of the studies on aromatherapy reported significantly improved BPSDs, especially agitation, while the remainder reported mixed results/insufficient evidence. Most studies (85.71%) on HM supported its significant benefits in BPSDs. Yokukansan, an individual HM, was most frequently studied for BPSDs, with a significant beneficial effect on delusions, hallucinations, and agitation/aggression. Moreover, some meta-analyses supported the benefits of HM as an adjunct to psychotropic drugs in BPSD management. Other CIM interventions had insufficient clinical evidence. The methodological quality of the included studies was poor, and most were rated low or critically low (92.11%). CONCLUSION Aromatherapy, the most frequently investigated CIM for BPSD, had mixed results or insufficient evidence. HM, as an adjunct to psychotropic drugs including antipsychotics, exhibited additional benefits regarding the efficacy and safety for BPSDs. This overview emphasizes the requirement for greater quantity and quality of research in this field. REGISTRATION NUMBER Open Science Framework registry (g5f3m) (https://osf.io/g5f3m), PROSPERO (CRD42020211009) (https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020211009).
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Shirobe M, Edahiro A, Motokawa K, Morishita S, Ohara Y, Motohashi Y, Iwasaki M, Watanabe Y, Hirano H. Association between Dementia Severity and Oral Hygiene Management Issues in Older Adults with Alzheimer's Disease: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3841. [PMID: 36900852 PMCID: PMC10001667 DOI: 10.3390/ijerph20053841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 02/18/2023] [Accepted: 02/20/2023] [Indexed: 06/18/2023]
Abstract
Oral hygiene management issues vary across types and clinical stages of dementia. We aimed to clarify the issues related to oral hygiene management in older adults with Alzheimer's disease (AD) according to stages defined by the Functional Assessment Staging of Alzheimer's Disease (FAST). In all, 397 records (45 men and 352 women; average age, 86.8 years; age range, 65-106) from older adults with AD were used for the cross-sectional study. We used data from a cohort of older adults (≥65 years old) who required long-term care and lived in the Omorimachi area of Yokote City, Akita Prefecture, Japan. Multilevel logistic regression analysis was conducted to examine the associations of the FAST stage, set as the exposure variable, with oral hygiene management parameters set as outcome variables. Compared to the reference category (combined FAST stage 1-3), FAST stages 6 and 7 had significantly higher odds ratios for refusal of oral health care, dependence in performing oral health care, and rinsing and gargling disability. FAST stages 4 and 7 were associated with dental plaque accumulation. Oral health care for older adults with AD should be planned appropriately according to dementia severity.
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Affiliation(s)
- Maki Shirobe
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo 173-0015, Japan
| | - Ayako Edahiro
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo 173-0015, Japan
| | - Keiko Motokawa
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo 173-0015, Japan
| | - Shiho Morishita
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo 173-0015, Japan
- School of Health Sciences, Meikai University, 1 Meikai, Urayasu-shi, Chiba 279-8550, Japan
| | - Yuki Ohara
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo 173-0015, Japan
| | - Yoshiko Motohashi
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo 173-0015, Japan
| | - Masanori Iwasaki
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo 173-0015, Japan
| | - Yutaka Watanabe
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo 173-0015, Japan
- Gerodontology, Department of Oral Health Science, Hokkaido University, Kita 13-jo Nishi 7-chome, Kita-ku, Sapporo-shi, Hokkaido 060-8586, Japan
| | - Hirohiko Hirano
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo 173-0015, Japan
- Dentistry and Oral Surgery, Tokyo Metropolitan Geriatric Hospital, 35-2 Sakae-cho, Itabashi-ku, Tokyo 173-0015, Japan
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10
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Kerry HJ. Providing person-centred dementia care on general hospital wards. Nurs Stand 2023; 38:77-82. [PMID: 36503971 DOI: 10.7748/ns.2022.e11932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2022] [Indexed: 12/14/2022]
Abstract
Dementia is caused by conditions that result in a progressive loss of brain function. People with dementia often have complex multimorbidity which increases their risk of admission to hospital. However, care in acute hospitals is often not adapted to patients with dementia, who have reported negative experiences of their hospital stay from admission to discharge. Person-centred care has been shown to make a positive difference to how well people with dementia cope in hospital. This article discusses how nurses working on general hospital wards can enhance the experiences of people with dementia and improve their outcomes by providing person-centred care.
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Affiliation(s)
- Hannah Jane Kerry
- Faculty of Health and Wellbeing, University of Bolton, Bolton, England
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11
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Backhouse T, Killett A, Mioshi E, Khondoker M. What are the factors associated with people with advanced dementia refusing assistance with personal care? Int J Geriatr Psychiatry 2023; 38:e5857. [PMID: 36490270 PMCID: PMC10107826 DOI: 10.1002/gps.5857] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 11/21/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND People with dementia sometimes refuse assistance with personal care activities such as washing or dressing. We aimed to investigate the factors associated with refusals of care in advanced dementia. METHODS A cross-sectional study using informant-based measures. Participants were people with advanced dementia and their caregivers (family carers or care-home staff) (n = 260, 130 dyads) in the UK. Mixed effects linear models were used to examine the effects of neuropsychiatric behaviours, ability with activities of daily living, professional input, co-morbidities, psychotropic medications, environment modifications, and caregiver factors including type and training status on refusals of care. The Refusal of Care Informant Scale was used, range 1-13; higher scores indicate more refusal behaviours. RESULTS Higher independence in activities of daily living was associated with less refusal behaviours (coefficient = -0.11, p < 0.001 [95% confidence interval -0.15, -0.07]). Higher agitation was associated with more refusal behaviours (0.11, p < 0.001 [0.06, 0.15]). No other statistically significant differences were found. There was no demonstrable evidence of differences in number of refusals of care between family and care-home caregivers or between dementia-trained or -untrained caregivers. CONCLUSIONS Results suggest refusals of care have similar prevalence regardless of caregiver type (family or care home) or dementia training status, indicating that current dementia training has no impact on refusals of care or may not be implemented as intended. Improving independence in activities of daily living and reducing agitations may help prevent refusals of care. To establish causality, future research should consider embedding these factors into interventions targeting refusal of care.
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Affiliation(s)
- Tamara Backhouse
- School of Health SciencesUniversity of East AngliaNorwichNorfolkUK
| | - Anne Killett
- School of Health SciencesUniversity of East AngliaNorwichNorfolkUK
| | - Eneida Mioshi
- School of Health SciencesUniversity of East AngliaNorwichNorfolkUK
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Chen HL, Li C, Wang J, Fei Y, Min M, Zhao Y, Shan EF, Yin YH, Liu CY, Li XW. Non-Pharmacological Interventions for Feeding and Eating Disorders in Persons with Dementia: Systematic Review and Evidence Summary. J Alzheimers Dis 2023; 94:67-88. [PMID: 37212096 DOI: 10.3233/jad-221032] [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] [Indexed: 05/23/2023]
Abstract
BACKGROUND Feeding and eating disorders related to cognitive and psycho-behavioral symptoms are strongly associated with health status in persons with dementia (PWD). Non-pharmacological interventions have been the priority selection to address this significant issue. However, the direct targets of non-pharmacological interventions are unclear and there is no consistent evidence of recommendations on the intervention of different dementia stages and the settings of intervention practice. OBJECTIVE To provide caregivers with a set of self-help non-pharmacological interventions for feeding and eating disorders in PWD. METHODS Based on the process of evidence summary, a systematic literature search was performed on dementia websites and seven databases. Two researchers screened the studies independently and appraise the quality. The evidence was graded by Joanna Briggs Institute Grades of Recommendation. RESULTS Twenty-eight articles were included. Twenty-three non-pharmacological intervention recommendations were categorized into six themes containing oral nutritional supplementation, assistance with eating and drinking, person-centered mealtime care, environmental modification, education or training, and multi-component intervention. These interventions corresponded to three direct targets including improving engagement, making up for loss ability, and increasing food intake directly. They were applied to different stages of dementia and most interventions were targeted at PWD in long-term care institutions. CONCLUSION This article summarized the direct targets and the specific implementation of recommendations at different stages of dementia to provide caregivers with self-help non-pharmacological interventions. The practice of recommendations was more applicable to institutionalized PWD. When applied to PWD at home, caregivers need to identify the specific feeding and eating conditions at different stages and adopted the interventions in conjunction with the wishes of the PWD and professional advice.
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Affiliation(s)
- Hong-Li Chen
- School of Nursing, Nanjing Medical University, Nanjing, PR China
| | - Cheng Li
- School of Nursing, Nanjing Medical University, Nanjing, PR China
| | - Jing Wang
- School of Nursing, Nanjing Medical University, Nanjing, PR China
| | - Yang Fei
- School of Nursing, Nanjing Medical University, Nanjing, PR China
| | - Min Min
- Landsea Long-term Care Facility, Nanjing, PR China
| | - Yue Zhao
- School of Nursing, Nanjing Medical University, Nanjing, PR China
| | - En-Fang Shan
- School of Nursing, Nanjing Medical University, Nanjing, PR China
| | - Yue-Heng Yin
- School of Nursing, Nanjing Medical University, Nanjing, PR China
| | - Chong-Yuan Liu
- Center of Clinical Reproductive Medicine, The NMU First Affiliated Hospital, Nanjing Medical University, Nanjing, PR China
| | - Xian-Wen Li
- School of Nursing, Nanjing Medical University, Nanjing, PR China
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13
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Jonker M, Engelsma C, Manton DJ, Visser A. Decision-Making concerning Involuntary Oral Care for Older Individuals with Dementia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16655. [PMID: 36554537 PMCID: PMC9779801 DOI: 10.3390/ijerph192416655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 12/06/2022] [Accepted: 12/09/2022] [Indexed: 06/17/2023]
Abstract
Many older individuals with dementia (OIWD) show care-resistant behavior for oral care. Providing care despite resistance is considered to be involuntary care. Although involuntary care should be minimized, in some OIWD it may be necessary to avoid health risks. This study aims to assess the attitudes of healthcare providers with regard to involuntary oral care provision for OIWD who show care-resistant behavior. An online questionnaire consisting of general questions and case specific questions was administered via social media and networking to individuals involved in the oral care of OIWD. A total of 309 participants were included in this study. The outcomes of the questionnaires were categorized per case. In all cases, a discrepancy was seen between the assessment of oral health problems as potentially harmful (range: 73.1-93.5%) and the willingness to provide involuntary care (range: 31.1-63.4%). Hence, many healthcare providers are aware of the subsequent potential health risks related to not providing care, but are still reluctant to provide involuntary oral care. Therefore, many OIWD who show care-resistant behavior potentially do not receive the necessary oral care they require.
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Affiliation(s)
- Maud Jonker
- Department of Gerodontology, Center for Dentistry and Oral Hygiene, University Medical Center Groningen, University of Groningen, 9713 AV Groningen, The Netherlands
| | - Coos Engelsma
- Medical Ethics and Decision Making, Department of Ethics, Center for Dentistry and Oral Hygiene, University Medical Center Groningen, University of Groningen, 9713 AV Groningen, The Netherlands
| | - David J. Manton
- Department of Cariology, Center for Dentistry and Oral Hygiene, University Medical Center Groningen, University of Groningen, 9713 AV Groningen, The Netherlands
- Department of Paediatric Dentistry, Academic Centre for Dentistry Amsterdam (ACTA), Vrije Universiteit Amsterdam and University of Amsterdam, 1081 LA Amsterdam, The Netherlands
| | - Anita Visser
- Department of Gerodontology, Center for Dentistry and Oral Hygiene, University Medical Center Groningen, University of Groningen, 9713 AV Groningen, The Netherlands
- Department of Gerodontology, Faculty for Dentistry, Radboud University Medical Center, Radboud University Nijmegen, 6525 EX Nijmegen, The Netherlands
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14
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Barry BJ, McConnell ES, Duea SR, Blodgett NP. A Standardized Positive Physical Approach to Improve Oral Hygiene for Nursing Home Residents With Alzheimer's Disease and Related Dementias. J Gerontol Nurs 2022; 48:15-20. [DOI: 10.3928/00989134-20221003-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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15
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Backhouse T, Jeon YH, Killett A, Mioshi E. How do family carers and care-home staff manage refusals when assisting a person with advanced dementia with their personal care? DEMENTIA 2022; 21:2458-2475. [PMID: 36053711 PMCID: PMC9583289 DOI: 10.1177/14713012221123578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background and objectives Caregivers may encounter, or inadvertently cause, refusals of care by a care
recipient. Managing refusals of care can be challenging and have potential
negative consequences. We aimed to examine caregivers’ (care-home staff and
family carers) experiences of managing refusals of personal care in advanced
dementia. Research design and methods One-to-one semi-structured interviews with 12 care assistants from six care
homes and 20 family carers who were physically assisting a person with
advanced dementia with their personal care in the UK. Interviews were audio
recorded and transcribed verbatim, with data analysed using qualitative
content analysis. Findings Core to the caregiver experience of refusals of care was
knowing the person. This underpinned
five key themes identified as caregivers’ strategies used in preventing or
managing refusals of care: (1) finding the right moment to care; (2) using
specific communication strategies; (3) being tactful: simplifying, leaving,
or adapting care; (4) having confidence in care; and (5) seeking support
from others when safety is at risk. Discussion and implications Different caregiver relationships with the person with dementia influenced
how they managed refusals of care. Refusals of care can place caregivers in
tough situations with tensions between providing care when it is seemingly
not wanted and leaving care incomplete. Both caregiver groups require
support such as coaching, mentoring and/or advice from other health and
social care practitioners to manage difficult personal care interactions
before crisis points occur.
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Affiliation(s)
- Tamara Backhouse
- School of Health Sciences, 83726University of East Anglia, Norwich, Norfolk, UK
| | - Yun-Hee Jeon
- Sydney Nursing School, 4334The University of Sydney, Sydney, NSW, Australia
| | - Anne Killett
- School of Health Sciences, 83726University of East Anglia, Norwich, Norfolk, UK
| | - Eneida Mioshi
- School of Health Sciences, 83726University of East Anglia, Norwich, Norfolk, UK
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16
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Shaw C, Ward C, Gordon J, Williams K, Herr K. Characteristics of elderspeak communication in hospital dementia care: Findings from The Nurse Talk observational study. Int J Nurs Stud 2022; 132:104259. [PMID: 35623154 PMCID: PMC10408664 DOI: 10.1016/j.ijnurstu.2022.104259] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 03/28/2022] [Accepted: 04/17/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Elderspeak communication is typically viewed as patronizing and infantilizing by older adults and can lead to resistive behaviors in persons living with dementia. Little is known about the presence of elderspeak communication in hospitals in the United States. Understanding this phenomenon in the hospital setting is needed in order to improve hospital dementia care. OBJECTIVES The purpose of the Nurse Talk study was to (1) describe attributes of elderspeak use in hospital dementia care and to (2) determine what characteristics are associated with nursing staff use of elderspeak communication with hospitalized patients with dementia. DESIGN A cross-sectional observational study design was used to collect and analyze audio-recordings of nursing staff during care for hospitalized patients with dementia. SETTING Three hospital units in one Midwestern university hospital in the United States. PARTICIPANTS A convenience sample of 53 staff nurses and nursing assistants that provided direct care to 16 patients with mild or more severe dementia recruited from October 2019 through mid-March 2020. METHODS Eighty-eight care encounters were audio-recorded and coded for elderspeak communication using the Iowa Coding of Elderspeak scheme to determine the frequency and characteristics of elderspeak communication. A linear mixed effects model was used to determine what characteristics were associated with elderspeak and the frequency of elderspeak use by nursing staff to hospitalized patients with dementia. RESULTS Over a quarter (28.7%) of all nursing staff speech directed towards patients with dementia constituted elderspeak and nearly all (96.6%) care encounters included some elderspeak. Particularly common attributes of elderspeak were minimizing words and mitigating expressions, childish terms and phrases, and collective pronoun substitution. A statistically significant interaction was identified between staff role and age (95% CI: -0.02, -0.00, p = .008) in predicting the frequency of elderspeak use, indicating that elderspeak was used more often by older staff nurses, whereas the age of nursing assistants remained constant across elderspeak use. Statically significant effects for delirium and length of stay were also demonstrated. Elderspeak use was 12.5% higher with patients with delirium (95% CI: 0.02, 0.23, p = .025) and increased 1.5% for each additional day the patient with dementia was hospitalized (95% CI: 0.00, 0.03, p = .035). CONCLUSIONS Elderspeak is present and pervasive in the acute care setting. Interventions targeted towards older staff nurses and nursing staff from hospital units that care for patients with delirium and longer lengths of stay are needed. TWEETABLE ABSTRACT This study identified that nursing staff are frequently using elderspeak (infantilizing speech) with hospitalized patients with dementia. @claireshaw_phd @IowaNursing.
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Affiliation(s)
- Clarissa Shaw
- University of Iowa College of Nursing, Iowa City, Iowa, USA.
| | - Caitlin Ward
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, Iowa, USA; Department of Mathematics and Statistics, Faculty of Science, University of Calgary, Calgary, Canada
| | - Jean Gordon
- Department of Communication Sciences and Disorders, University of Iowa, Iowa City, Iowa, USA
| | - Kristine Williams
- School of Nursing, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Keela Herr
- University of Iowa College of Nursing, Iowa City, Iowa, USA
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17
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Moermans VRA, Bleijlevens MHC, Verbeek H, Passos VL, Milisen K, Hamers JPH. District nurses' attitudes towards involuntary treatment in dementia care at home: A cross-sectional study. Geriatr Nurs 2022; 47:107-115. [PMID: 35905633 DOI: 10.1016/j.gerinurse.2022.07.009] [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: 05/06/2022] [Revised: 07/06/2022] [Accepted: 07/07/2022] [Indexed: 11/18/2022]
Abstract
One in two persons living with dementia (PLWD) at home receive care which they resist to and/or have not given consent to, defined as involuntary treatment. District nurses play a key role in the use of involuntary treatment. However, little is known how their attitudes and opinions influence the use of involuntary treatment. This cross-sectional study aims to investigate the attitudes of district nurses towards the use of involuntary treatment in dementia care at home, determinants and their opinion about its restrictiveness and discomfort. Results show that district nurses perceive involuntary treatment as regular part of nursing care, having neither positive nor negative attitude towards its appropriateness. They consider involuntary treatment usage as moderately restrictive to PLWD and feel moderately uncomfortable when using it. These findings underscore the need to increase the awareness of district nurses regarding the negative consequences of involuntary treatment use to PLWD at home.
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Affiliation(s)
- Vincent R A Moermans
- PhD - Student, Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Duboisdomein 30, Maastricht 6229 GT, The Netherlands; Regional Manager and Nurse Specialist, Department of Nursing, White and Yellow Cross Limburg, Genk, Belgium; Voluntary Scientific Assistant, Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium.
| | - Michel H C Bleijlevens
- Assistant Professor, Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Hilde Verbeek
- Professor, Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Valéria Lima Passos
- Associate Professor, Department Methodology and Statistics, Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Koen Milisen
- Professor, Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium
| | - Jan P H Hamers
- Professor, Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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18
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Shaw CA, Ward C, Gordon J, Williams KN, Herr K. Elderspeak communication and pain severity as modifiable factors to rejection of care in hospital dementia care. J Am Geriatr Soc 2022; 70:2258-2268. [PMID: 35642656 PMCID: PMC9378618 DOI: 10.1111/jgs.17910] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 03/10/2022] [Accepted: 03/25/2022] [Indexed: 11/28/2022]
Abstract
Background Rejection of care (RoC) occurs when persons living with dementia (PLWD) withstand or oppose the efforts of their caregiver. Improvements in hospital dementia care are needed, and one way to address this need is by identifying factors that lead to RoC, particularly those that are modifiable. Elderspeak communication is an established antecedent to RoC among PLWD in nursing homes. The purpose of this study was to extend these results to acute care settings by determining the impact of elderspeak communication by nursing staff on RoC by hospitalized PLWD. Methods Care encounters between nursing staff and PLWD were audio‐recorded, transcribed verbatim, and coded for semantic, pragmatic, and prosodic features of elderspeak. RoC behaviors was scored in real‐time using the Resistiveness to Care Scale. A Bayesian repeated‐measures hurdle model was used to evaluate the association between elderspeak and both the presence and severity of RoC. Results Eighty‐eight care encounters between 16 PLWD and 53 nursing staff were audio‐recorded for elderspeak and scored for RoC. Nearly all (96.6%) of the encounters included some form of elderspeak. Almost half of the care encounters (48.9%) included RoC behaviors. A 10% decrease in elderspeak was associated with a 77% decrease in odds of RoC (OR = 0.23, 95% CI = 0.03, 0.68) and a 16% decrease (eβ= 0.84, CI = 0.73, 0.96) in the severity of RoC. A one‐unit decrease in pain severity was associated with 73% reduced odds of RoC (OR = 0.27, CI = 0.12, 0.45) and a 28% decrease (eβ= 0.72, CI = 0.64, 0.80) in the severity of RoC. Conclusions Both elderspeak by nursing staff and RoC by PLWD are present and pervasive in acute care. Pain and elderspeak are two modifiable factors of RoC in hospitalized PLWD. Person‐centered interventions are needed that address communication practices and pain management for hospitalized PLWD.
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Affiliation(s)
- Clarissa A Shaw
- College of Nursing, University of Iowa, Iowa City, Iowa, USA
| | - Caitlin Ward
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, Iowa, USA.,Department of Mathematics and Statistics, Faculty of Science, University of Calgary, Calgary, Alberta, Canada
| | - Jean Gordon
- Department of Communication Sciences and Disorders, University of Iowa, Iowa City, Iowa, USA
| | - Kristine N Williams
- School of Nursing, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Keela Herr
- College of Nursing, University of Iowa, Iowa City, Iowa, USA
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19
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Morris P, McCloskey R, Bulman D. Iatrogenesis in the context of residential dementia care: A concept analysis. Innov Aging 2022; 6:igac028. [PMID: 35832201 PMCID: PMC9273406 DOI: 10.1093/geroni/igac028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Indexed: 11/12/2022] Open
Abstract
Background and Objectives This concept analysis aims to explore iatrogenesis within the context of residential dementia care and to distinguish this phenomenon from similar phenomena, such as abuse and inadvertent harm. Research Design and Methods Walker and Avant’s method for concept analysis was used to define critical attributes of iatrogenesis within residential dementia care, and to explore antecedents and consequences of its occurrence. A review of the literature about iatrogenesis in the context of residential dementia was conducted across 4 electronic databases. Texts about iatrogenesis in surgery, medicine, social work, psychology, and other relevant disciplines were also reviewed to provide additional context for the concept. Results Iatrogenesis takes a unique form in residential dementia care. The final definition of the concept proposed in this article is habituated, forceful, hands-on care provided to residents who exhibit responsive behaviors that result in emotional, physical, spiritual, social harm, and/or gradual functional decline, that is provided with the intention of supporting the resident’s safety and dignity. Discussion and Implications The definition of iatrogenesis proposed in this article is an initial step toward developing evidence-based practice for the provision of nonconsensual assistance in residential dementia care. A theoretical definition like the one proposed in this article may serve as a starting point for the operationalization of the concept, which would promote future empirical research into staff and residents’ experiences of health care-inflicted harms in this context. Theoretically, it contributes to critical conversations about the narratives, myths, and misperceptions that facilitate the provision of nonconsensual care.
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Affiliation(s)
- Patricia Morris
- School of Graduate Studies, University of New Brunswick, Saint John, New Brunswick, Canada
| | - Rose McCloskey
- Department of Nursing & Health Sciences, University of New Brunswick, Saint John, New Brunswick, Canada
| | - Donna Bulman
- Faculty of Nursing, University of New Brunswick, Fredericton, New Brunswick, Canada
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20
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Nguyen H, Eccleston CE, Doherty KV, Jang S, McInerney F. Communication in dementia care: Experiences and needs of carers. DEMENTIA 2022; 21:1381-1398. [PMID: 35333128 DOI: 10.1177/14713012221080003] [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: 11/15/2022]
Abstract
To ensure the well-being, quality of life and quality of care of people living with dementia, carers need to have the necessary communication knowledge and skills to respond appropriately to a person's changing abilities and needs. Understanding carers' communication experiences and needs in the context of dementia care is an important step in enabling effective education and support for carers. This study aimed to investigate communication challenges faced by carers and their coping strategies, influencing factors, and communication education and training needs. The sample involved 258 carers enrolled in an online dementia care program, and data were collected using a 16-item questionnaire. Descriptive statistics and non-parametric inferential statistics, including Chi-square, Mann-Whitney U, Kruskal-Wallis and Spearman's rho, were used to analyse the data. The participants reported experiencing a range of challenges in communicating with people living with dementia and employing various strategies in addressing these challenges, either independently or with the support of others. Improvements in a number of factors would be beneficial for carers, including more time for caring, more care and social support, as well as enhanced skills in communicating with people living with dementia. A large majority of the participants indicated their need for education or training in communication knowledge and skills, and those with higher learning needs were likely to be younger, care workers and other health professionals, and those with less care experience. Recommendations are made for future research and efforts to maximise effective education and support for carers of people living with dementia.
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Affiliation(s)
- Hoang Nguyen
- Wicking Dementia Research & Education Centre, College of Health and Medicine, 3925University of Tasmania, Hobart AU-TAS 7001, Australia
| | - Claire Ea Eccleston
- Wicking Dementia Research & Education Centre, College of Health and Medicine, 3925University of Tasmania, Hobart AU-TAS 7001, Australia
| | - Kathleen Veronica Doherty
- Wicking Dementia Research & Education Centre, College of Health and Medicine, 3925University of Tasmania, Hobart AU-TAS 7001, Australia
| | - Sunny Jang
- Wicking Dementia Research & Education Centre, College of Health and Medicine, 3925University of Tasmania, Hobart AU-TAS 7001, Australia
| | - Fran McInerney
- Wicking Dementia Research & Education Centre, College of Health and Medicine, 3925University of Tasmania, Hobart AU-TAS 7001, Australia
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21
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Okamoto R, Kiya M, Koide K, Tanaka M, Kageyama M. Cases of intervention refusal encountered by public health nurses in Japan and characteristics of their support- qualitative analysis of described mother-child and elderly cases. BMC Nurs 2022; 21:39. [PMID: 35114988 PMCID: PMC8812212 DOI: 10.1186/s12912-021-00706-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 09/22/2021] [Indexed: 11/26/2022] Open
Abstract
Background The purpose of this study is to clarify the actual situation of the cases and the characteristics of support, focusing on mothers and their children, and elderly persons among the cases of intervention refusal encountered by public health nurses (PHNs) in Japan. Methods The data were descriptions of intervention refusal cases that were freely described by PHNs working for prefectural and municipal governments in questionnaire surveys nationwide. The characteristics of the cases and the support were categorized according to the situation of the case, and the number of descriptions was summarized and interpreted. Results The results revealed that interventions involving mothers and children were refused in most of by mother or parents. The refusals were related to child abuse, parental mental illness, obsessiveness, and complex backgrounds. The actual status of intervention refusal in elderly persons, interventions are frequently refused by elderly persons themselves in the case of self-neglect and by family members living with the elderly in the case of abuse. The refusals were related to mental disorders or dementia and living alone. In both cases, PHNs provided support in collaboration with multi-disciplinary and multi-agencies, and attempts were made to alleviate the situation of refusal to intervene, from detecting cases through contact during home visits and in other settings, and by coordinating with appropriate team members as required. Conclusions It is suggested that PHNs need to acquire practical skills depending on the characteristics of the case to cope with critical situations throughout the process of engagement. Supplementary Information The online version contains supplementary material available at 10.1186/s12912-021-00706-z.
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Affiliation(s)
- Reiko Okamoto
- Division of Health Sciences, Osaka University Graduate School of Medicine, Yamadaoka 1-7, Suita-city, Osaka, 565-0871, Japan.
| | - Misaki Kiya
- Division of Health Sciences, Osaka University Graduate School of Medicine, Yamadaoka 1-7, Suita-city, Osaka, 565-0871, Japan
| | - Keiko Koide
- Division of Health Sciences, Osaka University Graduate School of Medicine, Yamadaoka 1-7, Suita-city, Osaka, 565-0871, Japan
| | - Miho Tanaka
- Division of Health Sciences, Osaka University Graduate School of Medicine, Yamadaoka 1-7, Suita-city, Osaka, 565-0871, Japan
| | - Masako Kageyama
- Division of Health Sciences, Osaka University Graduate School of Medicine, Yamadaoka 1-7, Suita-city, Osaka, 565-0871, Japan
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22
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Gutman G, Vashisht A, Kaur T, Karbakhsh M, Churchill R, Moztarzadeh A. A Novel Intervention for Management of Behavioral and Psychological Symptoms of Dementia in Nursing Home Communal Areas: Results of a Small-Scale Pilot Trial. J Alzheimers Dis Rep 2021; 5:847-853. [PMID: 35088034 PMCID: PMC8764626 DOI: 10.3233/adr-210054] [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: 10/25/2021] [Accepted: 11/01/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Behavioral and psychological symptoms of dementia (BPSD) exhibited by persons with dementia (PwD) in nursing home communal areas are generally managed by segregation and/or pharmacological interventions. OBJECTIVE This study trialed MindfulGarden (MG), a novel digital calming device, in a Canadian nursing home. METHODS Participants were 15 PwD (mean age = 87.67; 5m,10f; mean MMSE = 11.64±7.85). Each was observed by a research assistant (RA) for an average of 8-10 hours on two separate days. The RA followed them during time spent in communal areas of the nursing home including their unit's dining space, lounges, and corridors and spaces shared with other units (e.g., gym and gift shop) and documented any BPSD exhibited. Day-1 provided baseline data; on Day-2, residents were exposed to MG if nursing staff considered their BPSD were sufficiently intense or sustained to warrant intervention. Staff rated the impact as positive, neutral, or negative. RESULTS On Day-1, 9 participants exhibited both aggressive and non-aggressive behaviors, 4 non-aggressive behaviors only, and 2 no BPSD. On Day-2, 7 exhibiting aggressive behaviors were exposed to MG. Staff reported MG as having distracting/calming effects and gave positive impact ratings to 6/13 exposures; there were no negative ratings. The most common aggressive BPSD on days of observation were pushing/shoving and screaming. CONCLUSION MG may have value as a "psychiatric crash cart" in de-escalating agitation and aggression in care home settings.
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Affiliation(s)
- Gloria Gutman
- Gerontology Research Centre, Simon Fraser University, Vancouver, BC, Canada
- Department of Gerontology, Simon Fraser University, Vancouver, BC, Canada
| | - Avantika Vashisht
- Biomedical Physiology and Kinesiology Department, Simon Fraser University, Vancouver, BC, Canada
| | - Taranjot Kaur
- Biology Department, Simon Fraser University, Vancouver, BC, Canada
| | - Mojgan Karbakhsh
- Gerontology Research Centre, Simon Fraser University, Vancouver, BC, Canada
| | - Ryan Churchill
- Department of Gerontology, Simon Fraser University, Vancouver, BC, Canada
| | - Amir Moztarzadeh
- Gerontology Research Centre, Simon Fraser University, Vancouver, BC, Canada
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23
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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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Gutman G, Vashisht A, Kaur T, Churchill R, Moztarzadeh A, Karbakhsh M. Pilot Study of a Digital Screen-Based Calming Device for Managing Resistance During Morning and Evening Care of Persons With Dementia. J Gerontol Nurs 2021; 47:15-21. [PMID: 34704866 DOI: 10.3928/00989134-20211012-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Resistance to care is among the most common behaviors exhibited by persons with dementia (PwD). Resistance to care is a barrier to safety and comfort of PwD and caregivers. Nonpharmacological interventions are recommended as first-line management. In the current study, 13 long-term care (LTC) residents aged 74 to 100 years with a history of behavioral and psychological symptoms of dementia (BPSD) were randomized to intervention (n = 7) and control (n = 6) groups. On Days 1 to 3, the intervention group received usual care plus exposure to MindfulGarden (MG), a novel digital calming device during morning and evening care, activities widely recognized as problematic for PwD and staff; the control group received usual care only. On Day 4, both groups were exposed to MG with verbal prompting. Trends in the data suggest that MG reduced BPSD and duration of care in the morning and may be a useful tool in management of resistance to routine care in PwD in LTC settings. [Journal of Gerontological Nursing, 47(11), 15-21.].
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Mortensen AH, Stojiljkovic M, Lillekroken D. Strategies to manage cognitive dissonance when experiencing resistiveness to care in people living with dementia: A qualitative study. J Adv Nurs 2021; 78:486-497. [PMID: 34432326 DOI: 10.1111/jan.15030] [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: 05/07/2021] [Revised: 08/08/2021] [Accepted: 08/20/2021] [Indexed: 11/29/2022]
Abstract
AIMS To explore the experiences of healthcare personnel when they face resistiveness to care in people living with dementia in nursing homes. DESIGN The study has a qualitative explorative design. METHODS Three focus group interviews were conducted in June 2019. A total of 16 nurses and other healthcare personnel employed in three different nursing homes participated. A semi-structured interview guide was used during the focus group interviews. Data were transcribed verbatim and analysed using an inductive qualitative content analysis. RESULTS The analysis generated one overarching category-'Tension when facing resistiveness to care', which describes the discomfort healthcare personnel experienced when confronted with resistiveness to care in people with dementia-and two other categories: 'Attitude change' and 'Changing behaviour', which describes their strategies to reduce and/or manage the discomfort. Four subcategories-'Changing the mindset', Conceptual shift', Stepping back' and 'Not giving up'-described the actions taken by healthcare personnel to manage or reduce their cognitive dissonance. CONCLUSION The strategies used to manage or reduce cognitive dissonance provide a new understanding of how healthcare personnel choose to approach resistiveness to care in people living with dementia. IMPACT This study addresses cognitive dissonance, a discomfort experienced by healthcare personnel when facing resistiveness to care from people living with dementia. To reduce their dissonance, the participants employed several strategies, including coercive measures, when providing care. The theory of cognitive dissonance may help explain why healthcare personnel sometimes choose to employ coercive measures while providing care.
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Affiliation(s)
- Anne Helene Mortensen
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Marko Stojiljkovic
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Daniela Lillekroken
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
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Karacsony S, Abela MRL. Stimulating sense memories for people living with dementia using the Namaste Care programme: What works, how and why? J Clin Nurs 2021; 31:1921-1932. [PMID: 33462888 DOI: 10.1111/jocn.15665] [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] [Received: 07/31/2020] [Revised: 11/18/2020] [Accepted: 12/31/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Sensory-based program for people with advanced dementia aim to address unmet needs and to improve behaviours, mood or cognition. Pleasurable, involuntary sense memories stimulated by sensory-based program are difficult to evaluate because it is not possible to ask what people with dementia remember about their past, or what sense memories are being evoked. Notwithstanding the challenges in identifying what sense memories people with dementia experience, nurses and caregivers should recognise the potential value of sense memories for pleasure and happiness and provide optimum conditions to stimulate the senses. AIMS AND OBJECTIVES To examine the potential for involuntary sense memories to be activated by sensory stimulation, with a focus on the effects of the Namaste Care programme. DESIGN This is a discursive paper applying a content analysis to the qualitative findings of studies reporting on the Namaste Care programme to critically evaluate the topic of involuntary sense memories for people living with advanced dementia. METHODS A literature review and content analysis of qualitative findings on the Namaste Care programme was performed. Findings are reported in line with the COREQ checklist. RESULTS Eleven studies met the inclusion criteria. Codes were grouped into four categories representing enhanced mood, pleasure, happiness and comfort capturing the effects of the sensory stimulation observed or perceived by nurses and family caregivers. Descriptions provide some evidence of sensory memories activated by stimulation of some senses but not all. CONCLUSION Involuntary sense memories contribute to well-being of people living with advanced dementia. Caregivers, including nurses, need to be aware that involuntary sense memories that do not rely on cognitive processes can be triggered by sensory stimulation and have the potential to enhance mood and bestow pleasure, happiness and comfort over and above the "activity" of the sensory programme. RELEVANCE TO CLINICAL PRACTICE By integrating the documented experiential findings and conceptual understandings of sense memory, this paper contributes to advancing the understanding of the value of involuntary sense memories for people living with dementia that nurses and caregivers need to be aware of and, in turn, provide the optimum conditions for memory of the senses to be activated. A sensory-based programme, such as Namaste Care, provides optimum conditions at low cost to activate sense memories.
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Affiliation(s)
- Sara Karacsony
- School of Nursing, College of Health and Medicine, University of Tasmania, Sydney, Australia
| | - Melissa R L Abela
- Wicking Dementia Research & Education Centre, College of Health and Medicine, University of Tasmania, Hobart, Australia
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