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Verhees LHF, Banning LCP, Stalman H, Koopmans RTCM, Gerritsen DL. Transferring people with dementia to severe challenging behavior specialized units, an in-depth exploration. Aging Ment Health 2024; 28:838-848. [PMID: 37993411 DOI: 10.1080/13607863.2023.2280673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 10/16/2023] [Indexed: 11/24/2023]
Abstract
OBJECTIVES One of the main reasons for people with dementia to move to a dementia special care unit of a nursing home is challenging behavior. This behavior is often difficult to manage, and in the Netherlands, residents are sometimes relocated to a severe challenging behavior specialized unit. However, relocation often comes with trauma and should be prevented if possible. This study aimed to investigate the patient- and context-related reasons for these relocations. METHODS Qualitative multiple case study using individual (n = 15) and focus group interviews (n = 4 with n = 20 participants) were held with elderly care physicians, physician assistants, psychologists, nursing staff members, and relatives involved with people with dementia and severe challenging behavior who had been transferred to a severe challenging behavior specialized unit. Audio recordings were transcribed and analyzed with thematic analysis, including directed content analysis. RESULTS After five cases, data-saturation occurred. The thematic analysis identified three main processes: increasing severity of challenging behavior, increasing realization that the clients' needs cannot be met, and an increasing burden of nursing staff. The interaction between these processes, triggered mainly by a life-threatening situation, led to nursing staff reaching their limits, resulting in relocation of the client. CONCLUSION Our study resulted in a conceptual framework providing insight into reasons for relocation in cases of severe challenging behavior. To prevent relocation, the increasing severity of challenging behavior, increasing burden on nursing staff, and increasing realization that the clients' needs cannot be met need attention.
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Affiliation(s)
- Leon H F Verhees
- De Zorggroep, Center for Specialized Geriatric Care, Venlo, Netherlands
- Center for Specialized Psychiatric Care, Vincent van Gogh Institute, Venray, Netherlands
- Radboudumc Alzheimer Center, Department of Primary and Community Care, Radboud University Medical Center, Research Institute for Medical Innovation, Nijmegen, Netherlands
| | - Leonie C P Banning
- Radboudumc Alzheimer Center, Department of Primary and Community Care, Radboud University Medical Center, Research Institute for Medical Innovation, Nijmegen, Netherlands
| | - Hester Stalman
- De Zorggroep, Center for Specialized Geriatric Care, Venlo, Netherlands
| | - Raymond T C M Koopmans
- Radboudumc Alzheimer Center, Department of Primary and Community Care, Radboud University Medical Center, Research Institute for Medical Innovation, Nijmegen, Netherlands
- Center for Specialized Geriatric Care, Joachim en Anna, Nijmegen, Netherlands
| | - Debby L Gerritsen
- Radboudumc Alzheimer Center, Department of Primary and Community Care, Radboud University Medical Center, Research Institute for Medical Innovation, Nijmegen, Netherlands
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Veldwijk-Rouwenhorst AE, Zuidema SU, Smalbrugge M, Persoon A, Koopmans RTCM, Gerritsen DL. Losing hope or keep searching for a golden solution: an in-depth exploration of experiences with extreme challenging behavior in nursing home residents with dementia. BMC Geriatr 2022; 22:758. [PMID: 36114482 PMCID: PMC9479311 DOI: 10.1186/s12877-022-03438-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 08/25/2022] [Indexed: 11/21/2022] Open
Abstract
Background Situations of extreme challenging behavior such as very frequent and/or severe agitation or physical aggression in nursing home residents with dementia can be experienced as an impasse by nursing home staff and relatives. In this distinct part of our WAALBED (WAAL-Behavior-in-Dementia)-III study, we aimed to explore these situations by obtaining the experiences and perspectives of nursing home staff and relatives involved. This can provide a direction in providing tools for handling extreme challenging behavior of nursing home residents with dementia and may improve their quality of life. Methods Qualitative multiple case study with individual interviews and focus group discussions. Interviewees were elderly care physicians, psychologists, care staff members, unit managers and relatives (n = 42). They were involved with nursing home residents with dementia and extreme challenging behavior living on dementia special care units in the Netherlands. For these residents, external consultation by the Centre for Consultation and Expertise was requested. Audio-recordings of the interviews were transcribed verbatim and analyzed with thematic analysis, including conventional content analysis. Results Seven cases were included. Forty-one individual interviews and seven focus group discussions were held. For six stakeholder groups (resident, relative, care staff, treatment staff, nursing home staff, and the organization), three main factors could be identified that contributed to experiencing a situation of extreme challenging behavior as an impasse: 1) characteristics and attitudes of a stakeholder group, 2) interaction issues within a stakeholder group and 3) interaction issues among (groups of) stakeholders. The experienced difficulties with the resident’s characteristics, as well as suboptimal interdisciplinary collaboration and communication among the nursing home staff are remarkable. Nursing home staff kept searching for a golden solution or lost hope. Conclusions This study offers important insights into situations of extreme challenging behavior in nursing home residents with dementia and offers caregivers targets for improving care, treatment and interdisciplinary collaboration, such as working uniformly and methodically. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03438-0.
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Sun FC, Lin LC, Chang SC, Li HC, Cheng CH, Huang LY. Reliability and Validity of a Chinese Version of the Cohen–Mansfield Agitation Inventory-Short Form in Assessing Agitated Behavior. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159410. [PMID: 35954767 PMCID: PMC9368134 DOI: 10.3390/ijerph19159410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 06/20/2022] [Accepted: 07/04/2022] [Indexed: 11/24/2022]
Abstract
Background: Patients with dementia often present agitated behaviors. The Cohen–Mansfield Agitation Inventory-short form (CMAI-SF) is one of the most widely used instruments to evaluate agitated behaviors that affect patients’ quality of life and impose burden on caregivers. However, there is no simplified Chinese version of the CMAI-SF (C-CMAI-SF) in clinical settings. Purpose: This study aimed to develop a Chinese version of the C-CMAI-SF and examine its validity and reliability. Methods: This cross-sectional study included three phases. In Phase I, the original CMAI-SF was translated to Chinese. In Phase II, experts were invited to examine the content validity index (CVI). Phase III was conducted to test the validity and reliability of the C-CMAI-SF. Results: The scale showed good validity and reliability with a scale-level CVI of 0.89, Cronbach’s alpha (measure of internal consistency) of 0.874, and test–retest correlation coefficient of 0.902 (for 257 individuals). Using factor analysis, three factors were identified. Regarding concurrent validity, the C-CMAI-SF score was correlated with the Neuropsychiatric Inventory (agitation aggression subscale) and the Cornell Scale for Depression in Dementia (agitation subscale). Conclusions: The study demonstrated that the C-CMAI-SF is a valid and reliable instrument for evaluating agitated behaviors in people with dementia. Relevance to clinical practice: The C-CMAI-SF is an easy and quick tool used to identify and evaluate agitated behaviors in busy clinical settings.
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Affiliation(s)
- Feng-Ching Sun
- Department of Nursing, Kaohsiung Municipal United Hospital, Kaohsiung 80457, Taiwan; (F.-C.S.); (L.-Y.H.)
- College of Nursing, Fooyin University, Kaohsiung 83102, Taiwan
| | - Li-Chan Lin
- College of Nursing, Asia University, Taichung 41354, Taiwan;
| | - Shu-Chen Chang
- Department of Nursing, Changhua Christian Hospital, Changhua 50006, Taiwan;
- College of Nursing and Health Sciences, Da-Yeh University, Changhua 515006, Taiwan
| | - Hui-Chi Li
- College of Nursing, Asia University, Taichung 41354, Taiwan;
- Correspondence:
| | - Chia-Hsin Cheng
- Department of Nursing, I-Shou University, Kaohsiung 82445, Taiwan;
| | - Ling-Ya Huang
- Department of Nursing, Kaohsiung Municipal United Hospital, Kaohsiung 80457, Taiwan; (F.-C.S.); (L.-Y.H.)
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Du J, Janus S, Voorthuis B, van Manen J, Achterberg W, Smalbrugge M, Zwijsen S, Gerritsen D, Koopmans R, Zuidema S. Time trends in psychotropic drug prescriptions in Dutch nursing home residents with dementia between 2003 and 2018. Int J Geriatr Psychiatry 2022; 37:10.1002/gps.5697. [PMID: 35297551 PMCID: PMC9311063 DOI: 10.1002/gps.5697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 03/01/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Several European studies investigated the trends in psychotropic drug prescriptions (PDPs) among nursing home (NH) residents and reported a decline in antipsychotics prescriptions. Since the Dutch long-term care system differs from other European systems (e.g. higher threshold for NH admission and trained elderly care physicians), this study explores the trends in PDPs in Dutch NH residents with dementia. METHODS The study used data from nine studies, comprising two cross-sectional studies, one cohort study, and six cluster-randomized controlled trials, collected in Dutch NHs between 2003 and 2018. With multilevel logistic regression analysis, NHs as a random effect, we estimated the trends in PDPs overall and for five specific psychotropic drug groups (antipsychotics, antidepressants, anxiolytics, hypnotics, and anti-dementia drugs), adjusting for confounders: age, gender, severity of dementia, severity of neuropsychiatric symptoms, and length of stay in NHs. RESULTS The absolute prescription rate of antipsychotics was 37.5% in 2003 and decreased (OR = 0.947, 95% CI [0.926, 0.970]) every year. The absolute prescription rate of anti-dementia drugs was 0.8% in 2003 and increased (OR = 1.162, 95% CI [1.105, 1.223]) per year. The absolute rate of overall PDPs declined from 62.7% in 2003 to 40.4% in 2018. CONCLUSIONS Among Dutch NH residents with dementia, the odds of antipsychotics prescriptions decreased by 5.3% per year while the odds of anti-dementia drug prescriptions increased by 16.2%. There were no distinct trends in antidepressants, anxiolytics, and hypnotics prescriptions. However, overall PDPs were still high. The PDPs in NH residents remain an issue of concern.
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Affiliation(s)
- Jiamin Du
- Department of General Practice and Elderly Care MedicineUniversity of GroningenUniversity Medical Centre GroningenGroningenThe Netherlands
| | - Sarah Janus
- Department of General Practice and Elderly Care MedicineUniversity of GroningenUniversity Medical Centre GroningenGroningenThe Netherlands
| | - Brenda Voorthuis
- Health Technology and Services Research DepartmentTechnical Medical CentreUniversity of TwenteEnschedeThe Netherlands
| | | | - Wilco Achterberg
- Department of Public Health and Primary CareLeiden University Medical CenterLeidenThe Netherlands
| | - Martin Smalbrugge
- Department of Medicine for Older PeopleAmsterdam Public Health Research InstituteAmsterdam UMC ‐ Vrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Sandra Zwijsen
- Quality DepartmentKorian Zorg, Korian GroupArnhemThe Netherlands
| | - Debby Gerritsen
- Department of Primary and Community CareRadboud University Medical CenterNijmegenThe Netherlands
| | - Raymond Koopmans
- Department of Primary and Community CareRadboud University Medical CenterNijmegenThe Netherlands
- Joachim en AnnaCenter for Specialized Geriatric CareNijmegenThe Netherlands
| | - Sytse Zuidema
- Department of General Practice and Elderly Care MedicineUniversity of GroningenUniversity Medical Centre GroningenGroningenThe Netherlands
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Dutch Long-Term Care in Transition: A Guide for Other Countries. J Am Med Dir Assoc 2022; 23:204-206. [DOI: 10.1016/j.jamda.2021.09.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 09/06/2021] [Accepted: 09/15/2021] [Indexed: 11/24/2022]
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Jones E, Aigbogun MS, Pike J, Berry M, Houle CR, Husbands J. Agitation in Dementia: Real-World Impact and Burden on Patients and the Healthcare System. J Alzheimers Dis 2021; 83:89-101. [PMID: 34250934 PMCID: PMC8461728 DOI: 10.3233/jad-210105] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background: At least 90%of patients with dementia experience behavioral or neuropsychiatric symptoms including agitation, psychotic symptoms, apathy, depression, and sleep disturbances. Agitation has been reported to be experienced by 60%of patients with mild cognitive impairment and 76%of patients with Alzheimer’s disease. Objective: We aimed to assess the impact of agitation in patients with dementia on healthcare resource utilization (HCRU) and healthcare costs. Methods: This was a retrospective analysis of physician-reported patient data from a point-in-time survey. Patients included were aged≥50 years, with early cognitive impairment or dementia. Agitated and non-agitated patients were compared. Regression analyses assessed the relationship of agitation score (calculated from number/severity of agitation symptoms) with outcomes, with covariates including age and Mini-Mental State Examination score. Sensitivity analyses compared patients with 0 and≥2 agitation symptoms following propensity score matching on the base-case covariates. Results: Data were included for 1,349 patients (agitated, n = 693; non-agitated, n = 656). Based on regression analyses, agitation score was correlated with proportion of patients with professional caregivers (p < 0.01), institutionalized (p < 0.01), hospitalized in a psychiatric ward (p < 0.05), and receiving an antipsychotic/antidepressant (both p < 0.001); number of consultations with a healthcare professional (HCP), psychiatrist, or psycho-geriatrician; number and cost of hospitalizations (p < 0.01); cost of HCP consultations (p < 0.001); and total direct healthcare costs (p < 0.001). Sensitivity analyses generally supported the base-case analysis. Conclusion: Agitation in dementia is associated with increased HCRU and healthcare costs. Effective therapies are needed to address agitation in dementia, with the potential to alleviate patient impact, HCRU, and healthcare costs.
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Veldwijk-Rouwenhorst AE, Zuidema SU, Smalbrugge M, Bor H, Wetzels R, Gerritsen DL, Koopmans RTCM. Very frequent physical aggression and vocalizations in nursing home residents with dementia. Aging Ment Health 2021; 25:1442-1451. [PMID: 32602746 DOI: 10.1080/13607863.2020.1786799] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES We investigated the 2-week prevalence and correlates of very frequent physical aggression (PA) and vocalizations in nursing home (NH)-residents with dementia. METHOD/DESIGN This cross-sectional study used combined data of 2074 NH-residents from four studies, collected from 119 dementia special care units in 26 Dutch NH. Very frequent PA was defined as scoring 6 or 7 on the items 'hitting', pushing', 'biting' and 'kicking' of the Cohen Mansfield Agitation Inventory; very frequent vocalizations as scoring 6 or 7 on 'screaming' and 'making strange noises'. We compared NH-residents with very frequent PA or vocalizations with residents with less frequent PA or vocalizations, assessing correlates using univariate and multivariate multilevel logistic regression analyses. RESULTS We found a 2-week prevalence of 2.2% (95% confidence interval (CI): 1.63-2.89) of very frequent PA and 11.5% of very frequent vocalizations (95% CI: 10.23-12.98). Very frequent PA was only associated with apathy (odds ratio (OR)=1.93, 95% CI: 1.04-3.61). Correlates of very frequent vocalizations were age (OR = 0.97, 95% CI: 0.951-0.998), dementia severity (overall p-value 0.020), antipsychotic drug use (OR = 1.56, 95% CI: 1.08-2.26), antiepileptic drug use (OR = 2.75, 95% CI: 1.34-5.68) and euphoria (OR = 2.01, 95% CI: 1.22-3.31). CONCLUSION Characteristics of NH-residents with very frequent PA or very frequent vocalizations differ from those of NH-residents with less frequent PA or vocalizations. Frontal lobe damage, boredom, pain and/or external factors may explain several of the found associations, but further research is necessary. Our findings may contribute to better care for these residents and thereby to improving their quality of life.
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Affiliation(s)
- Annelies E Veldwijk-Rouwenhorst
- Department of Primary and Community Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands.,Radboudumc Alzheimer Center, Nijmegen, the Netherlands
| | - Sytse U Zuidema
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Martin Smalbrugge
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Hans Bor
- Department of Primary and Community Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | - Roland Wetzels
- Department of Primary and Community Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands.,Radboudumc Alzheimer Center, Nijmegen, the Netherlands
| | - Debby L Gerritsen
- Department of Primary and Community Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands.,Radboudumc Alzheimer Center, Nijmegen, the Netherlands
| | - Raymond T C M Koopmans
- Department of Primary and Community Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands.,Radboudumc Alzheimer Center, Nijmegen, the Netherlands.,Center for Specialized Geriatric Care, De Waalboog "Joachim en Anna", Nijmegen, the Netherlands
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Schmüdderich K, Holle D, Ströbel A, Holle B, Palm R. Relationship between the severity of agitation and quality of life in residents with dementia living in German nursing homes - a secondary data analysis. BMC Psychiatry 2021; 21:191. [PMID: 33849487 PMCID: PMC8042694 DOI: 10.1186/s12888-021-03167-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 03/11/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Severe agitation and its relation to single dimensions of quality of life are not well understood. The aim of this study was to gain more knowledge about severe agitation and to examine the relationships between the severity of agitation and single dimensions of quality of life among residents with dementia living in German nursing homes. METHODS This exploratory secondary analysis included data from 1947 residents of 66 German nursing homes from the DemenzMonitor study. The construct of agitation was defined as a composite score of the items agitation/aggression, irritability/lability and disinhibition from the Neuropsychiatric Inventory Questionnaire (NPI-Q); the resident was classified as severely agitated if at least one of these symptoms was rated as 'severe'. The single dimensions of quality of life were measured with the short version of the QUALIDEM instrument. To avoid selection bias, two controls with mild or no agitation were selected for each resident with severe agitation using propensity score matching. Mixed linear regression models were then generated to determine the differences in the dimensions of quality of life for the severity of agitation and the defining items. RESULTS For four out of five dimensions of quality of life of the short version of QUALIDEM, residents with severe agitation had significantly lower values than residents without severe agitation. Converted to scale size, the greatest difference between both groups was found in the dimension social isolation with 23.0% (-2.07 (95% CI: -2.57, -1.57)). Further differences were found in the dimensions restless tense behaviour with 16.9% (-1.52 (95% CI: -2.04, -1.00)), positive affect with 14.0% (-1.68 (95% CI: -2.28, -1.09)) and social relations with 12.4% (-1.12 (95% CI: -1.54, -0.71)). CONCLUSIONS Severe agitation is a relevant phenomenon among nursing home residents with dementia and is associated with lower values of quality of life in the dimensions social isolation, restless tense behaviour, positive affect and social relations from the QUALIDEM instrument. Therefore, more attention should be paid to severe agitation in nursing practice and research. Moreover, care strategies used to reduce severe agitation should be considered in terms of their impact on the dimensions of quality of life.
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Affiliation(s)
- Kathrin Schmüdderich
- German Center for Neurodegenerative Diseases (DZNE), Stockumer Str. 12, Witten, 58453 Germany
- Witten/Herdecke University, Faculty of Health, School of Nursing Science, Stockumer Str. 12, Witten, 58453 Germany
| | - Daniela Holle
- University of Applied Sciences (hsg Bochum), Department of Nursing Science, Gesundheitscampus 6-8, Bochum, 44801 Germany
| | - Armin Ströbel
- German Center for Neurodegenerative Diseases (DZNE), Stockumer Str. 12, Witten, 58453 Germany
- Universitätsklinikum Erlangen, Center for Clinical Studies, Krankenhausstraße 12, Erlangen, 91054 Germany
| | - Bernhard Holle
- German Center for Neurodegenerative Diseases (DZNE), Stockumer Str. 12, Witten, 58453 Germany
- Witten/Herdecke University, Faculty of Health, School of Nursing Science, Stockumer Str. 12, Witten, 58453 Germany
| | - Rebecca Palm
- German Center for Neurodegenerative Diseases (DZNE), Stockumer Str. 12, Witten, 58453 Germany
- Witten/Herdecke University, Faculty of Health, School of Nursing Science, Stockumer Str. 12, Witten, 58453 Germany
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Veldwijk-Rouwenhorst AE, Smalbrugge M, Zuidema SU, Hanssen SAJ, Koopmans RTCM, Gerritsen DL. Continuous Palliative Sedation in Nursing Home Residents With Dementia and Refractory Neuropsychiatric Symptoms. J Am Med Dir Assoc 2020; 22:305-311.e4. [PMID: 33275905 DOI: 10.1016/j.jamda.2020.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 10/27/2020] [Accepted: 11/02/2020] [Indexed: 01/10/2023]
Abstract
OBJECTIVES Extreme neuropsychiatric symptoms can be a heavy burden for nursing home (NH) residents, relatives, and caregivers. Sometimes, when extreme neuropsychiatric symptoms are considered refractory, continuous palliative sedation is administered. The aim of this study was to explore the trajectory leading to continuous palliative sedation and its administration in NH residents with dementia and refractory neuropsychiatric symptoms. DESIGN A qualitative interview and explorative study was performed. SETTING AND PARTICIPANTS Relatives, elderly care physicians, and other staff members involved with 3 NH residents with dementia and extreme refractory neuropsychiatric symptoms who received continuous palliative sedation were interviewed. These NH residents lived on dementia special care units of 3 NHs in the Netherlands. METHODS Consecutive sampling was used to select participants. Medical files were studied. Semistructured interviews were conducted. Transcriptions were analyzed with thematic analysis, including directed content analysis. RESULTS Nine in-depth interviews with 13 participants were held. Analysis resulted in 6 main themes, with several subthemes reflecting phases of the continuous palliative sedation trajectory: (1) run-up, describing an unbearable struggle of the resident; (2) turning point, at which hope was lost; (3) considering continuous palliative sedation and administration of intermittent sedation; (4) decision to start continuous palliative sedation based on 1 decisive trigger; (5) administration of continuous palliative sedation with stakeholders experiencing relief; and (6) evaluation. CONCLUSIONS AND IMPLICATIONS The trajectory leading up to continuous palliative sedation in NH residents with dementia and extreme refractory neuropsychiatric symptoms was complex and burdensome, but the initiation led to relief and contentment for all those involved. This study highlights that continuous palliative sedation can be a valuable treatment option among these residents. A recommendation is to include external consultation in the decision process and to administer intermittent sedation as a preceding step when continuous palliative sedation is considered.
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Affiliation(s)
- Annelies E Veldwijk-Rouwenhorst
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands; Radboudumc Alzheimer Center, Nijmegen, the Netherlands.
| | - Martin Smalbrugge
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers Location VUmc, Amsterdam, the Netherlands
| | - Sytse U Zuidema
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Suzan A J Hanssen
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands; Radboudumc Alzheimer Center, Nijmegen, the Netherlands
| | - Raymond T C M Koopmans
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands; Radboudumc Alzheimer Center, Nijmegen, the Netherlands; De Waalboog "Joachim en Anna," Center for Specialized Geriatric Care, Nijmegen, the Netherlands
| | - Debby L Gerritsen
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands; Radboudumc Alzheimer Center, Nijmegen, the Netherlands.
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10
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Elyn A, Sourdet S, Morin L, Nourhashemi F, Saffon N, de Souto Barreto P, Rolland Y. End of life care practice and symptom management outcomes of nursing home residents with dementia: secondary analyses of IQUARE trial. Eur Geriatr Med 2019; 10:947-955. [PMID: 34652768 DOI: 10.1007/s41999-019-00234-9] [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: 06/11/2019] [Accepted: 08/29/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE End-of-life care is a central issue in nursing homes. Poor care outcomes have been reported, especially among residents with dementia. Our aim was two-fold: to assess whether the diagnosis of dementia was associated with specific patterns of care and symptom management for residents with dementia during the last 6 months of life, and to compare these patterns of care between residents with dementia who died within 6 months and those who survived longer. METHODS Secondary prospective analyses of the IQUARE trial (trial registration number NCT01703689). 175 nursing homes in South West France. Residents with and without dementia at baseline (May-June 2011), stratified according to their vital status at 6-month follow-up. RESULTS Of 6275 residents enrolled in IQUARE study (including 2688 with dementia), 494 (7.9%) died within 6 months. Compared to residents without dementia (n = 254), those with dementia (n = 240) were less likely to be self-sufficient (OR = 0.08, 95% CI 0.01-0.64). They were more likely to have physical restraints (OR = 1.65, 95% CI 1.08-2.51) and less likely to be prescribed benzodiazepines (OR = 0.58, 95% CI 0.38-0.88). Among residents with dementia, those who died during the first 6 months of follow-up were more likely to be identified with a formal "end-of-life" status (OR = 5.71, 95% CI 3.48-9.37) although such identification remains low with only 15% of them. They were more likely to experience pain (OR = 1.43, 95% CI 1.04-1.97) and to be physically restrained (OR = 1.46, 95% CI 1.08-1.98). However, pain relief and psychological distress management were not improved. CONCLUSIONS Poor quality indicators such as physical restraints are associated with end-of-life care for residents with dementia. Among symptom management outcomes, pain medication remains low even if pain complaint increased at life end.
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Affiliation(s)
- Antoine Elyn
- Palliative Care Unit "Résonance", University Hospital of Toulouse, Place du Docteur Baylac, TSA 40031, 31059, Toulouse Cedex 9, France.
| | - Sandrine Sourdet
- Frailty Hospital, Gerontology and Internal Medicine, University Hospital of Toulouse, Cité de la santé, 20, Rue du Pont Saint-Pierre, TSA 60033, 31059, Toulouse Cedex 9, France.,INSERM, URM1027 "Aging and Alzheimer Disease: From Observation to Intervention", Faculté de Médecine, 37 Allées Jules Guesde, 31000, Toulouse, France
| | - Lucas Morin
- Aging Research Centre, Karolinska Institutet and Stockholm University, Gävlegatan 16-113, 30, Stockholm, Sweden
| | - Fati Nourhashemi
- INSERM, URM1027 "Aging and Alzheimer Disease: From Observation to Intervention", Faculté de Médecine, 37 Allées Jules Guesde, 31000, Toulouse, France.,Gerontology and Internal Medicine, University Hospital of Toulouse, Cité de la santé, 20, Rue du Pont Saint-Pierre, TSA 60033, 31059, Toulouse Cedex 9, France
| | - Nicolas Saffon
- Palliative Care Unit "Résonance", University Hospital of Toulouse, Place du Docteur Baylac, TSA 40031, 31059, Toulouse Cedex 9, France
| | - Philipe de Souto Barreto
- INSERM, URM1027 "Aging and Alzheimer Disease: From Observation to Intervention", Faculté de Médecine, 37 Allées Jules Guesde, 31000, Toulouse, France
| | - Yves Rolland
- INSERM, URM1027 "Aging and Alzheimer Disease: From Observation to Intervention", Faculté de Médecine, 37 Allées Jules Guesde, 31000, Toulouse, France.,Gerontology and Internal Medicine, University Hospital of Toulouse, Cité de la santé, 20, Rue du Pont Saint-Pierre, TSA 60033, 31059, Toulouse Cedex 9, France
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11
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Palm R, Sorg CGG, Ströbel A, Gerritsen DL, Holle B. Severe Agitation in Dementia: An Explorative Secondary Data Analysis on the Prevalence and Associated Factors in Nursing Home Residents. J Alzheimers Dis 2019; 66:1463-1470. [PMID: 30412491 PMCID: PMC6294574 DOI: 10.3233/jad-180647] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Background: The phenomena of severe agitation is not well understood and often not adequately treated. Objective: This article determines the prevalence and associated factors of severe agitation in nursing home residents with dementia. Methods: Secondary data analysis within an observational study in German nursing homes with n = 1,967 participants. We assessed severity of agitation with the Neuropsychiatric Inventory Questionnaire (NPI-Q) and defined the construct of agitation as a composite score of the NPI-Q items agitation/aggression, disinhibition, and irritability/lability; the dependent variable of severe agitation was considered as being present in residents who scored ‘severe’ in at least one of these symptoms. A binary logistic regression model was calculated to estimate associations. Results: The prevalence of severe agitation was 6.3% (n = 124). The strongest associations were found for elation/euphoria (OR 7.6, CI 3.1–18.5), delusions (OR 7.3, CI 4.0–13.2), apathy/indifference (OR 2.8, CI 1.7–4.7), anxiety (OR 2.2, CI 1.2–3.8), nighttime behaviors (OR 2.4, CI 1.4–4.2), motor disturbances (OR 2.4, CI 1.4–4.1), and male sex (OR 2.4. CI 1.3–4.2). Conclusion: Severe agitation in nursing home residents with dementia is a relevant clinical issue as approximately 70% of residents have a dementia. Residents with elation/euphoria and delusions may have a stronger risk of showing severe agitation. We consider delusions as a possible cause of agitation and therefore a prelude to agitation. Although it might be possible that elation/euphoria follows from agitation, we hypothesize that the residents first experience elation/ euphoria and exhibit agitation afterwards.
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Affiliation(s)
- Rebecca Palm
- German Center for Neurodegenerative Diseases (DZNE), Witten, Germany.,School of Nursing Science, University Witten/Herdecke, Witten, Germany
| | | | - Armin Ströbel
- German Center for Neurodegenerative Diseases (DZNE), Witten, Germany
| | - Debby L Gerritsen
- Department of Primary and Community Care and Radboudumc Alzheimer Centre, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Bernhard Holle
- German Center for Neurodegenerative Diseases (DZNE), Witten, Germany.,School of Nursing Science, University Witten/Herdecke, Witten, Germany
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12
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Gerritsen DL, van Beek APA, Woods RT. Relationship of care staff attitudes with social well-being and challenging behavior of nursing home residents with dementia: a cross sectional study. Aging Ment Health 2019; 23:1517-1523. [PMID: 30409022 DOI: 10.1080/13607863.2018.1506737] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objectives: This study investigates the relationship between attitudes of care staff and social well-being and challenging behavior of residents in long-term dementia care. Methods: The study was based on a cross-sectional design using questionnaires. Care staff members (N = 291) of 15 long-term care facilities in the Netherlands completed the Approaches to Dementia Questionnaire. Additionally, the primary professional caregiver of each participating resident (N = 239) completed an observational questionnaire regarding that resident's behavior, which contained the scale for Social Wellbeing Of Nursing home residents and the Cohen-Mansfield Agitation Inventory. Data were analyzed using multilevel analyses, taking characteristics of residents into account. Results: Attitudes of care staff towards residents with dementia differed between facilities. Further, residents experienced more social well-being and displayed less challenging behavior in facilities where care staff had more hopeful attitudes. Conclusion: This study demonstrates a relationship between attitudes of care staff and resident well-being. The results indicate that it is important to address attitudes towards residents with dementia in the education of (future) care staff. Care processes may also be improved by focusing on the attitudes of care staff. In this way, the well-being of residents with dementia can potentially be improved as well.
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Affiliation(s)
- D L Gerritsen
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboudumc Alzheimer Centre, Radboud University Medical Centre , Nijmegen , the Netherlands
| | - A P A van Beek
- NIVEL, Netherlands Institute for Health Services Research , Utrecht , the Netherlands
| | - R T Woods
- Dementia Services Development Centre Wales, Bangor University , Bangor , UK
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13
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Kuring JK, Mathias JL, Ward L. Prevalence of Depression, Anxiety and PTSD in People with Dementia: a Systematic Review and Meta-Analysis. Neuropsychol Rev 2018; 28:393-416. [PMID: 30536144 DOI: 10.1007/s11065-018-9396-2] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 11/19/2018] [Indexed: 12/31/2022]
Abstract
There appears to be a link between depression/anxiety/PTSD and dementia, although the evidence is incomplete and the reason is unclear. Mental illness may cause dementia or may be prodromal or comorbid with dementia, or dementia may trigger a relapse of symptoms in individuals with a history of mental illness. This study examined the link between depression/anxiety/PTSD and dementia by evaluating the prevalence of these disorders in people with dementia, relative to their healthy peers. Existing meta-analyses have examined the prevalence of clinically-significant depression and anxiety in Alzheimer's disease (AD), and depression in frontotemporal dementia (FTD), but have not considered vascular dementia (VaD), dementia with Lewy bodies (DLB), PTSD, or anxiety in FTD. The current meta-analysis compared the prevalence of clinically-significant depression, anxiety and PTSD in the four most common types of dementia (AD, VaD, DLB, FTD) and in unspecified dementia to that of healthy controls (PROSPERO number: CRD42017082086). PubMed, EMBASE, PsycINFO and CINAHL database searches identified 120 eligible studies. Prevalence rates were calculated for depression and anxiety in AD, VaD, DLB, FTD, unspecified dementia, and controls. PTSD data were only available for unspecified dementia. Subgroup analyses indicated that depression, but not anxiety, was more prevalent in people with dementia compared to controls; however, the anxiety analyses were probably under-powered. The results support a link between depression and dementia; however, the link between anxiety or PTSD and dementia remains unclear due to insufficient data. Longitudinal data is now needed to clarify whether depression/anxiety/PTSD may be risk factors for dementia.
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Affiliation(s)
- J K Kuring
- School of Psychology, Faculty of Health & Medical Sciences, University of Adelaide, Adelaide, South Australia, 5005, Australia
| | - J L Mathias
- School of Psychology, Faculty of Health & Medical Sciences, University of Adelaide, Adelaide, South Australia, 5005, Australia.
| | - L Ward
- School of Psychology, Faculty of Health & Medical Sciences, University of Adelaide, Adelaide, South Australia, 5005, Australia
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14
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Conn DK. Caring for Nursing Home Residents with Agitation Continues to be Very Challenging. Am J Geriatr Psychiatry 2017; 25:1349-1350. [PMID: 29037752 DOI: 10.1016/j.jagp.2017.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 09/11/2017] [Indexed: 11/28/2022]
Affiliation(s)
- David K Conn
- Baycrest Centre and Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
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