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Woon C. A Literature Review: Violence and Aggression in Neuroscience Nursing. J Neurosci Nurs 2023; 55:60-64. [PMID: 36857134 DOI: 10.1097/jnn.0000000000000692] [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: 03/02/2023]
Abstract
ABSTRACT BACKGROUND: Violence and aggression is commonly encountered in nursing worldwide and is an increasing concern, although it is largely underreported by staff. Violence and aggression can take many forms, from verbal and physical abuse to sexual assault. This study aims to define agitation, violence, and aggression and to explore the prevalence of violence and aggression among neuroscience patients. This review also examines why violence and aggression occurs for neuroscience patients and to determine the effects on the patients, the environment, and the nursing staff. METHODS: A review of articles was conducted using CINAHL, PubMed, the Cochrane Database, and Google Scholar between 2012 and 2022. DISCUSSION: Agitation can escalate to violence and aggression. The reasons a neuroscience patient may become agitated are multifactorial. An injury to the brain may not cause agitation; however, the effect on the frontal lobe, hypothalamus, and hippocampus may cause a lack of self-control, impulsivity, an inability to control emotions, and an uncontrolled release of hormones, leading to a heightened sympathetic response. The effects of violence and aggression can be detrimental to the patient and include isolation, increased sedation, reduced observations, and even death. The effects on the nurse are profound including a decline in productivity at work, an increased risk of drug errors, and posttraumatic stress disorder or burnout as longer-term consequences. CONCLUSION: Violence and aggression is commonly experienced within neuroscience nursing, and the contributing factors are multifactorial. The effects for the patients and staff can be profound, and this is why prevention of agitation is fundamental to ensure the safety and retention of nursing staff.
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Affiliation(s)
- Caroline Woon
- Questions or comments about this article may be directed to Caroline Woon at . C.W. is a Neuroscience Clinical Nurse Educator, Wellington Hospital, Wellington, New Zealand
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Wilberforce M, Newbould L, Tucker S, Mitchell W, Niman D. Maximising the engagement of older people with mental health needs and dementia with social care. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e6467-e6474. [PMID: 36334261 PMCID: PMC10099804 DOI: 10.1111/hsc.14091] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 10/01/2022] [Indexed: 06/16/2023]
Abstract
Older people with mental health needs and dementia often face difficulties with daily living and community participation, requiring the intervention of social care services. However, cognitive and emotional needs often mean that mainstream support is not appropriate. In England, mental health support workers may attempt to address these concerns, to prevent mounting care needs and the potential for institutional care. Yet, their work has not been researched to identify good practices and to understand the mechanisms through which they engage older people. A new qualitative study used semi-structured interviews and focus groups with specialist support workers (n = 22), managers (n = 7), homecare staff (n = 4) and service users and carers (n = 6). The latter group were interviewed by co-authors with lived experiences of dementia and care. Participants were recruited from mental health services, home care organisations and third-sector agencies across the North of England in 2020-2021. The study identified three themes that described support worker activities. First, 'building trusting relationships' identified steps to establish the foundations of later interventions. Paradoxically, these may involve misleading clients if this was necessary to overcome initial reluctance, such as by feigning a previous meeting. Second, 're-framing care' referred to how the provision of care was positioned within a narrative that made support easier to engage with. Care framed as reciprocal, as led by clients, and having a positive, non-threatening description would more likely be accepted. Third, 'building supportive networks' described how older people were enabled to draw upon other community resources and services. This required careful staging of support, joint visits alongside workers in other services, and recognition of social stigma. The study was limited by constrained samples and covid context requiring online data collection. The study recommends that support workers have more opportunity for sharing good practice across team boundaries, and improved access to specialist training.
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Affiliation(s)
| | | | - Sue Tucker
- Division of Population Health, Health Services Research & Primary CareUniversity of ManchesterManchesterUK
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Newbould L, Tucker S, Wilberforce M. Enabling older people with mental health needs to engage with community social care: A scoping review to inform a theory of change. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:1286-1306. [PMID: 34854154 DOI: 10.1111/hsc.13648] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 11/01/2021] [Accepted: 11/05/2021] [Indexed: 05/06/2023]
Abstract
Despite apparent need, many older people with cognitive impairment and/or mental health needs do not fully engage with social care. This can manifest in different ways, including passive or aggressive attempts to avoid or repel care workers. However, little is known about how to support such individuals in their own homes and deliver effective care. Against this background, we undertook a scoping review with a view to developing a preliminary theory of change suggesting how care might be modified to engage this client group. The most recent search was conducted on 21/04/21. Papers were included if they (i) focused on older people (65+) living at home with social care needs and (ii) described difficulties/problems with the provision/receipt of social care associated with individuals' mental health needs. Twenty-six citations were identified through electronic database searches and reference screening, and the results were charted according to key theory of change concepts (long-term outcomes, preconditions, interventions, rationale and assumptions). All the included papers were related to people with dementia. Four subgroups of papers were identified. The first highlights those external conditions that make it more likely an intervention will be successful; the second describes specific interventions to engage older people who by virtue of their mental health needs have not engaged with social care; the third explores what services can be done to increase service uptake by older people with mental health needs and their caregivers more generally; and the fourth details theoretical approaches to explaining the behaviour of people with dementia. Each provides information that could be used to inform care delivery and the development of interventions to improve engagement with health and social care for these individuals. The study concludes that different framing of engagement difficulties, such as that offered through positioning theory, may assist in future service design.
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Affiliation(s)
| | - Sue Tucker
- Social Care and Society, University of Manchester, Manchester, UK
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Graham F, Beattie E, Fielding E. Hospital nurses' management of agitation in older cognitively impaired patients: do they recognise pain-related agitation? Age Ageing 2022; 51:6632478. [PMID: 35796135 DOI: 10.1093/ageing/afac140] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND cognitively impaired hospital patients often experience agitation and aggression due to pain. Agitation complicates care, increasing the risk of adverse outcomes and patient-to-nurse violence. Managing agitation is challenging for nurses. Literature suggests they may rely on antipsychotics while missing other more appropriately targeted treatments. However, nurses' management of agitation remains unclear and under-researched. OBJECTIVE the aim of this study was to investigate hospital nurses' management of agitation in older cognitively impaired patients with pain. DESIGN this was a descriptive correlational study using virtual simulation. SETTING AND PARTICIPANTS a total of 274 registered medical and surgical nurses from 10 public hospitals in Queensland, Australia participated in the study. METHODS nurses undertook a virtual simulation requiring them to manage agitation in a patient with dementia and an injury. Nurses also completed a post-simulation questionnaire. Their simulation performances were correlated with demographics such as seniority, workplace, training, experience and gerontology-specific knowledge. Constructed from an original, validated vignette, the simulation included branching pathways, video scenarios and an avatar that could converse with participants. RESULTS thirteen nurses (4.7%) recognised and treated the virtual patient's agitation as pain-related. Most nurses (89%) gave antipsychotics of which 207 (78%) gave these first-line and 102 (38%) used them twice. Independent of other variables, nurses most likely to diagnose pain were dementia-unit nurses (OR = 8.7), surgical-unit nurses (OR = 7.3) and senior nurses (OR = 5). CONCLUSIONS hospital nurses predominately managed agitation with antipsychotics, a decision that most made after undertaking inadequate patient assessments. This confirmed a common gap in practice that may lead to the missing of pain in the clinical care of agitated patients with dementia and/or delirium.
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Affiliation(s)
- Frederick Graham
- Division of Medicine, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
- School of Nursing, Queensland University of Technology, Brisbane City, QLD, Australia
| | - Elizabeth Beattie
- School of Nursing, Queensland University of Technology, Brisbane City, QLD, Australia
| | - Elaine Fielding
- School of Nursing, Queensland University of Technology, Brisbane City, QLD, Australia
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Ward K, Citrome L. AXS-05: an investigational treatment for Alzheimer's disease-associated agitation. Expert Opin Investig Drugs 2022; 31:773-780. [PMID: 35763451 DOI: 10.1080/13543784.2022.2096006] [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: 11/04/2022]
Abstract
INTRODUCTION Agitation is common in patients with Alzheimer's disease (AD). Although nonpharmacologic de-escalation strategies are recommend as first-line treatment, medication is often needed to treat agitation. Currently, there are no FDA-approved medications for this indication. Psychotropics used to treat agitation include antipsychotics, which are notable for their efficacy but also their potential to cause serious side effects. AXS-05, a combination of dextromethorphan and bupropion, is currently being investigated for this indication. AREAS COVERED This review will discuss the pharmacology of AXS-05 and available clinical trial results from completed Phase I and Phase II/III studies assessing the potential for this compound to treat agitation in patients with AD. Ongoing research investigating AXS-05 for this indication will also be highlighted. Resources used for this review include PubMed, Embase, clinicaltrials.gov, and literature available on the manufacturer's website. EXPERT OPINION Early released clinical trial data indicate that AXS-05 may be a useful option to treat agitation in patients with AD, and that it appears to be generally well tolerated. AXS-05 may be especially helpful for patients with comorbid depression, when considering available data from separate phase III studies assessing the efficacy and safety of this compound in the treatment of depression.
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Affiliation(s)
- Kristen Ward
- Clinical Pharmacy Department, University of Michigan College of Pharmacy, Ann Arbor, MI, USA
| | - Leslie Citrome
- Clinical Professor of Psychiatry & Behavioral Sciences, Department of Psychiatry and Behavioral Science, New York Medical College, Valhalla, NY, USA
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Hjell G, Szabo A, Mørch-Johnsen L, Holst R, Tesli N, Bell C, Fischer-Vieler T, Werner MCF, Lunding SH, Ormerod MBEG, Johansen IT, Dieset I, Djurovic S, Melle I, Ueland T, Andreassen OA, Steen NE, Haukvik UK. Interleukin-18 signaling system links to agitation in severe mental disorders. Psychoneuroendocrinology 2022; 140:105721. [PMID: 35301151 DOI: 10.1016/j.psyneuen.2022.105721] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 02/05/2022] [Accepted: 03/09/2022] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Agitation is a challenging clinical feature in severe mental disorders, but its biological correlates are largely unknown. Inflammasome-related abnormalities have been linked to severe mental disorders and implicated in animal models of agitation. We investigated if levels of circulating inflammasome-related immune markers were associated with agitation in severe mental disorders. METHODS Individuals with a psychotic or affective disorder (N = 660) underwent blood sampling and clinical characterization. Plasma levels of interleukin (IL)-18, IL-18 binding protein (IL-18BP), IL-18 receptor 1 (IL-18R1), IL-18 receptor accessory protein (IL-18RAP), and IL-1 receptor antagonist (IL-1RA) were measured. Agitation levels were estimated with the Positive and Negative Syndrome Scale Excited Component. Multiple linear- and logistic regression were used to investigate the associations between agitation and the immune markers, while controlling for confounders. The influence of psychotic and affective symptoms was assessed in follow-up analyses. RESULTS Agitation was positively associated with IL-18BP (β = 0.13, t = 3.41, p = 0.0007) after controlling for multiple confounders, including BMI, smoking, medication, and substance use. Adjustment for psychotic, manic, and depressive symptoms did not affect the results. There were no significant associations between agitation and the other investigated immune markers (IL-1RA (β = 0.06, t = 1.27, p = 0.20), IL-18 (β = 0.05, t = 1.25, p = 0.21), IL-18R1 (β = 0.04, t = 1.01, p = 0.31), IL-18RAP (odds ratio = 0.96, p = 0.30)). In a subsample (N = 463), we also adjusted for cortisol levels, which yielded unaltered results. CONCLUSION Our findings add to the accumulating evidence of immune system disturbances in severe mental disorders and suggest the IL-18 system as a part of the biological correlate of agitation independent of affective and psychotic symptoms.
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Affiliation(s)
- Gabriela Hjell
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Psychiatry & Department of Clinical Research, Østfold Hospital, Grålum, Norway.
| | - Attila Szabo
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Lynn Mørch-Johnsen
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Psychiatry & Department of Clinical Research, Østfold Hospital, Grålum, Norway
| | - René Holst
- Department of Psychiatry & Department of Clinical Research, Østfold Hospital, Grålum, Norway; Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Natalia Tesli
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Christina Bell
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Thomas Fischer-Vieler
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Maren Caroline Frogner Werner
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Synve Hoffart Lunding
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | - Ingrid Torp Johansen
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ingrid Dieset
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Division of Mental Health and Addiction, Acute Psychiatric Department, Oslo University Hospital, Oslo, Norway
| | - Srdjan Djurovic
- Department of Medical Genetics, Oslo University Hospital, Oslo, Norway; NORMENT, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Ingrid Melle
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Thor Ueland
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Research Institute of Internal Medicine, Oslo University Hospital, Oslo, Norway; K.G. Jebsen Thrombosis Research and Expertise Center, University of Tromsø, Tromsø, Norway
| | - Ole Andreas Andreassen
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Nils Eiel Steen
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Unn Kristin Haukvik
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Adult Psychiatry, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Ishimaru D, Kanemoto H, Hotta M, Nagata Y, Satake Y, Taomoto D, Ikeda M. Case Report: Treatment of Delusions of Theft Based on the Assessment of Photos of Patients' Homes. Front Psychiatry 2022; 13:825710. [PMID: 35370805 PMCID: PMC8968168 DOI: 10.3389/fpsyt.2022.825710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 02/07/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The occurrence of behavioral and psychological symptoms of dementia is affected by individualized context. However, details regarding delusion of theft have been poorly documented. This report describes a useful assessment to understand the environmental context of delusion through two cases of Alzheimer's disease (AD).Familial interview was conducted to assess the phenomenological features. Photos of patients' homes were used to increase the assessment accuracy and check the individualized environmental contexts; this is known as Photo Assessment of Living Environment (PA-LE). CASE DESCRIPTION Case 1 was of an 88-year-old woman whose Mini-Mental State Examination (MMSE) score was 23/30. She believed that one neighbor stole her wallet and stored it on a shelf in the living room. She sometimes placed it in other places, such as under the bed as safekeeping. The delusion often occurred when getting ready to go shopping. PA-LE confirmed that the room and shelf were not cluttered, although the incorrect storage place seemed to be hard-to-find.Case 2 was of a 78-year-old woman. The MMSE score was 20/30. She believed that some neighbors stole her garden items. The delusion was limited to her garden, yet the items were varied. Auditory hallucinations exacerbated her belief that the neighbors intruded the garden. PA-LE confirmed that the garden was cluttered with several duplicated items. Moreover, the patient inaccurately remembered the condition of the garden.Non-pharmacological approaches were tailored to the patients' environmental and psychological states, referring to the interview and PA-LE. This included environmental adjustment or increasing self-esteem. Antipsychotics were also prescribed. Environmental and psychological triggers of delusion were improved by the interventions, and the patients had uneventful courses without active delusions. CONCLUSION Evaluating patients' homes using photos could detect the environmental context of delusion of theft among patients with AD and assist in the management.
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Affiliation(s)
- Daiki Ishimaru
- Department of Medical Technology, Osaka University Hospital, Suita, Japan.,Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hideki Kanemoto
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan
| | - Maki Hotta
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yuma Nagata
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yuto Satake
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan
| | - Daiki Taomoto
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan
| | - Manabu Ikeda
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan
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Adams AMN, Chamberlain D, Grønkjær M, Thorup CB, Conroy T. Caring for patients displaying agitated behaviours in the intensive care unit - A mixed-methods systematic review. Aust Crit Care 2021; 35:454-465. [PMID: 34373173 DOI: 10.1016/j.aucc.2021.05.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 05/16/2021] [Accepted: 05/23/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Patient agitation is common in the intensive care unit (ICU), with consequences for both patients and health professionals if not managed effectively. Research indicates that current practices may not be optimal. A comprehensive review of the evidence exploring nurses' experiences of caring for these patients is required to fully understand how nurses can be supported to take on this important role. OBJECTIVES The aim of this study was to identify and synthesise qualitative and quantitative evidence of nurses' experiences of caring for patients displaying agitated behaviours in the adult ICU. METHODS A mixed-methods systematic review was conducted. MEDLINE, CINAHL, PsycINFO, Web of Science, Emcare, Scopus, ProQuest, and Cochrane Library were searched from database inception to July 2020 for qualitative, quantitative, and mixed-methods studies. Peer-reviewed, primary research articles and theses were considered for inclusion. A convergent integrated design, described by Joanna Briggs Institute, was utilised transforming all data into qualitative findings before categorising and synthesising to form the final integrated findings. The review protocol was registered with PROSPERO CRD42020191715. RESULTS Eleven studies were included in the review. Integrated findings include (i) the strain of caring for patients displaying agitated behaviours; (ii) attitudes of nurses; (iii) uncertainty around assessment and management of agitated behaviour; and (iv) lack of effective collaboration and communication with medical colleagues. CONCLUSIONS This review describes the challenges and complexities nurses experience when caring for patients displaying agitated behaviours in the ICU. Findings indicate that nurses lack guidelines together with practical and emotional support to fulfil their role. Such initiatives are likely to improve both patient and nurse outcomes.
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Affiliation(s)
- Anne Mette N Adams
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Sturt Road, Bedford Park, 5042 SA, GPO Box 2100, Adelaide 5001, SA, Australia.
| | - Diane Chamberlain
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Sturt Road, Bedford Park, 5042 SA, GPO Box 2100, Adelaide 5001, SA, Australia
| | - Mette Grønkjær
- Alborg University Hospital & Department of Clinical Medicine, Aalborg University, Denmark
| | - Charlotte Brun Thorup
- Department of Intensive Care and Clinical Nursing Research Unit, Aalborg University Hospital, Denmark
| | - Tiffany Conroy
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Sturt Road, Bedford Park, 5042 SA, GPO Box 2100, Adelaide 5001, SA, Australia
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Abstract
Aggressive behavior is one of the most disturbing symptoms of Alzheimer disease and other progressive neurodegenerative dementias. Development of strategies for management of aggressive behaviors in people with dementia is hindered by a lack of recognition that aggression is not a uniform behavioral construct. It is possible to distinguish 2 types of aggression: reactive or impulsive aggression and proactive or premeditated aggression. Research concerning aggressive behaviors in people with dementia is hindered by scales describing behavioral symptoms of dementia which do not distinguish between reactive and proactive aggressions because they do not consider the factors leading to these behaviors. Reactive aggression is caused by lack of understanding, leading to rejection of care, while proactive aggression could be caused by a psychopathic personality, hallucinations or delusions, and other determinants. It is difficult to underestimate the importance of distinguishing reactive and proactive aggressions in people with dementia because there are different strategies that can be used for management of these behaviors. For reactive aggression, delayed treatment, distraction, improved communication, and change in treatment strategy is useful, while antipsychotic medication may be needed for treatment of proactive aggression. Dementia is increasing the risk of both types of aggressions and antidepressant treatment can be helpful. Most importantly, persons exhibiting reactive aggression should not be labeled "aggressors" because this behavior could be caused by unmet persons' needs, pain and poor communication with care providers.
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Affiliation(s)
- Ladislav Volicer
- School of Aging Studies, 7831University of South Florida, Tampa, FL, USA.,3rd Medical Faculty, Charles University, Prague, Czech Republic
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Tucker J, Whitehead L, Palamara P, Rosman JX, Seaman K. Recognition and management of agitation in acute mental health services: a qualitative evaluation of staff perceptions. BMC Nurs 2020; 19:106. [PMID: 33292208 PMCID: PMC7653876 DOI: 10.1186/s12912-020-00495-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 10/23/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Agitation among patients is a common and distressing behaviour across a variety of health care settings, particularly inpatient mental health. Unless recognised early and effectively managed it can lead to aggression and personal injury. The aim of this paper is to explore the experiences of mental health nurses in recognising and managing agitation in an inpatient mental health setting and the alignment of these experiences with best practice and person-centred care. METHODS This study used a descriptive qualitative methodology. Semi-structured focus group interviews were conducted with 20 nurses working in a mental health unit in 2018. Nursing staff described their experiences of assessing and managing agitation. Descriptive and Thematic Analysis were undertaken of the transcribed focus group dialogue. RESULTS Nurses combined their clinical knowledge, assessment protocols and training with information from patients to make an individualised assessment of agitation. Nurses also adopted an individualised approach to management by engaging patients in decisions about their care. In keeping with best practice recommendations, de-escalation strategies were the first choice option for management, though nurses also described using both coercive restraint and medication under certain circumstances. From the perspective of patient-centred care, the care provided aligned with elements of person-centred care nursing care. CONCLUSION The findings suggest that clinical mental health nurses assess and manage agitation, with certain exceptions, in line with best practice and a person-centred care nursing framework.
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Affiliation(s)
- Joshua Tucker
- Albany Health Campus, 30 Warden Avenue, Spencer Park, Western Australia, 6330, Australia
| | - Lisa Whitehead
- Centre for Nursing, Midwifery and Health Services Research, School of Nursing and Midwifery, Edith Cowan University, Building 21, Level 4, 270 Joondalup Drive, Joondalup, Western Australia, 6027, Australia.
| | - Peter Palamara
- Centre for Nursing, Midwifery and Health Services Research, School of Nursing and Midwifery, Edith Cowan University, Building 21, Level 4, 270 Joondalup Drive, Joondalup, Western Australia, 6027, Australia
| | - Josephine Xenia Rosman
- Centre for Nursing, Midwifery and Health Services Research, School of Nursing and Midwifery, Edith Cowan University, Building 21, Level 4, 270 Joondalup Drive, Joondalup, Western Australia, 6027, Australia
| | - Karla Seaman
- Centre for Nursing, Midwifery and Health Services Research, School of Nursing and Midwifery, Edith Cowan University, Building 21, Level 4, 270 Joondalup Drive, Joondalup, Western Australia, 6027, Australia
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Volicer L. Physiological and pathological functions of beta-amyloid in the brain and alzheimer's disease: A review. CHINESE J PHYSIOL 2020; 63:95-100. [PMID: 32594062 DOI: 10.4103/cjp.cjp_10_20] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Alzheimer's disease is a major health problem all over the world. The role of beta-amyloid (Aβ) is at the center of investigations trying to discover the disease pathogenesis and to develop drugs for treatment or prevention on Alzheimer's disease. This review summarizes both physiological and pathological functions of Aβ and factors that may participate in the disease development. Known genetic factors are trisomy of chromosome 21, mutations of presenilin 1 and 2, and apolipoprotein E4. Lifetime stresses that increase the risk of development of Alzheimer's disease are described. Another important factor is the level of education, especially of linguistic ability. Lifestyle factors include mental and physical exercise, head injury, social contacts, and diet. All these factors might potentiate the effect of aging on the brain to increase the risk of development of pathological changes. The review summarizes pathological features of Alzheimer brain, Aβ plaques, neurofibrillary tangles composed of hyperphosphorylated tau, and brain atrophy. Consequences of Alzheimer's disease that are reviewed include cognitive deficit, loss of function, and neuropsychiatric symptoms. Because there is no effective treatment, many persons with Alzheimer's disease survive to severe and terminal stages which they may fear. Alzheimer's disease at this stage should be considered a terminal disease for which palliative care is indicated. Importance of advance directives, promoting previous wishes of the person who was developing dementia and who subsequently lost decision-making capacity, and limitations of these directives are discussed. Information in this review is based on author's knowledge and clinical experience that were updated by searches of PubMed.
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Affiliation(s)
- Ladislav Volicer
- School of Aging Studies, University of South Florida, Tampa, FL, USA; 3rd Medical Faculty, Charles University, Prague, Czech Republic, Europe
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Ye B, Khan SS, Chikhaoui B, Iaboni A, Martin LS, Newman K, Wang A, Mihailidis A. Challenges in Collecting Big Data in A Clinical Environment with Vulnerable Population: Lessons Learned from A Study Using A Multi-modal Sensors Platform. SCIENCE AND ENGINEERING ETHICS 2019; 25:1447-1466. [PMID: 30357559 DOI: 10.1007/s11948-018-0072-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 10/03/2018] [Indexed: 06/08/2023]
Abstract
Agitation is one of the most common behavioural and psychological symptoms in people living with dementia (PLwD). This behaviour can cause tremendous stress and anxiety on family caregivers and healthcare providers. Direct observation of PLwD is the traditional way to measure episodes of agitation. However, this method is subjective, bias-prone and timeconsuming. Importantly, it does not predict the onset of the agitation. Therefore, there is a need to develop a continuous monitoring system that can detect and/or predict the onset of agitation. In this study, a multi-modal sensor platform with video cameras, motion and door sensors, wristbands and pressure mats were set up in a hospital-based dementia behavioural care unit to develop a predictive system to identify the onset of agitation. The research team faced several barriers in the development and initiation of the study, namely addressing concerns about the study ethics, logistics and costs of study activities, device design for PLwD and limitations of its use in the hospital. In this paper, the strategies and methodologies that were implemented to address these challenges are discussed for consideration by future researchers who will conduct similar studies in a hospital setting.
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Affiliation(s)
- Bing Ye
- University of Toronto, 160 - 500 University Ave., Toronto, ON, M5G 1V7, Canada.
- 12th Floor, Research Department, Toronto Rehabilitation Institute - University Health Network, 550 University Ave., Toronto, ON, M5G 2A2, Canada.
| | - Shehroz S Khan
- University of Toronto, 160 - 500 University Ave., Toronto, ON, M5G 1V7, Canada
- 12th Floor, Research Department, Toronto Rehabilitation Institute - University Health Network, 550 University Ave., Toronto, ON, M5G 2A2, Canada
- AGE-WELL Network of Centres of Excellence, 550 University Ave., Toronto, ON, M5G 2A2, Canada
| | - Belkacem Chikhaoui
- TELUQ University, 455 Rue du Parvis, Ville De Québec, QC, G1K 9H6, Canada
| | - Andrea Iaboni
- 12th Floor, Research Department, Toronto Rehabilitation Institute - University Health Network, 550 University Ave., Toronto, ON, M5G 2A2, Canada
| | | | - Kristine Newman
- Ryerson University, 350 Victoria St, Toronto, ON, M5B 2K3, Canada
| | - Angel Wang
- Ryerson University, 350 Victoria St, Toronto, ON, M5B 2K3, Canada
| | - Alex Mihailidis
- University of Toronto, 160 - 500 University Ave., Toronto, ON, M5G 1V7, Canada
- 12th Floor, Research Department, Toronto Rehabilitation Institute - University Health Network, 550 University Ave., Toronto, ON, M5G 2A2, Canada
- AGE-WELL Network of Centres of Excellence, 550 University Ave., Toronto, ON, M5G 2A2, Canada
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Bourbonnais A, Goulet MH, Landreville P, Ellefsen E, Larue C, Lalonde MH, Gendreau PL. Physically aggressive behaviors in older people living with cognitive disorders: a systematic scoping review protocol. Syst Rev 2019; 8:164. [PMID: 31296261 PMCID: PMC6621942 DOI: 10.1186/s13643-019-1091-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 07/02/2019] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Physically aggressive behaviors are very common among older people living with cognitive impairment. These behaviors may have significant consequences for family and formal caregivers, as well as for the other people in the older people's environment, and are also a frequent cause of institutionalization. Two relevant systematic reviews have been published on the subject but do not specifically target physically aggressive behaviors or only focus on care in nursing homes. Moreover, they do not address the causes, associated factors, and consequences of these behaviors, even though these should indeed be considered when developing interventions. Thus, the purpose of this scoping review is to map the state of knowledge on these physically aggressive behaviors with a view to developing personalized interventions. Offering a humanist and relational perspective by which these behaviors may be examined, the Senses Framework will guide this review. METHODS The scoping review method of Levac, Colquhoun, and O'Brien will be used. Several databases (e.g., CINAHL, PubMed, PsycINFO, SCOPUS, Grey Literature Report, clinical trials registries) will be searched for literature published in the past 15 years, using a combination of keywords and descriptors. Other data sources will be used to identify non-indexed literature or unpublished results (e.g., articles references, journal tables of content, contact with key authors). The literature will be selected regardless of setting, if it concerns older people, aged 65, or older with cognitive impairment who present physically aggressive behaviors. Data will be extracted systematically by the research team. A quality assessment of the literature will be done to consider this aspect in the data synthesis. A content analysis will be used to synthesize the results. DISCUSSION No scoping review has been found on the physically aggressive behaviors of older people living with cognitive impairment in various settings. The results of this review will identify needs for further research and for clinical and training development on this problem from a humanist standpoint. SYSTEMATIC REVIEW REGISTRATION Currently, it is not possible to register a systematic scoping review protocol (e.g., PROSPERO).
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Affiliation(s)
- Anne Bourbonnais
- Faculty of Nursing, Université de Montréal, Research Chair in Nursing Care for Older People and their Families, Research Centre of the Institut universitaire de gériatrie de Montréal, PO Box 6128, Station Centre-Ville, Montréal, Quebec H3C 3J7 Canada
| | - Marie-Hélène Goulet
- Faculty of Nursing, Université de Montréal, PO Box 6128, Station Centre-Ville, Montréal, Quebec H3C 3J7 Canada
| | - Philippe Landreville
- School of Psychology, Université Laval, 2325 Allée des Bibliothèques, Québec City, Quebec G1V 0A6 Canada
| | - Edith Ellefsen
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, 150 Place Charles-Le Moyne, Longueuil, Quebec J4K 0A8 Canada
| | - Caroline Larue
- Faculty of Nursing, Université de Montréal, PO Box 6128, Station Centre-Ville, Montréal, Quebec H3C 3 J7 Canada
| | - Marie-Hélène Lalonde
- Research Centre of the Institut universitaire de gériatrie de Montréal, 4565 Queen Mary, Montréal, Quebec H3W 1W5 Canada
| | - Paul L. Gendreau
- Department of Psychoeducation, Université de Montréal, PO Box 6128, Station Centre-Ville, Montréal, Quebec H3C 3J7 Canada
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Band-Winterstein T, Avieli H. Women Coping With a Partner's Dementia-Related Violence: A Qualitative Study. J Nurs Scholarsh 2019; 51:368-379. [PMID: 31173457 DOI: 10.1111/jnu.12485] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE The aim of the present study was to differentiate between the lived experience of two groups of women caregiving for a partner with dementia. One group was coping with lifelong intimate partner violence (IPV) and dementia-related violence (Group 1); the other group was coping with dementia-related violence only (Group 2). DESIGN An interpretive phenomenological analysis perspective was used. Data collection was performed through in-depth, semistructured interviews with eight female spouses of men with dementia from each of the two above-mentioned groups, followed by a content analysis. FINDINGS Comparing the narratives of the aging women revealed their different experiences over several dimensions: (a) the identification of violence as a symptom of dementia; (b) the use of past couplehood memories; (c) feelings over time; (d) willingness to care for the partner with dementia; and (e) a prospective view of life. CONCLUSIONS The complexities of being old and having to cope with caregiving responsibilities for a spouse with dementia, accompanied by violent behaviors, emphasize the significance of the couple's past relationship. This notion should be taken into account in practical interventions. CLINICAL RELEVANCE As part of the aging process, there is an increase in people who are engaged in dementia-related violence. Nurses' education and practice should focus on the dynamics of dyads coping with violence and identify the particular needs of the caregiver spouse in this context.
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Affiliation(s)
- Tova Band-Winterstein
- Associate Professor, Department of Gerontology, University of Haifa, Mt. Carmel, Haifa, Israel
| | - Hila Avieli
- Lecturer, Department of Criminology, Ariel University, Ariel, Israel
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15
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Volicer L. Review of Programs for Persons Facing Death with Dementia. Healthcare (Basel) 2019; 7:healthcare7020062. [PMID: 30991668 PMCID: PMC6628090 DOI: 10.3390/healthcare7020062] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 04/10/2019] [Accepted: 04/12/2019] [Indexed: 01/05/2023] Open
Abstract
Background: Persons with advanced dementia cannot initiate activities because of the executive dysfunction. The lack of activities was identified as one of the most important factors contributing to behavioral problems of these persons. The unmet needs were boredom/sensory deprivation, loneliness/need for social interaction, and need for meaningful activities. There is a need for activities designed specifically for residents with advanced dementia. Objective: A description of patient’s needs and of programs that intend to maintain quality of life for people with dementia and facing death. Data sources: A literature review of programs used for persons with advanced dementia and residing in long-term facilities, using the PubMed data base and collateral sources. Results: Since palliative care is appropriate for persons with advanced dementia, attention has to be paid to three following important aspects of care: Medical issues, behavioral symptoms, and meaningful activities. Medical interventions should be limited to those which have more benefits than burdens, behavioral symptoms should be distinguished according to the context in which they occur, and treated by non-pharmacological interventions that involve meaningful activities. This review describes four programs that may promote the quality of life in persons with advanced dementia and facing death. They are designed for persons with advanced dementia, taking into account their functional impairments. Most of these programs involve short infrequent sessions. In contrast, Namaste Care is a daily extended program of enhanced nursing care that can provide quality of life until the last breath. Conclusions: It is possible to maintain quality life for people with advanced dementia if a special program of activities is available.
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Affiliation(s)
- Ladislav Volicer
- School of Aging Studies, University of South Florida, Tampa, FL 34639, USA.
- The 3rd Medical Faculty, Charles University, 11000 Prague, Czech Republic.
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Zabegalov KN, Kolesnikova TO, Khatsko SL, Volgin AD, Yakovlev OA, Amstislavskaya TG, Friend AJ, Bao W, Alekseeva PA, Lakstygal AM, Meshalkina DA, Demin KA, de Abreu MS, Rosemberg DB, Kalueff AV. Understanding zebrafish aggressive behavior. Behav Processes 2019; 158:200-210. [DOI: 10.1016/j.beproc.2018.11.010] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 11/19/2018] [Accepted: 11/19/2018] [Indexed: 12/15/2022]
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Abstract
Behavioral problems decrease quality of life of people with dementia and their care providers. Three main consequences of dementia are functional impairment and in some cases also mood disorders and psychosis. These consequences, alone or in combination, result in 3 main behavioral problems: apathy, agitation, and rejection of care/aggression. Nonpharmacologic management strategies include meaningful activities and individualized comfort care, for example, Namaste Care. If needed, pharmacologic management should concentrate on treatment of main dementia consequences, especially depression, instead of treating secondary symptoms, for example, insomnia. Use of antipsychotics should be minimized but antipsychotics may be necessary for augmentation of antidepressants.
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