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Bilal Ahmed S, Obieta A, Santos T, Ahmad S, Elliot Ibrahim J. Effects of Nonpharmacological Interventions on Disruptive Vocalisation in Nursing Home Patients With Dementia—A Systematic Review. FRONTIERS IN REHABILITATION SCIENCES 2022; 2:718302. [PMID: 36188852 PMCID: PMC9397760 DOI: 10.3389/fresc.2021.718302] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 12/07/2021] [Indexed: 11/25/2022]
Abstract
Background Vocally disruptive behaviour is a common and difficult to treat condition in older residents with dementia. The aim of this systematic review is to evaluate the efficacy of nonpharmacological interventions in its management in persons with dementia residing in a nursing home. Methodology A systematic search was conducted using Ovid MEDLINE, CINAHL, and Cochrane databases and reference lists from relevant publications on various nonpharmacological approaches to manage vocally disruptive behaviour in nursing home residents. The method of appraisal was through the National Institutes of Health scoring for the Quality Assessment of controlled intervention studies. Inclusion criteria included residents of nursing homes over the age of 65 with dementia and disruptive vocalisation. Only randomised controlled trials published in English were included. Results A total of 5,606 articles were identified, which cover 501 trials, of which 23 were selected. There were fourteen studies observed to have an impact of clinical and statistical significance with interventions including (i) a multidimensional approach with different nonpharmacological interventions, (ii) multisensory stimulation, (iii) staff education and training, (iv) personalised bathing, and (v) pain recognition and appropriate management. Seven studies demonstrated no observable effect whereas two showed worsening in vocally disruptive behaviour. Conclusions Many aspects of vocally disruptive behaviour management are poorly understood. Limited empirical evidence supports the use of several nonpharmacological interventions to reduce it. There is more robust evidence to support the use of a tailored approach to management over the universal approach.
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Affiliation(s)
- Saad Bilal Ahmed
- Department of Geriatrics, Ballarat Health Services Ballarat, Queen Elizabeth Centre, Ballarat Central, VIC, Australia
- *Correspondence: Saad Bilal Ahmed
| | - Alfredo Obieta
- Department of Geriatrics, Ballarat Health Services Ballarat, Queen Elizabeth Centre, Ballarat Central, VIC, Australia
| | - Tamsin Santos
- Department of Geriatrics, Ballarat Health Services Ballarat, Queen Elizabeth Centre, Ballarat Central, VIC, Australia
| | - Saara Ahmad
- Department of Biological and Biomedical Sciences, The Aga Khan University, Karachi, Pakistan
| | - Joseph Elliot Ibrahim
- Health Law and Ageing Research Unit, Department of Forensic Medicine, Monash University, Melbourne, VIC, Australia
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Nakanishi M, Yamasaki S, Endo K, Niimura J, Ziylan C, Bakker TJEM, Granvik E, Nägga K, Nishida A. e-Learning and Web-Based Tools for Psychosocial Interventions Addressing Neuropsychiatric Symptoms of Dementia During the COVID-19 Pandemic in Tokyo, Japan: Quasi-Experimental Study. JMIR MEDICAL EDUCATION 2021; 7:e30652. [PMID: 34543224 PMCID: PMC8513743 DOI: 10.2196/30652] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/19/2021] [Accepted: 09/19/2021] [Indexed: 05/25/2023]
Abstract
BACKGROUND Concern has been raised that the COVID-19 pandemic and consequent social distancing measures may increase neuropsychiatric symptoms in people with dementia. Thus, we developed and delivered an e-learning training course to professional caregivers on using a web-based tool for psychosocial interventions for people with dementia. OBJECTIVE The aim of our study was to evaluate the feasibility and efficacy of an e-learning course in combination with a web-based tool in addressing neuropsychiatric symptoms of dementia. METHODS A quasi-experimental design was used in Tokyo, Japan. The e-learning course was delivered three times to professional caregivers between July and December 2020. Caregivers who completed the course assessed the level of neuropsychiatric symptoms in people with dementia using the total score from the Neuropsychiatric Inventory (NPI) via a web-based tool. The primary outcome measures were the number of caregivers who implemented follow-up NPI evaluations by March 2021 and the change in NPI scores from baseline to their most recent follow-up evaluations. As a control group, information was also obtained from professional caregivers who completed a face-to-face training course using the same web-based tool between July 2019 and March 2020. RESULTS A total of 268 caregivers completed the e-learning course in 2020. Of the 268 caregivers, 56 (20.9%) underwent follow-up evaluations with 63 persons with dementia. The average NPI score was significantly reduced from baseline (mean 20.4, SD 16.2) to the most recent follow-up evaluations (mean 14.3, SD 13.4). The effect size was assumed to be medium (Cohen drm [repeated measures]=0.40). The control group consisted of 252 caregivers who completed a face-to-face training course. Of the 252 caregivers, 114 (45.2%) underwent follow-up evaluations. Compared to the control group, caregivers who completed the e-learning course were significantly less likely to implement follow-up evaluations (χ21=52.0, P<.001). The change in NPI scores did not differ according to the type of training course (baseline-adjusted difference=-0.61, P=.69). CONCLUSIONS The replacement of face-to-face training with e-learning may have provided professionals with an opportunity to participate in the dementia behavior analysis and support enhancement (DEMBASE) program who may not have participated in the program otherwise. Although the program showed equal efficacy in terms of the two training courses, the feasibility was suboptimal with lower implementation levels for those receiving e-learning training. Thus, further strategies should be developed to improve feasibility by providing motivational triggers for implementation and technical support for care professionals. Using online communities in the program should also be investigated.
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Affiliation(s)
- Miharu Nakanishi
- Department of Psychiatric Nursing, Tohoku University Graduate School of Medicine, Sendai-shi, Japan
- Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Setagaya-ku, Japan
| | - Syudo Yamasaki
- Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Setagaya-ku, Japan
| | - Kaori Endo
- Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Setagaya-ku, Japan
| | - Junko Niimura
- Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Setagaya-ku, Japan
| | - Canan Ziylan
- Research Center Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, Netherlands
| | - Ton J E M Bakker
- Research Center Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, Netherlands
- Stichting Wetenschap Balans, Rotterdam, Netherlands
| | - Eva Granvik
- Center for Excellence in Dementia, University Hospital, Malmö, Malmö, Sweden
| | - Katarina Nägga
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
- Department of Acute Internal Medicine and Geriatrics, Linköping University, Linköping, Sweden
| | - Atsushi Nishida
- Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Setagaya-ku, Japan
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Dasgupta M, Beker L, Schlegel K, Hillier LM, Joworski L, Crunican K, Coulter C. A Non-Pharmacologic Approach to Manage Behaviours in Confused Medically Ill Older Adults in Acute Care. Can Geriatr J 2021; 24:125-137. [PMID: 34079606 PMCID: PMC8137457 DOI: 10.5770/cgj.24.469] [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] Open
Abstract
Background Non-pharmacological interventions are recommended to manage challenging behaviours among cognitively impaired older adults, however few studies have enrolled patients in acute care. This study aimed to determine the feasibility of implementing non-pharmacological interventions to manage behaviours in hospitalized older adults. Method A self-identity approach was used to identify potentially engaging activities for 13 older medically ill adults admitted to acute hospital; these activities were trialed for a two-week period. Data were collected on frequency of intervention administration and assistance required, as well as frequency of behaviours and neuroleptic use in the seven days prior to and following the trial of activities. Results Per participant, 5–11 interventions were prescribed. Most frequently interventions were tried two or more times (46%); 9% were not tried at all. Staff or family assistance was not required for 27% of activities. The mean number of documented behaviours across participants was 4.8 ± 2.3 in the pre-intervention period and 2.1 ± 1.9 in the post-intervention period. Overall the interventions were feasible and did not result in increasing neuroleptic use Conclusion Non-pharmacologic interventions may be feasible to implement in acute care. More research in this area is justified.
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Affiliation(s)
- Monidipa Dasgupta
- Division of Geriatric Medicine, Shulich School of Medicine, Western University, London, ON.,Lawson Health Research Institute, London, ON
| | | | - Kim Schlegel
- London Health Sciences Centre, London, ON.,Fanshawe College, London, ON
| | - Loretta M Hillier
- GERAS Centre for Aging Research, Hamilton Health Sciences, Hamilton, ON
| | | | | | - Corrine Coulter
- Department of Family Medicine, Shulich School of Medicine, Western University, London, ON
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4
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Sefcik JS, Ersek M, Cacchione PZ. Nursing home residents with advanced dementia and persistent vocalisations: Observations of surrounding context. Int J Older People Nurs 2020; 15:e12322. [PMID: 32383798 PMCID: PMC7648731 DOI: 10.1111/opn.12322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 03/05/2020] [Accepted: 04/14/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE Persistent vocalisations are commonly exhibited by persons with dementia and are often characterised as agitation or aggression. There has been little focus on persistent vocalisations independent from other behavioural and psychological symptoms of dementia making it difficult to differentiate information about the context that surrounds the person with dementia, including the circumstances and events that precede and accompany the expression. Therefore, the aim of this study was to describe the context surrounding persistent vocalisations expressed by older adults residing in nursing homes (NH) with advanced dementia. DESIGN AND METHODS The need-driven dementia-compromised behaviour model informed this qualitative descriptive study. This naturalistic qualitative observational study involved direct observations of nine older adults diagnosed with dementia residing in four NHs and included informal interviews with formal caregivers. Field notes were taken and analysed using conventional content analysis. RESULTS Variability of exhibited persistent vocalisations was both observed by the investigator and explained by NH staff. Two themes emerged from the field notes; Routine of Staying in Room was identified for participants considered 'disruptive' to others, and Providing Care Without Communicating triggered persistent vocalisations. IMPLICATIONS The findings provide insight into the lack of therapeutic interactions between NH staff and persons with advanced dementia and persistent vocalisations residing in NHs. Ongoing, mandatory, evidence-based training on person-centred interventions and dementia care communication for all NH staff globally could have a significant impact on the delivery of holistic quality care for persons with dementia and persistent vocalisations.
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Affiliation(s)
- Justine S. Sefcik
- Drexel University College of Nursing and Health Professions, Philadelphia, PA, USA
| | - Mary Ersek
- Department of Veterans Affairs, Philadelphia, PA, USA
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Pamela Z. Cacchione
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA
- Penn Presbyterian Medical Center, Philadelphia, PA, USA
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5
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Nakanishi M, Niimura J, Ziylan C, Bakker TT, Granvik E, Nägga K, Shindo Y, Nishida A. Time Investment for Program Implementation to Manage Neuropsychiatric Symptoms: An Observational Longitudinal Study in In-Home and Residential Care Settings. J Alzheimers Dis Rep 2020; 4:441-453. [PMID: 33283165 PMCID: PMC7683103 DOI: 10.3233/adr-200235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background There are no studies on how the same psychosocial dementia care program is adapted to both in-home and residential care settings. Objective To evaluate the time investment required by professionals to implement a psychosocial dementia care program to manage neuropsychiatric symptoms. Methods A prospective observational study design was used. The program consisted of 1) a one-day training course, 2) three interdisciplinary discussion meetings in five months, and 3) a web-based tool for the continued assessment of neuropsychiatric symptoms. Care professionals implemented the intervention in in-home (19 in-home care management agencies and 14 multiple in-home service providers) and residential care settings (19 group homes and eight nursing homes) in Japan from October 2019 to February 2020. The level of neuropsychiatric symptoms for the participants was evaluated using the Neuropsychiatric Inventory (NPI: 0-144). The time investment was reported by participating professionals. A total of 125 persons with dementia were included at baseline. Results Neuropsychiatric symptoms were significantly decreased at the final follow-up in all types of providers (Cohen's drm = 0.44-0.61). The mean (SD) time required for the five-month implementation was 417.9 (219.8) minutes. There was a mean (SD) decrease of 8.6 (14.0) points in the total NPI score among the 103 persons with completed interventions. The time investment was significantly lower in in-home care management agencies than in group homes, and lower in follow-ups than at baseline assessment. Conclusion The program implementation may incur a substantial time investment regardless of setting. An additional benefit scheme to reward the time investment would be helpful to encourage implementation until the follow-ups.
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Affiliation(s)
- Miharu Nakanishi
- Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Setagaya-ku, Tokyo, Japan
| | - Junko Niimura
- Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Setagaya-ku, Tokyo, Japan
| | - Canan Ziylan
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
| | - Ton Tjem Bakker
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands.,Stichting Wetenschap Balans, Rotterdam, The Netherlands
| | - Eva Granvik
- Center of Excellence in Dementia, University Hospital, Malmö, Sweden
| | - Katarina Nägga
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.,Department of Acute Internal Medicine and Geriatrics, Linköping University, Linköping, Sweden
| | - Yumi Shindo
- National Center for Geriatrics and Gerontology, Aichi, Japan
| | - Atsushi Nishida
- Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Setagaya-ku, Tokyo, Japan
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6
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Hurst A, Coyne E, Kellett U, Needham J. Volunteering in dementia care in an Australian hospital: A phenomenological study. Collegian 2020. [DOI: 10.1016/j.colegn.2019.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Ferreira AR, Simões MR, Moreira E, Guedes J, Fernandes L. Modifiable factors associated with neuropsychiatric symptoms in nursing homes: The impact of unmet needs and psychotropic drugs. Arch Gerontol Geriatr 2020; 86:103919. [DOI: 10.1016/j.archger.2019.103919] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 07/01/2019] [Accepted: 07/24/2019] [Indexed: 01/15/2023]
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8
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Alves GS, Casali ME, Veras AB, Carrilho CG, Bruno Costa E, Rodrigues VM, Dourado MCN. A Systematic Review of Home-Setting Psychoeducation Interventions for Behavioral Changes in Dementia: Some Lessons for the COVID-19 Pandemic and Post-Pandemic Assistance. Front Psychiatry 2020; 11:577871. [PMID: 33132937 PMCID: PMC7550734 DOI: 10.3389/fpsyt.2020.577871] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 09/07/2020] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Impacts of social isolation measures imposed by COVID-19 Pandemic on mental health and quality of life of older adults living with dementia and their caregivers remain unexplored. Studies have shown that psychoeducational and psychosocial interventions can manage behavioral and psychological symptoms in dementia (BPSD) and reduce the emotional burden on family members when applied in home-setting scenarios. METHOD a comprehensive systematic review of useful interventions for easing the BPSD burden in patients with dementia (PwD) and their caregivers in the context of COVID-19 quarantine was performed from January 2010 to March 2020. RESULTS From a total of 187 articles retrieved from electronic databases (MEDLINE, LILACS, Cochrane and SCOPUS), 43 studies were eligible for this review. Most of the psychosocial and psychoeducational interventions described were person-centered strategies based on the cognitive-behavioral approach or informational tools to enhance care providers' knowledge of dementia. Most studies achieved successful results in handling BPSD and mood-anxiety symptoms of care providers, contributing to an overall improvement in dyad life quality. CONCLUSION Evidence from the last few years suggest that low-cost techniques, tailored to the dyad well-being, with increasing use of technology through friendly online platforms and application robots, can be an alternative to conventional assistance during COVID-19 Pandemic. Nevertheless, the world's current experience regarding the duration of the COVID-19 Pandemic and its effects on the cognition, behavior, and life quality of PwD will demand research on preventive and protective factors of dementia and the pursue of efficient interventions in different scenarios.
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Affiliation(s)
- Gilberto Sousa Alves
- Translational Psychiatry Research Group, Federal University of Maranhão, São Luís, Brazil.,Post Graduation in Psychiatry and Mental Health (PROPSAM), Institute of Psychiatry, UFRJ, Rio de Janeiro, Brazil
| | | | | | | | - Eriko Bruno Costa
- Translational Psychiatry Research Group, Federal University of Maranhão, São Luís, Brazil
| | - Valeska Marinho Rodrigues
- Post Graduation in Psychiatry and Mental Health (PROPSAM), Institute of Psychiatry, UFRJ, Rio de Janeiro, Brazil.,Center for Alzheimer's Disease, Institute of Psychiatry, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Marcia Cristina Nascimento Dourado
- Post Graduation in Psychiatry and Mental Health (PROPSAM), Institute of Psychiatry, UFRJ, Rio de Janeiro, Brazil.,Center for Alzheimer's Disease, Institute of Psychiatry, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
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9
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Mashlan W, Ralston S, Jones L. Meaningful engagement between secondary school students and older patients in an acute hospital. Nurs Older People 2019; 32:e1190. [PMID: 31617337 DOI: 10.7748/nop.2019.e1190] [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: 05/07/2019] [Indexed: 11/09/2022]
Abstract
This article discusses the development and outcomes of a project involving a shared care acute hospital ward (mental health and medical) and a local secondary school in South Wales. The project enabled meaningful interaction between school pupils and patients with dementia, depression and delirium. It also provided secondary school pupils with the opportunity to understand the role of hospital-based healthcare staff and the needs of older patients.
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Affiliation(s)
- Wendy Mashlan
- care of the elderly medicine, Cwm Taf Morgannwg University Health Board, Bridgend, Wales
| | - Sara Ralston
- shared care ward, Cwm Taf Morgannwg University Health Board, Bridgend, Wales
| | - Lauren Jones
- care of the elderly medicine, Cwm Taf Morgannwg University Health Board, Bridgend, Wales
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10
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Bray J, Brooker DJ, Garabedian C. What is the evidence for the activities of Namaste Care? A rapid assessment review. DEMENTIA 2019; 20:247-272. [DOI: 10.1177/1471301219878299] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Objectives To assess the quality of research evidence for the different activity components for the psycho-social Namaste Care intervention for care home residents with advanced dementia. Design Namaste Care is a multi-component intervention delivered on a daily basis to people living with advanced dementia or people at end of life with dementia. A significant part of its operationalisation within care homes is the delivery of a number of activities delivered by trained in-house Namaste Care workers to a group of residents with similar high dependency needs. The Namaste Care workers focus on touch, music, nature, sensory experience, aromas and interactions with objects delivered in a way to enhance feelings of enjoyment and wellbeing. This review evaluated the evidence for using these activities with people living with advanced dementia. A systematic search of peer-reviewed research articles was conducted between November 2016 and September 2018 using search terms of activities used in Namaste Care. The quality of each accepted article was rated using the Rapid Evidence Assessment scale. Results The initial literature search returned 1341 results: 127 articles including 42 reviews were included. The majority of activity interventions yielded between 10 and 20 peer-reviewed papers. The use of smells and aromas, interacting with animals and dolls, the use of various forms of music (e.g. background music, singing, personalised music), nature, lighting, various forms of touch/massage and sensory interventions (including Snoezelen) all appear to have proven efficacy with people living with advanced dementia. Conclusions There is generally a limited number of research papers and reviews in this area, but overall there is a good evidence base for including these activities within Namaste Care for people living with advanced dementia.
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Affiliation(s)
- Jennifer Bray
- Association for Dementia Studies, University of Worcester, UK
| | - Dawn J Brooker
- Association for Dementia Studies, University of Worcester, UK
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11
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Gerritsen DL, Smalbrugge M, Veldwijk-Rouwenhorst AE, Wetzels R, Zuidema SU, Koopmans RT. The Difficulty With Studying Challenging Behavior. J Am Med Dir Assoc 2019; 20:879-881. [DOI: 10.1016/j.jamda.2019.01.148] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 01/25/2019] [Accepted: 01/25/2019] [Indexed: 11/25/2022]
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Selles MC, Oliveira MM, Ferreira ST. Brain Inflammation Connects Cognitive and Non-Cognitive Symptoms in Alzheimer's Disease. J Alzheimers Dis 2019; 64:S313-S327. [PMID: 29710716 DOI: 10.3233/jad-179925] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Alzheimer's disease (AD) is the main form of dementia in the elderly and affects greater than 47 million people worldwide. Care for AD patients poses very significant personal and economic demands on individuals and society, and the situation is expected to get even more dramatic in the coming decades unless effective treatments are found to halt the progression of the disease. Although AD is most commonly regarded as a disease of the memory, the entire brain is eventually affected by neuronal dysfunction or neurodegeneration, which brings about a host of other behavioral disturbances. AD patients often present with apathy, depression, eating and sleeping disorders, aggressive behavior, and other non-cognitive symptoms, which deeply affect not only the patient but also the caregiver's health. These symptoms are usually associated with AD pathology but are often neglected as part of disease progression due to the early and profound impact of disease on memory centers such as the hippocampus and entorhinal cortex. Yet, a collection of findings offers biochemical insight into mechanisms underlying non-cognitive symptoms in AD, and indicate that, at the molecular level, such symptoms share common mechanisms. Here, we review evidence indicating mechanistic links between memory loss and non-cognitive symptoms of AD. We highlight the central role of the pro-inflammatory activity of microglia in behavioral alterations in AD patients and in experimental models of the disease. We suggest that a deeper understanding of non-cognitive symptoms of AD may illuminate a new beginning in AD research, offering a fresh approach to elucidate mechanisms involved in disease progression and potentially unveiling yet unexplored therapeutic targets.
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Affiliation(s)
- M Clara Selles
- Institute of Medical Biochemistry Leopoldo de Meis, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Mauricio M Oliveira
- Institute of Medical Biochemistry Leopoldo de Meis, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Sergio T Ferreira
- Institute of Medical Biochemistry Leopoldo de Meis, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil.,Institute of Biophysics Carlos Chagas Filho, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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13
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Abstract
Vocally disruptive behavior (VDB) is a common and particularly difficult symptom to manage in dementia. VDB is usually considered collectively with agitation and aggression as a component of behavioral and psychological symptoms in dementia and is therefore poorly understood as an individual symptom. A review of the literature is described where VDB as a challenging behavior has been individually examined as a symptom. A case of VDB occurring in patient with dementia is described where the patient's repetitive vocalizations responded to treatment with pregabalin. This has not been previously reported in the literature. The prevalence of VDB, the factors associated with it and the current management guidelines for clinicians are outlined with a review of the drug treatment strategies for VDB. Pregabalin with its unique pharmacological profile and excellent tolerability should be considered as a possible treatment for VDB where drug treatment is indicated.
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14
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Sefcik JS, Ersek M, Harnett SC, Cacchione PZ. Integrative review: Persistent vocalizations among nursing home residents with dementia. Int Psychogeriatr 2019; 31:667-683. [PMID: 30303058 PMCID: PMC6458099 DOI: 10.1017/s1041610218001205] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
ABSTRACTBackground:Nursing home (NH) residents with dementia commonly exhibit persistent vocalizations (PVs), otherwise known in the literature as disruptive or problematic vocalizations. Having a better understanding of PVs and the research completed to date on this phenomenon is important to guide further research and clinical practice in NHs. This integrative review examines the current literature on the phenomenon of PVs among NH residents with dementia. METHODS We conducted a search in the PubMed, Scopus, Ovid Medline, and CINAHL databases for articles published in English. Articles were included if the focus was specifically on research involving vocal behaviors of older adults with dementia residing in NHs. RESULTS Our literature search revealed eight research articles that met the inclusion criteria. These studies were published in 2011 or earlier and involved small sample sizes. Seven of these studies were descriptive and the eighth was a non-pharmacological intervention study for PVs exhibited by NH residents with dementia. These studies were vastly different in their labeling, definitions, and categorization of the PVs as well as methods of measuring PVs. CONCLUSION The heterogeneity of the evidence limits the ability to make recommendations for practice. Given the paucity of research on this phenomenon; recommendations for additional research are given.
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Affiliation(s)
- Justine S. Sefcik
- University of Pennsylvania School of Nursing, 418 Curie Blvd, Philadelphia,
PA 19104, USA
| | - Mary Ersek
- Professor of Palliative Care, University of Pennsylvania School of Nursing,
418 Curie Blvd, Philadelphia, PA 19104, USA
| | - Sasha C. Harnett
- University of Pennsylvania School of Nursing, 418 Curie Blvd, Philadelphia,
PA 19104, USA
| | - Pamela Z. Cacchione
- Ralston House Term Chair in Gerontological Nursing, Associate Professor of
Geropsychiatric Nursing Clinician Educator, University of Pennsylvania School of
Nursing, 418 Curie Blvd, Philadelphia, PA 19104, USA
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15
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Lindholm C, Wide C. Self-directed speech and dialogue in dementia care: the potential of co-participants' contributions. LOGOP PHONIATR VOCO 2019; 44:14-22. [PMID: 30693814 DOI: 10.1080/14015439.2019.1554853] [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: 10/27/2022]
Abstract
PURPOSE Dementia is associated with an ongoing decline in language function, involving both language production and comprehension. Maintaining a conversation with persons with dementia may be challenging. In this study, we investigate how the contributions of professional caregivers affect the linguistic contributions of the speaker with dementia. METHODS This is a conversation analytic case study of one individual with dementia. The data are drawn from a five-hour video corpus collected at a Swedish speaking care facility in Finland. RESULTS In comparing self-directed speech and dialogue, the results show how professional caregivers can induce change in the linguistic and interactional behaviors of a person with dementia. CONCLUSIONS Introducing an interactional perspective to self-directed speech and dialogue, this study provides new insights into the notion of a "good conversation" in dementia care.
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Affiliation(s)
- Camilla Lindholm
- a Department of Finnish Language, Finno-Ugrian and Scandinavian Studies , University of Helsinki , Helsinki , Finland
| | - Camilla Wide
- b Scandinavian Languages , University of Turku , Turku , Finland
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16
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Hitzig SL, Sheppard CL. Implementing Montessori Methods for Dementia: A Scoping Review. THE GERONTOLOGIST 2018; 57:e94-e114. [PMID: 28062518 DOI: 10.1093/geront/gnw147] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 08/22/2016] [Indexed: 11/12/2022] Open
Abstract
Purpose of the Study A scoping review was conducted to develop an understanding of Montessori-based programing (MBP) approaches used in dementia care and to identify optimal ways to implement these programs across various settings. Design and Methods Six peer-reviewed databases were searched for relevant abstracts by 2 independent reviewers. Included articles and book chapters were those available in English and published by the end of January 2016. Twenty-three articles and 2 book chapters met the inclusion criteria. Results Four approaches to implementing MBP were identified: (a) staff assisted (n = 14); (b) intergenerational (n = 5); (c) resident assisted (n = 4); and (d) volunteer or family assisted (n = 2). There is a high degree of variability with how MBP was delivered and no clearly established "best practices" or standardized protocol emerged across approaches except for resident-assisted MBP. Implications The findings from this scoping review provide an initial road map on suggestions for implementing MBP across dementia care settings. Irrespective of implementation approach, there are several pragmatic and logistical issues that need to be taken into account for optimal implementation.
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Affiliation(s)
- Sander L Hitzig
- St. John's Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, Ontario, Canada.,Toronto Rehabilitation Institute, University Health Network, Ontario, Canada
| | - Christine L Sheppard
- School of Public Health and Health Systems, Applied Health Sciences, University of Waterloo, Ontario, Canada
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Mileski M, Baar Topinka J, Brooks M, Lonidier C, Linker K, Vander Veen K. Sensory and memory stimulation as a means to care for individuals with dementia in long-term care facilities. Clin Interv Aging 2018; 13:967-974. [PMID: 29844663 PMCID: PMC5962307 DOI: 10.2147/cia.s153113] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Objective The primary objective of this study was to identify and further examine the facilitators and barriers of utilizing sensory and memory stimulation as a means to care for individuals with dementia who live in long-term care settings. Materials and methods The authors conducted a literature review of 30 academic articles found using the databases such as CINAHL, PubMed, and Academic Search Ultimate from the past 15 years. Facilitator and barrier themes were found within each article and analyzed for their relevance to sensory and memory stimulation therapies and their effects on individuals with dementia. Results The most common facilitator was improved communication. The top three barriers were access, staff training, and mixed results. Discussion Reminiscence therapy appears to provide a person-centered method of care for those who otherwise have problems communicating. These implementations will be more effective if they have the support of staff and management. Conclusion The authors conclude that sensory and memory stimulation therapies have the potential to help improve many dementia-specific issues for individuals living in long-term care settings.
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Affiliation(s)
- Michael Mileski
- School of Health Administration, Texas State University, San Marcos, TX, USA
| | - Joseph Baar Topinka
- School of Health Administration, Texas State University, San Marcos, TX, USA
| | - Matthew Brooks
- School of Health Administration, Texas State University, San Marcos, TX, USA
| | - Corie Lonidier
- School of Health Administration, Texas State University, San Marcos, TX, USA
| | - Kelly Linker
- School of Health Administration, Texas State University, San Marcos, TX, USA
| | - Kelsey Vander Veen
- School of Health Administration, Texas State University, San Marcos, TX, USA
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Nakanishi M, Endo K, Hirooka K, Granvik E, Minthon L, Nägga K, Nishida A. Psychosocial behaviour management programme for home-dwelling people with dementia: A cluster-randomized controlled trial. Int J Geriatr Psychiatry 2018; 33:495-503. [PMID: 28857263 DOI: 10.1002/gps.4784] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 07/31/2017] [Indexed: 11/10/2022]
Abstract
UNLABELLED Little is known about the effectiveness of a psychosocial behaviour management programme on home-dwelling people with dementia. We developed a Behaviour Analytics & Support Enhancement (BASE) programme for care managers and professional caregivers of home care services in Japan. We investigated the effects of BASE on challenging behaviour of home-dwelling people with dementia. METHODS A cluster-randomized controlled trial was conducted with home care providers from 3 different districts in Tokyo. Each provider recruited persons with dementia aged 65 years or older to receive home care in the BASE programme in August 2016. An online monitoring and assessment system was introduced to the intervention group for repeated measures of challenging behaviour with a total score of the Neuropsychiatric Inventory. Care professionals in both the intervention and control groups evaluated challenging behaviour of persons with dementia at baseline (September 2016) and follow-up (February 2017). RESULTS A majority of persons with dementia had Alzheimer disease (59.3%). One-hundred and forty-one persons with dementia were included in the intervention group and 142 in the control group. Multilevel modelling revealed a significant reduction in challenging behaviour in the intervention group after 6 months (mean score, 18.3 to 11.2) compared with that of the control group (11.6 to 10.8; P < .05). CONCLUSION The implementation of the BASE programme resulted in a reduction of challenging behaviour of home-dwelling people with dementia. Future research should examine the long-term effects of behaviour management programmes on behaviour, nursing home placement, and hospital admission of home-dwelling people with dementia.
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Affiliation(s)
- Miharu Nakanishi
- Mental Health and Nursing Research Team, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Kaori Endo
- Mental Health Promotion Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Kayo Hirooka
- Mental Health Promotion Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Eva Granvik
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Lennart Minthon
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Katarina Nägga
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Atsushi Nishida
- Mental Health Promotion Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
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Halek M, Holle D, Bartholomeyczik S. Development and evaluation of the content validity, practicability and feasibility of the Innovative dementia-oriented Assessment system for challenging behaviour in residents with dementia. BMC Health Serv Res 2017; 17:554. [PMID: 28806934 PMCID: PMC5557472 DOI: 10.1186/s12913-017-2469-8] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 07/24/2017] [Indexed: 11/15/2022] Open
Abstract
Background One of the most difficult issues for care staff is the manifestation of challenging behaviour among residents with dementia. The first step in managing this type of behaviour is analysing its triggers. A structured assessment instrument can facilitate this process and may improve carers’ management of the situation. This paper describes the development of an instrument designed for this purpose and an evaluation of its content validity and its feasibility and practicability in nursing homes. Methods The development process and evaluation of the content validity were based on Lynn’s methodology (1998). A literature review (steps 1 + 2) provided the theoretical framework for the instrument and for item formation. Ten experts (step 3) evaluated the first version of the instrument (the Innovative dementia-oriented Assessment (IdA®)) regarding its relevance, clarity, meaningfulness and completeness; content validity indices at the scale-level (S-CVI) and item-level (I-CVI) were calculated. Health care workers (step 4) evaluated the second version in a workshop. Finally, the instrument was introduced to 17 units in 11 nursing homes in a field study (step 5), and 60 care staff members assessed its practicability and feasibility. Results The IdA® used the need-driven dementia-compromised behaviour (NDB) model as a theoretical framework. The literature review and expert-based panel supported the content validity of the IdA®. At the item level, 77% of the ratings had a CVI greater than or equal to 0.78. The majority of the question-ratings (84%, n = 154) and answer-ratings (69%, n = 122) showed valid results, with none below 0.50. The health care workers confirmed the understandability, completeness and plausibility of the IdA®. Steps 3 and 4 led to further item clarification. The carers in the study considered the instrument helpful for reflecting challenging behaviour and beneficial for the care of residents with dementia. Negative ratings referred to the time required and the lack of effect on residents´ behaviour. Conclusions There was strong evidence supporting the content validity of the IdA®. Despite the substantial length and time requirement, the instrument was considered helpful for analysing challenging behaviour. Thus, further research on the psychometric qualities, implementation aspects and effectiveness of the IdA® in understanding challenging behaviour is needed. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2469-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Margareta Halek
- German Center for Neurodegenerative Diseases (DZNE), Stockumer Str. 12, 58453, Witten, Germany. .,School of Nursing Science, Witten/Herdecke University, Witten, Germany.
| | - Daniela Holle
- German Center for Neurodegenerative Diseases (DZNE), Stockumer Str. 12, 58453, Witten, Germany.,School of Nursing Science, Witten/Herdecke University, Witten, Germany
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Delirium and Dementia in the Intensive Care Unit: Increasing Awareness for Decreasing Risk, Improving Outcomes, and Family Engagement. Dimens Crit Care Nurs 2017; 34:259-64. [PMID: 26244239 DOI: 10.1097/dcc.0000000000000133] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
: Longer stays in the intensive care unit (ICU) can be an opportunistic battlefield where not only is the length of stay longer, but also there is increased time that lapses with the potential for a patient fall, nosocomial infection, urinary tract infection, and other untoward events (http://oig.hhs.gov/oei/reports/oei-06-09-00090.pdf; ASHRM Forum. 2014;Q3:10-14). As such, the push has become for shorter lengths of stay whenever possible. Delirium and dementia are 2 conditions that the ICU clinician must remain diligent in monitoring for status changes. Delirium poses the threat of longer-term undesirable outcomes and is a potential inherent risk in the care delivered. It rises to the level of a medical emergency that can be deadly but, when caught early, can be treated and resolved (Science Daily, September 16, 2013). Setting expectations with families, providing adequate education, and involving them in a holistic view of patient-centered care can help toward the detection of differences that may occur from an ICU stay. Interventions the ICU clinician can take for increasing self, patient, and family awareness to decrease risk and improve outcomes and ways to deepen family engagement in these populations are explored with practical applications.
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Travers C, Brooks D, Hines S, O’Reilly M, McMaster M, He W, MacAndrew M, Fielding E, Karlsson L, Beattie E. Effectiveness of meaningful occupation interventions for people living with dementia in residential aged care: a systematic review. ACTA ACUST UNITED AC 2016; 14:163-225. [DOI: 10.11124/jbisrir-2016-003230] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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O'Rourke HM, Fraser KD, Duggleby W, Keating N. The association of perceived conflict with sadness for long-term care residents with moderate and severe dementia. DEMENTIA 2016; 17:801-820. [PMID: 27306962 DOI: 10.1177/1471301216654336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives Research into the lived experiences of long-term care residents with dementia has identified perceived conflict, and its impact on sadness, as priorities for quality of life from the perspectives of people with dementia. However, whether and to what extent perceived conflict and sadness are associated has not been previously tested in this population. This study tested the associations between perceived conflicts with staff, family or friends and co-residents and their experience of sadness, and whether cognitive impairment or functional dependence modified these associations. Methods The study design was cross-sectional, correlational retrospective. Participants were 5001 residents of 613 long-term care facilities in Ontario, Canada with moderate and severe dementia. Clinical administrative data collected from 2012 to 2013 using the Resident Assessment Instrument 2.0 were used to measure the person's perception of conflicts with family/friends, staff, or co-residents, as well as verbal and non-verbal indicators of sadness. Hypotheses were tested using logistic regression, with cluster correction. Results Sadness (adjusting for age, sex, family/friend contact, pain, cognitive impairment, and functional dependence) was positively associated with perceived conflicts with family or friends (OR 1.91; 95% CI 1.26-2.88; p = 0.002) and staff (OR 1.51; 95% CI 1.07-2.13; p = 0.020). These associations did not differ depending on the level of cognitive impairment or functional dependence. The association between co-resident conflict and sadness was statistically significant for people with moderate (OR 2.02; 95% CI 1.45-2.82; p < 0.001) but not for those with severe dementia (OR 1.18; 95% CI 0.72-1.91; p = 0.511). Conclusion Long-term care residents with dementia who perceive conflict with others require support to maintain high quality relationships, particularly with family and friends. Future research should rigorously assess the modifiability of perceived conflict for people with moderate and severe dementia, and whether interventions to ameliorate perceived conflict result in decreased sadness and improved quality of life.
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Affiliation(s)
| | | | | | - Norah Keating
- Centre for Innovative Ageing, Swansea University, UK; North-West University, South Africa
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Cohen-Mansfield J, Dakheel-Ali M, Marx MS, Thein K, Regier NG. Which unmet needs contribute to behavior problems in persons with advanced dementia? Psychiatry Res 2015; 228:59-64. [PMID: 25933478 PMCID: PMC4451402 DOI: 10.1016/j.psychres.2015.03.043] [Citation(s) in RCA: 151] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2014] [Revised: 01/26/2015] [Accepted: 03/27/2015] [Indexed: 11/30/2022]
Abstract
The Unmet Needs Model states that problem behaviors of people with dementia result from unmet needs stemming from a decreased ability to communicate those needs and to provide for oneself. The purpose of this study is to describe the unmet needs of persons with dementia exhibiting behavior problems. Eighty-nine residents with dementia from six Maryland nursing homes were assessed by research assistants and nursing assistants for their unmet needs using multiple assessment tools. Three unmet needs per resident were identified on average, with informants rating boredom/sensory deprivation, loneliness/need for social interaction, and need for meaningful activity as the most prevalent needs. Discomfort was associated with higher levels of verbally agitated behaviors (e.g., complaining). Based on results and independent ratings of pain, the authors estimate notable under-detection of discomfort and pain by both types of informants. The study demonstrates methodologies for uncovering unmet needs among persons with dementia and highlights the importance of developing programs that address those unmet needs, especially social and activity needs of nursing home residents. The detection of pain, and possibly that of discomfort, may require a different methodology.
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Affiliation(s)
- Jiska Cohen-Mansfield
- Herczeg Institute on Aging, Minerva Center for the Interdisciplinary Study of End of Life, and Department of Health Promotion, School of Public Health, Sackler Faculty of Medicine, Tel-Aviv University, P.O.B. 39040, Ramat Aviv, Tel Aviv 69978, Israel; Innovative Aging Research, Silver Spring, MD 20902, USA; George Washington University Medical Center, Washington, DC 20037, USA.
| | | | | | - Khin Thein
- Innovative Aging Research, Silver Spring, MD, USA 20902
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Randall EW, Clissett PC. What are the relative merits of interventions used to reduce the occurrences of disruptive vocalisation in persons with dementia? - a systematic review. Int J Older People Nurs 2015; 11:4-17. [PMID: 26123749 DOI: 10.1111/opn.12083] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 03/18/2015] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Dementia is a major health issue, and many people who have the progressive disease express disruptive vocalisation. These behaviours place large burdens on carers, family and on the individual themselves. BACKGROUND This systematic review explored the use of interventions that could be used within practice to reduce the occurrences of disruptive vocalisation in people with dementia. METHODS Three online databases (CINAHL, MEDLINE and EMBASE) were searched for papers published after 1997 against two concept criteria of dementia and disruptive vocalisation. Any person diagnosed with dementia or suspected of having dementia symptoms were included identifying any interventions. Studies were appraised and data extracted using the Joanna Briggs Institute frameworks. RESULTS This systematic review identified eight relevant papers for inclusion, and these assessed the implementation of eight separate interventions that could be used within practice. Three interventions were found to be supported by statistically significant research: a staff training programme, a behavioural management technique using cue cards and hand massage. CONCLUSION The overall conclusion is that the evidence base is insufficient to make recommendations for practice. However, the studies gave some indication of how research and practice might develop in this area. In particular, five elements were identified that appear to promote the best patient outcomes. These include making sure interventions are person-centred, individualised, adaptable, with the use of multiple approaches, carried out by staff trained in the identification of disruptive vocalisation and ways to avoid triggering these behaviours. IMPLICATIONS FOR PRACTICE Triggers which lead to older people with dementia expressing disruptive vocalisation should be identified. Multiple individualised interventions should be used to reduce the occurrences of the disruptive vocalisation.
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O'Rourke HM, Duggleby W, Fraser KD. Embedding the perceptions of people with dementia into quantitative research design. Qual Life Res 2015; 24:1145-55. [PMID: 25809650 DOI: 10.1007/s11136-015-0967-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE Patient perspectives about quality of life are often found in the results of qualitative research and could be applied to steer the direction of future research. The purpose of this paper was to describe how findings from a body of qualitative research on patient perspectives about quality of life were linked to a clinical administrative dataset and then used to design a subsequent quantitative study. METHODS Themes from two systematic reviews of qualitative evidence (i.e., metasyntheses) identified what affects quality of life according to people with dementia. Selected themes and their sub-concepts were then mapped to an administrative dataset (the Resident Assessment Instrument 2.0) to determine the study focus, formulate nine hypotheses, and select a patient-reported outcome. A literature review followed to confirm existence of a knowledge gap, identify adjustment variables, and support design decisions. RESULTS A quantitative study to test the association between conflict and sadness for people with dementia in long-term care was derived from metasynthesis themes. Challenges included (1) mapping broad themes to the administrative dataset; (2) decisions associated with inclusion of variables not identified by people with dementia from the qualitative research; and (3) selecting a patient-reported outcome, when the dataset lacked a valid subjective quality-of-life measure. CONCLUSIONS Themes derived from a body of qualitative research capturing a target populations' perspective can be linked to administrative data and used to design a quantitative study. Using this approach, the quantitative findings will be meaningful with respect to the quality of life of the target population.
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Affiliation(s)
- Hannah M O'Rourke
- Daphne Cockwell School of Nursing, 350 Victoria Street, Toronto, ON, M5B 2K3, Canada,
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Cohen-Mansfield J. Nonpharmacologic Treatment of Behavioral Disorders in Dementia. Curr Treat Options Neurol 2013; 15:765-85. [DOI: 10.1007/s11940-013-0257-2] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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