Person-centred dementia care: moving beyond caregiving

How the interrelated physical, social and organizational environment impacts daily life of residents with dementia on a Green Care Farm

Green Care Farms (GCF) are innovative long-term care environments and an alternative to regular nursing homes in the Netherlands. Following a culture change movement, GCFs have radically altered the care environment. Research suggests positive effects on residents. However, knowledge is limited regarding their physical, social and organizational environment. This article explores the care environment of 24-h GCFs for people with dementia and its impact on residents and their daily life. An ethnographic study using mixed methods was carried out at a GCF in the Netherlands between June and October 2021. Researchers lived on the GCF and completed 28 days of participatory observations in three groups. During the day, informal conversations were held with residents (n = 48), staff and family members. Twenty four semi-structured interviews were conducted with residents, their family members, staff and the managers, complemented by a focus group with staff. The physical environment was additionally assessed with the OAZIS-dementia tool. Data collection methods informed each other. Qualitative data was thematically analyzed, quantitative data descriptively. Four themes were identified as crucial during daily life on the GCF: stimulating the senses, engaging in purposeful activities, sharing responsibilities and creating a community in a new home. Realizing these topics in practice, physical, social and organizational environmental components were highly interrelated. The physical environment encouraged and facilitated meaningful in-/outdoor activities and social encounters. The organizational environment supported the use of the physical environment by aligning processes and transporting the vision. The social environment focused on collaboration and creating a home-like atmosphere by including residents in household- and farm chores. This community-building led to more meaningful activities and social interaction. In conclusion, this study revealed the central influence of the management in paving the way for a new form of care delivery. As leaders shape the three environments, the organization influences the design of the physical environment and the actions taking place within it. By creating a community, the care home benefits residents, their families and staff equally. The conscious interrelation and harmonization of the physical, social and organizational components of a long-term care environment has the potential to improve the daily life of residents.

Promoting meaningful engagement for residents living with dementia through intergenerational programs: a pilot study

OBJECTIVES

Residents living with dementia in residential aged care facilities (RACFs) have reduced access to, and opportunities for, participation in meaningful activities. This leads to increased social isolation and disengagement. Intergenerational programs aim to overcome these issues. Allied health students piloted a live-intergenerational program (LIP), living onsite at a residential aged care facility (RACF) while volunteering for 30 h a month. The purpose of this study was to explore the impact and practicalities for implementing a LIP in an Australian RACF.

METHODS

This qualitative descriptive pilot study was undertaken to explore the diverse perspectives of various stakeholders. Qualitative data were collected during group discussions directed by the nominal group technique with live-in-students. Interviews were conducted with staff members, relatives, facility management and volunteers. All qualitative data were analysed thematically.

RESULTS

Two overarching themes emerged. The first, community of care, indicated how care partners and the care context, organisational support and being a live-in-student supported the sustainability of the program. Live-in-students' accessibility promoted opportunities for occupational and social engagement of residents when staff was less available. The second, a collective based on belonging and shared doing, highlighted the program's potential impact and uncovered the development of a collective based on shared belonging.

CONCLUSION

The LIP highlighted the potential for new dimensions to person-centred care. The pilot study demonstrated intergenerational contact within aged residential care supported the evolvement of a collective and promoted a social approach for ageing well. Further research is needed to identify the long-term impact of the LIP and explore the feasibility of expanding the program.

The influence of job crafting on the quality of care provided by nursing home employees: The moderating effect of organizational identification

Our goal was to analyze the positive effect of job crafting activities involving nursing home employees on their perceived quality of care, and the moderating effect of organizational identification. A two-wave non-experimental design (with an interval of 12 months) was used. The Job Crafting Questionnaire, the Identification-Commitment Inventory, and the Quality of Care Questionnaire (QoC) were administered to 226 nursing home employees in two waves. The results of the hierarchical regression analyses found significant association between job crafting subdimensions and quality of care twelve months later. Organizational identification was shown to play a moderating role in these relationships when analyzing the effect of cognitive crafting. In this sense, the effect of cognitive crafting on quality of care is only found with high levels of identification. The findings highlight the importance of the job crafting dimensions (task, relational and cognitive) when it comes to enhancing quality of care in residential homes for the elderly. This is especially relevant for cognitive crafting among employees with high levels of organizational identification. This research provides managers with guidance when allocating job crafting opportunities aimed at making improvements in quality of care. In this respect, organizations must offer job crafting training to stimulate and support their employees and, on the other hand, managers should encourage employees to craft their jobs, gearing their needs, abilities, and goals to corporate values and competencies.

Family involvement with care homes following placement of a relative living with dementia: a review

This review updated a previous review [Gaugler JE (2005) Family involvement in residential long-term care: a synthesis and critical review. Aging and Mental Health9, 105–118] and focused on dementia. Fourteen years of development in family involvement with care homes following placement of a relative was explored. The review aimed to investigate two questions: (1) What types of involvement do families have with care homes following placement of people living with dementia? (2) Which factors influence family involvement with care homes? PsycINFO, MEDLINE and CINAHL Plus were searched for publications between January 2005 and December 2018. Thirty-three papers representing 30 studies were included. Papers were appraised using a quality rating tool designed for use with mixed study designs. Studies were of a reasonable quality though some weaknesses included single-site samples, high attrition rates and poor reporting. Twenty-eight papers highlighted types of involvement including collaboration, family–staff relationship development, decision making and visiting. Twenty-five papers pertained to factors influencing involvement, which included outcome of care quality evaluation, wish for recognition and sense of integration into the care team. Type of family involvement has changed over time with increased emphasis on families’ desire for partnership, to be active rather than passive advocates, and to focus on care monitoring and evaluation. Seven themes of family involvement activities are featured and a non-linear process is proposed. When compared to patient and family-centred care principles, an analysis of family involvement types found good fit overall and potential for framework improvements. Over 30 diverse factors influence inter-family variation in the level and nature of family involvement. Consideration of these factors and resolution of the gaps in evidence, including intergenerational and cultural concerns, can improve care home facilitation of family participation. This dementia-specific review is a comprehensive timely complement to Gaugler's seminal work about older adults in care.

Differences in Burden Severity in Adult-Child Family Caregivers and Spousal Caregivers of Persons with Dementia

Researchers are continuing to focus on the nature and sources of burden of family caregivers of persons living with dementia. Caregiving stress and burden are assessed and addressed by social workers, including at high-risk times such as hospitalization. This study tested whether adult-child family caregivers experience greater perceived burden than spousal caregivers, accounting for risks of acute stress which can accompany hospitalization for their care recipient, where social workers may be meeting with family caregivers for the first time. Family caregivers (N = 76; n = 42 adult-child; n = 34 spouse) were recruited during care-recipient clinical treatment. The settings of care included an outpatient memory care program and an inpatient geriatric psychiatry service. Results showed that adult-child caregivers reported greater burden as compared with spousal caregivers, but no differences regarding depressive symptoms, perceived stress, or grief. After controlling for demographics and location of care, being an adult-child caregiver remained a predictor of greater burden severity. Being an adult-child family caregiver may place an individual at increased risk for experiencing high burden. These findings suggest socials workers should consider how adult-child caregivers may benefit from strategies to address and reduce burden, beyond those typically offered to spousal caregivers.

Developing a virtual reality for people with dementia in nursing homes based on their psychological needs: a feasibility study

Background

The purpose of this study was (1) to develop a virtual reality (VR) intervention program based on the psychological needs of patients residing in nursing facilities in South Korea to alleviate their behavioral and psychological symptoms and (2) to confirm the possibility of utilizing VR in patients with dementia.

Methods

In the first phase, patients with dementia residing in nursing homes and experiencing behavioral and psychological symptoms were recruited. Surveys and questionnaires were used to identify activities that alleviated the behavioral and psychological symptoms of dementia (BPSD) among the patients. These activities were classified into five types of psychological needs. In the second phase, a fully immersive, interactive, easy-to-use VR platform was developed that reflected these psychological needs. Patients with dementia experienced the VR content. The researchers assessed the level of the participants’ immersion, preference, and interaction with the VR using a 5-point Likert scale.

Results

In the feasibility test, 10 nursing home residents were recruited. The mean immersion score was 4.93 ± 0.16 points, the mean preference score was 4.35 ± 0.41 points, and the mean interaction score was 3.84 ± 0.43 points using a 5-point Likert scale. Higher mean scores indicated a more positive outcome. Six of the 10 participants required assistance while using the VR. The mean VR experience duration was 10.00 ± 3.46 min.

Conclusions

The VR-based intervention program that was developed to reduce BPSD was feasible for the participants and provided them with a high degree of satisfaction and immersion. Furthermore, this study also confirmed the convenience and safety of the program. These findings support the potential use of VR-based BPSD intervention programs to treat patients with dementia.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-021-02125-w.

Reflections on a personalized cognitive rehabilitation intervention: Experiences of people living with dementia and their carers participating in the GREAT trial

Cognitive rehabilitation for people living with early-stage dementia improves functional ability in areas targeted in the therapy, but little is known about how participants experience this intervention. This qualitative paper investigates participants' views about a cognitive rehabilitation intervention in a randomized controlled trial (the GREAT trial) and aims to help explain and interpret the findings and to inform further intervention development. Using in-depth thematic analysis, 43 semi-structured interviews (35 individual and 8 dyadic) were conducted with 25 people living with dementia and 26 family carers from three sites. The person-centred, individualized approach was valued. Some participants' views about dementia were questioned as a consequence of taking part in the therapy; they considered the effectiveness of the intervention in the context of the progressive nature of the condition. Certain participants continued to be doubtful, focussing on the inevitability of decline, rather than the possibility of reablement. Such views may have influenced engagement. The therapeutic relationship played a vital role as it was how personalized care was provided and participants' views had changed positively. Therapists engendered greater confidence and reduced anxiety and social isolation. Positive responses support personalized rehabilitative care to address the specific needs of people living with dementia.

Autonomy Support of Nursing Home Residents With Dementia in Staff-Resident Interactions: Observations of Care

OBJECTIVES

People with dementia living in nursing homes benefit from a social environment that fully supports their autonomy. Yet, it is unknown to what extent this is supported in daily practice. This study aimed to explore to which extent autonomy is supported within staff-resident interactions.

DESIGN

An exploratory, cross-sectional study.

SETTING AND PARTICIPANTS

In total, interactions between 57 nursing home residents with dementia and staff from 9 different psychogeriatric wards in the Netherlands were observed.

METHODS

Structured observations were carried out to assess the support of resident autonomy within staff-resident interactions. Observations were performed during morning care and consisted of 4 main categories: getting up, physical care, physical appearance, and breakfast. For each morning care activity, the observers consecutively scored who initiated the care activity, how staff facilitated autonomy, how residents responded to staff, and how staff reacted to residents' responses. Each resident was observed during 3 different mornings. In addition, qualitative field notes were taken to include environment and ambience.

RESULTS

In total, 1770 care interactions were observed. Results show that autonomy seemed to be supported by staff in 60% of the interactions. However, missed opportunities to engage residents in choice were frequently observed. These mainly seem to occur during interactions in which staff members took over tasks and seemed insensitive to residents' needs and wishes. Differences between staff approach, working procedures, and physical environment were observed across nursing home locations.

CONCLUSIONS AND IMPLICATIONS

The findings of this study indicate that staff members support resident autonomy in more than one-half of the cases during care interactions. Nonetheless, improvements are needed to support resident autonomy. Staff should be encouraged to share and increase knowledge in dementia care to better address residents' individual needs. Especially for residents with severe dementia, it seems important that staff develop skills to support their autonomy.

Slow Nursing and Its Holistic Place in Dementia Care: A Secondary Analysis of Qualitative Data From Nurses Working in Nursing Homes

Despite a growing body of research literature within dementia care, research concerning how to provide holistic quality care and its benefit for people with dementia is still scarce. In this study, a secondary analysis of original qualitative data from a former study was employed. Findings demonstrated that slow nursing embodies a holistic caring approach, which may improve the care quality provided to people with dementia. The current findings also provide key knowledge that may contribute to nursing research and education.

"I´m the one who has written this": reciprocity in writing courses for older adults in Norway

Purpose: The aim of this article is to explore, theoretically and empirically, the reciprocity of care afforded by writing courses as community interventions for older adults.

Methods: We narratively analyzed 209 excerpts of the anthology “I´m the one who has written this” written by teachers and participants of courses organized by the Church City Mission in Norway.

Results: The reciprocity that appeared in the writing courses is grounded in the sense of vulnerability that both teachers and participants embraced, and that is experienced in three main relational movements that these writing courses convey: self-exploration, otherness and togetherness. In addition, the data suggests that these courses promote affective processing and existential meaning-making, motivation, as well as improvements of memory and attention. However, more research is needed to confirm these preliminary findings, and their possible effects in older adults with and without symptoms of dementia.

Conclusion: Even though these writing courses for older adults are not explicitly therapeutic, they can have therapeutic effects, given the reciprocity afforded in these cultural community interventions. A theoretical exploration upon reciprocity in eldercare is hereby provided. These findings could shape improvements in aging and health care policies that are person-centered and focus on reciprocity.

Nursing students' cultural beliefs and understanding of dementia: A phenomenological study across three continents

BACKGROUND

Migrant nurses have reported difficulties adapting to their new culture and providing culturally sensitive care for people with dementia. However, to date no studies have explored the impact of student nurse's cultural heritage on their beliefs and understanding of dementia.

OBJECTIVES

To explore the cultural beliefs of dementia of student nurses studying in England, Slovenia, Philippines and New Zealand.

DESIGN

An explorative hermeneutic phenomenology design.

SETTINGS

Higher Education Institutes delivering undergraduate nursing education in England (University of Greenwich and University of Essex), Slovenia (Angela Boškin Faculty of Health Care), New Zealand (University of Auckland), and the Philippines (University of Silliman).

PARTICIPANTS

Student nurses studying nursing in England (n = 81), Slovenia (n = 41), Philippines (n = 53) and New Zealand (n = 6). Participants from England and New Zealand were from diverse cultural backgrounds. Student nurses at the beginning of their studies (n = 100) and towards the end of their studies (n = 81) participated.

METHODS

Completion of focus groups (n = 23), in England (n = 10), Slovenia (n = 6), Philippines (n = 6), and New Zealand (n = 1). All focus groups were audio recorded and transcribed verbatim. Data was analysed by applying an inductive theoretical approach of the Framework Method, which supports the generation of themes through open unhindered coding, pinpointing, examining, and recording patterns within the data.

RESULTS

Two major themes were identified in the data: familial piety and dementia discourse. Familial piety emerged from the importance of family and caring for family members with dementia, subthemes included: 'my granddad': familial experience, and 'better to be with her': familial home. Dementia discourse emerged from the terminology student nurses applied, such as: 'preconceptions and misconceptions' of aggression, and 'considered crazy' stigma of dementia due to a lack of awareness.

CONCLUSIONS

The cultural heritage of student nurses impacted on their beliefs of dementia; however their understanding of the needs, care and support of a person with dementia changed and developed through clinical experience and education.

Embracing Cultural Diversity: Meaningful Engagement for Older Adults With Advanced Dementia in a Residential Care Setting

Providing person-centered care (PCC) that focuses on meaningful engagement in residential care settings for older adults with moderate to advanced dementia is an internationally recognized challenge. In this study, we aimed to identify best-practice scenarios for supporting older adults with moderate to advanced dementia from culturally and linguistically diverse backgrounds who lived in care facilities. A mixed-methods study with a concurrent triangulation strategy was adopted. Data collection occurred with care partners by means of a preworkshop questionnaire, an appreciative-inquiry workshop, and an adapted Delphi technique. The findings indicate that care partners valued the care facilities' residents' needs for doing, being, and belonging. Collaborative data generation reflected the setting-specific PCC practices. Leadership team members agreed that enabling inclusion and celebrating cultural diversity were important but that cultural humility needed to be promoted.

Quality of care for frail older adults

Our successes in improving life expectancy has led to increased years of life lived with multimorbidity and dementia with increased support needs. Much of the support given to frail older people is provided by family and informal support networks with significant impact on their physical, psychological, and financial well-being. Demographic and societal changes are reducing the capacity of family to offer this care. Formal home-based, center-based, and long-term/residential/nursing home care services are predominately provided by untrained care staff working under supervision from nursing staff. Difficulties recruiting and retaining these staff is leading to major challenges to meeting the needs of older people (Chenoweth et al., 2010). This volume contains a number of studies focusing on ways to improve care provided by these services for frail older people. The approach underpinning these papers and many perspectives of good quality care for older people is the need to be person-centered where the older person identifies their own goals for care and assessment of need, employing a holistic and strength-based approach incorporating their interests, values, and capacities (Vernooij-Dassen and Moniz-Cook, 2016).

Living Life and Doing Things Together: Collaborative Research With Couples Where One Partner Has a Diagnosis of Dementia

The aim of this study is to identify relevant content for a self-management guide by using the outcomes of previous research in combination with knowledge and experiences from couples where one partner has a diagnosis of dementia. The study was carried out in three phases: (a) literature search of previous research related to well-being and couplehood in dementia; (b) interviews with couples with dementia based on the findings of the literature search; and (c) further authentication of the findings within expert groups of people with dementia and carers. For analysis of data, we used a hybrid approach of thematic analysis with combined deductive and inductive approaches. The findings of this study indicated that the four main themes "Home and Neighborhood," "Meaningful Activities and Relationships," "Approach and Empowerment," and "Couplehood" with related subthemes could be appropriate targets for a self-management guide for couples where one partner has a diagnosis of dementia.

Involvement of Hospitalized Persons With Dementia in Everyday Decisions: A Dyadic Study

Background and Objectives

To examine the involvement of persons with dementia (PWDs) in everyday decision making from the perspectives of hospitalized PWDs and their family caregivers, and to identify determinants thereof.

Research Design and Methods

Using multilevel modeling, we examined cross-sectional data collected prospectively from 42 family care dyads regarding the care values of the PWD.

Results

Both members of the dyad rated the PWD, on average, as being "somewhat involved". There was a significant amount of variability around the average perceptions of PWD involvement in decision making for both PWDs (χ2 = 351.02, p < .001) and family caregivers (χ2 = 327.01, p < .001). Both PWDs and family caregivers were significantly more likely to perceive greater PWD involvement in decision making when the family caregiver reported the PWD as valuing autonomy. Additionally, PWDs were significantly more likely to report greater involvement when they had greater cognitive function. Finally, family caregivers perceived significantly greater involvement of the patient in decision making when they reported less strain in the relationship. Together, autonomy, relationship strain, cognitive function, and care-related strain accounted for 38% and 46% of the variability in PWDs' and family caregivers' perceptions, respectively, of the PWD's decision-making involvement.

Discussion and Implications

Although research indicates that decision-making abilities decline with advancing dementia, these results imply that working with families to support PWDs in their value of autonomy and mitigate strain in the dyad's relationship may help prolong PWDs' decision-making involvement.

Through the eyes of others - the social experiences of people with dementia: a systematic literature review and synthesis

ABSTRACTBackground:Psychosocial models suggest that the lived experience of dementia is affected by interpersonal factors such as the ways in which others view, talk about, and behave toward the person with dementia. This review aimed to illuminate how informal, everyday interpersonal relationships are experienced by people with dementia within their social contexts.

METHOD

A systematic review of qualitative literature published between 1989 and May 2016 was conducted, utilizing the electronic databases PsycINFO, MEDLINE, and CINAHL-Complete. This was followed by a critical interpretative synthesis to understand how people with dementia perceive the attitudes, views, and reactions of other people toward them, and the subjective impact that these have.

RESULTS

Four major themes were derived from the findings of the 23 included studies: being treated as an "other" rather than "one of us"; being treated as "lesser" rather than a full, valued member of society; the impact of others' responses; and strategies to manage the responses of others. Thus, people with dementia can feel outcast and relegated, or indeed feel included and valued by others. These experiences impact upon emotional and psychological well-being, and are actively interpreted and managed by people with dementia.

CONCLUSION

Experiences such as loss and diminishing identity have previously been understood as a direct result of dementia, with little consideration of interpersonal influences. This review notes that people with dementia actively engage with others, whose responses can foster or undermine social well-being. This dynamic relational aspect may contribute to emerging understandings of social health in dementia.

Incongruent perceptions of the care values of hospitalized persons with dementia: a pilot study of patient-family caregiver dyads

OBJECTIVE

Many difficult decisions are made in the inpatient hospital setting regarding the daily care of persons with dementia (PWDs). Incongruent perceptions of the PWD's care values limit the family caregiver's ability to make surrogate decisions. The objectives of this pilot study were to describe and identify determinants of incongruent perceptions in the hospital setting.

METHODS

Using multilevel modeling (MLM), we examined cross-sectional data collected from 42 PWD-family caregiver dyads.

RESULTS

There was a significant amount of incongruence, on average, for all four subscales representing the PWD's care values: autonomy = -0.33 (p < .001); burden = -.49 (p < .001); safety/quality of care = -.26 (p < .001); and social interactions = -.21 (p = .004). Family caregivers (CG) rated the importance of care values to the PWD as lower than the PWD rated the importance. Determinants of greater incongruence included higher relationship strain and fewer positive dyadic interactions.

CONCLUSION

Our findings reveal significant levels of incongruence in perceptions of the PWD's values among dementia care dyads in the hospital setting. Our analysis suggests a potential impact of relationship variables on incongruence. Further research is needed around this overlooked interpersonal context for supporting the dementia care dyad in the hospital setting.