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Brimelow R, Beattie E, Byrne G, Dissanayaka N. Frequency of changed behaviours in residential aged care and common mitigation strategies - A retrospective review of behavioural report logs. J Clin Nurs 2022. [PMID: 36168200 DOI: 10.1111/jocn.16531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 06/27/2022] [Accepted: 08/23/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Changed behaviours in residential aged care facilities (RACF) are frequently reported in the literature. How RACF staff routinely respond to these observed changed behaviours represents a significant gap. OBJECTIVE To analyse the frequency of changed behaviour reported within RACF behavioural report logs and to ascertain how staff typically manage these behaviours. METHODS Residents (N = 25) with varying levels of cognitive function were recruited from a 160 bed RACF in Queensland, Australia. A retrospective analysis of behavioural report logs was conducted to elucidate prevalence of reported changed behaviours as categorised by RACF staff. Thematic analysis of staff recorded behavioural mitigation strategies was used to categorise staff actions. A case analysis was also conducted to highlight the challenges faced by RACF staff managing persistent acute changed behaviours using identified common mitigation strategies. The STROBE guidelines were followed for reporting. RESULTS There were 395 behaviours recorded in a two-month period. Physical agitation, interfering while wandering, trying to get to inappropriate places, verbal refusal of care, physical aggression, and verbal disruption were most frequently reported by staff. Management strategies included redirection, PRN psychotropic medication, reassurance, routine care practices, offering of beverages, repositioning, and rarely analgesia. A 24-h case analysis highlighted how staff utilised redirection and multiple doses of a PRN benzodiazepine with limited effectiveness. CONCLUSION This study reveals current mitigation strategies employed by RACF staff in response to acute changed behaviours often associated with dementia. Agitation and wandering are prevalent and are difficult for staff to manage effectively. RELEVANCE TO CLINICAL PRACTICE This study highlights that careful consideration should be taken to avoid overuse of PRN benzodiazepines in management of changed behaviours. Short-term mitigation strategies, such as redirection, may not be effective if underlying causes such as pain, physiological, mental, emotional, or social needs are not met. PATIENT AND PUBLIC CONTRIBUTION A RACF participated in project design and review.
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Affiliation(s)
- Rachel Brimelow
- The University of Queensland Centre for Clinical Research, Herston, Queensland, Australia
| | - Elizabeth Beattie
- School of Nursing, Queensland University of Technology, Kelvin Grove, Queensland, Australia.,Institute of Health and Biomedical Innovation, Kelvin Grove, Queensland, Australia
| | - Gerard Byrne
- The University of Queensland Centre for Clinical Research, Herston, Queensland, Australia.,Royal Brisbane Clinical Unit, Royal Brisbane & Woman's Hospital, Queensland, Australia
| | - Nadeeka Dissanayaka
- The University of Queensland Centre for Clinical Research, Herston, Queensland, Australia.,The University of Queensland School of Psychology, Faculty of Health and Behavioural Sciences, St Lucia, Queensland, Australia.,Department of Neurology, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
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2
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Cho E, Kim S, Hwang S, Kwon E, Heo SJ, Lee JH, Ye BS, Kang B. Factors Associated With Behavioral and Psychological Symptoms of Dementia: Prospective Observational Study Using Actigraphy. J Med Internet Res 2021; 23:e29001. [PMID: 34714244 PMCID: PMC8590188 DOI: 10.2196/29001] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 06/07/2021] [Accepted: 09/27/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Although disclosing the predictors of different behavioral and psychological symptoms of dementia (BPSD) is the first step in developing person-centered interventions, current understanding is limited, as it considers BPSD as a homogenous construct. This fails to account for their heterogeneity and hinders development of interventions that address the underlying causes of the target BPSD subsyndromes. Moreover, understanding the influence of proximal factors-circadian rhythm-related factors (ie, sleep and activity levels) and physical and psychosocial unmet needs states-on BPSD subsyndromes is limited, due to the challenges of obtaining objective and/or continuous time-varying measures. OBJECTIVE The aim of this study was to explore factors associated with BPSD subsyndromes among community-dwelling older adults with dementia, considering sets of background and proximal factors (ie, actigraphy-measured sleep and physical activity levels and diary-based caregiver-perceived symptom triggers), guided by the need-driven dementia-compromised behavior model. METHODS A prospective observational study design was employed. Study participants included 145 older adults with dementia living at home. The mean age at baseline was 81.2 (SD 6.01) years and the sample consisted of 86 (59.3%) women. BPSD were measured with a BPSD diary kept by caregivers and were categorized into seven subsyndromes. Independent variables consisted of background characteristics and proximal factors (ie, sleep and physical activity levels measured using actigraphy and caregiver-reported contributing factors assessed using a BPSD diary). Generalized linear mixed models (GLMMs) were used to examine the factors that predicted the occurrence of BPSD subsyndromes. We compared the models based on the Akaike information criterion, the Bayesian information criterion, and likelihood ratio testing. RESULTS Compared to the GLMMs with only background factors, the addition of actigraphy and diary-based data improved model fit for every BPSD subsyndrome. The number of hours of nighttime sleep was a predictor of the next day's sleep and nighttime behaviors (odds ratio [OR] 0.9, 95% CI 0.8-1.0; P=.005), and the amount of energy expenditure was a predictor for euphoria or elation (OR 0.02, 95% CI 0.0-0.5; P=.02). All subsyndromes, except for euphoria or elation, were significantly associated with hunger or thirst and urination or bowel movements, and all BPSD subsyndromes showed an association with environmental change. Age, marital status, premorbid personality, and taking sedatives were predictors of specific BPSD subsyndromes. CONCLUSIONS BPSD are clinically heterogeneous, and their occurrence can be predicted by different contributing factors. Our results for various BPSD suggest a critical window for timely intervention and care planning. Findings from this study will help devise symptom-targeted and individualized interventions to prevent and manage BPSD and facilitate personalized dementia care.
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Affiliation(s)
- Eunhee Cho
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, Republic of Korea
| | - Sujin Kim
- College of Nursing, Yonsei University, Seoul, Republic of Korea
| | - Sinwoo Hwang
- Korea Armed Forces Nursing Academy, Daejeon, Republic of Korea
| | - Eunji Kwon
- Korea Armed Forces Nursing Academy, Daejeon, Republic of Korea
| | - Seok-Jae Heo
- Department of Biostatistics and Computing, Yonsei University Graduate School, Yonsei University, Seoul, Republic of Korea
| | - Jun Hong Lee
- National Health Insurance Service, Ilsan Hospital, Goyang, Republic of Korea
| | - Byoung Seok Ye
- College of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Bada Kang
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, Republic of Korea
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3
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Veldwijk-Rouwenhorst AE, Zuidema SU, Smalbrugge M, Bor H, Wetzels R, Gerritsen DL, Koopmans RTCM. Very frequent physical aggression and vocalizations in nursing home residents with dementia. Aging Ment Health 2021; 25:1442-1451. [PMID: 32602746 DOI: 10.1080/13607863.2020.1786799] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES We investigated the 2-week prevalence and correlates of very frequent physical aggression (PA) and vocalizations in nursing home (NH)-residents with dementia. METHOD/DESIGN This cross-sectional study used combined data of 2074 NH-residents from four studies, collected from 119 dementia special care units in 26 Dutch NH. Very frequent PA was defined as scoring 6 or 7 on the items 'hitting', pushing', 'biting' and 'kicking' of the Cohen Mansfield Agitation Inventory; very frequent vocalizations as scoring 6 or 7 on 'screaming' and 'making strange noises'. We compared NH-residents with very frequent PA or vocalizations with residents with less frequent PA or vocalizations, assessing correlates using univariate and multivariate multilevel logistic regression analyses. RESULTS We found a 2-week prevalence of 2.2% (95% confidence interval (CI): 1.63-2.89) of very frequent PA and 11.5% of very frequent vocalizations (95% CI: 10.23-12.98). Very frequent PA was only associated with apathy (odds ratio (OR)=1.93, 95% CI: 1.04-3.61). Correlates of very frequent vocalizations were age (OR = 0.97, 95% CI: 0.951-0.998), dementia severity (overall p-value 0.020), antipsychotic drug use (OR = 1.56, 95% CI: 1.08-2.26), antiepileptic drug use (OR = 2.75, 95% CI: 1.34-5.68) and euphoria (OR = 2.01, 95% CI: 1.22-3.31). CONCLUSION Characteristics of NH-residents with very frequent PA or very frequent vocalizations differ from those of NH-residents with less frequent PA or vocalizations. Frontal lobe damage, boredom, pain and/or external factors may explain several of the found associations, but further research is necessary. Our findings may contribute to better care for these residents and thereby to improving their quality of life.
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Affiliation(s)
- Annelies E Veldwijk-Rouwenhorst
- Department of Primary and Community Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands.,Radboudumc Alzheimer Center, Nijmegen, the Netherlands
| | - Sytse U Zuidema
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Martin Smalbrugge
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Hans Bor
- Department of Primary and Community Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | - Roland Wetzels
- Department of Primary and Community Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands.,Radboudumc Alzheimer Center, Nijmegen, the Netherlands
| | - Debby L Gerritsen
- Department of Primary and Community Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands.,Radboudumc Alzheimer Center, Nijmegen, the Netherlands
| | - Raymond T C M Koopmans
- Department of Primary and Community Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands.,Radboudumc Alzheimer Center, Nijmegen, the Netherlands.,Center for Specialized Geriatric Care, De Waalboog "Joachim en Anna", Nijmegen, the Netherlands
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4
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Kang B, Karel MJ, Corazzini KN, McConnell ES. A mixed methods study on the manifestations of behavioural symptoms of dementia among veterans with and without posttraumatic stress disorder. J Adv Nurs 2021; 77:3176-3188. [PMID: 33969916 DOI: 10.1111/jan.14864] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 02/11/2021] [Accepted: 03/30/2021] [Indexed: 12/20/2022]
Abstract
AIMS To explore how behavioural symptoms of dementia are manifested among veterans in residential long-term care settings, in the context of personal, interpersonal/social and environmental triggers and how the manifestations differ between veterans with and without posttraumatic stress disorder. DESIGN Secondary analysis using a mixed methods approach. METHODS We analysed text data from a stratified random sample of 66 cases derived from the programme evaluation dataset of the Staff Training in Assisted Living Residences-Veterans Health Administration (STAR-VA) intervention from 2013 to 2016, using framework analysis. The detailed behavioural assessment descriptions in this dataset are consistent with contemporary non-pharmacologic symptom management. Qualitative categories were converted to quantitative variables for two group comparisons. RESULTS Four patterns emerged linking specific types of triggers and behavioural symptoms: (1) unmet physical needs or emotional distress triggers non-aggressive behaviours; (2) unsolicited direct care approach triggers care refusal, resistance or combativeness; (3) interpersonal interactions interfering with self-direction trigger aggressive behaviours; and (4) uncontrolled stimulation from environments trigger non-aggressive behaviours. The organisational culture of care influenced how staff conceptualised behavioural symptoms. Veterans with co-existing posttraumatic stress disorder and dementia tended to exhibit rejection of care with aggression compared to those with dementia alone. CONCLUSION Contextualised accounts of behavioural symptoms of dementia revealed symptom heterogeneity, with different clusters of multi-level triggers arising from specific personal, interpersonal and environmental circumstances. Distinct patterns of symptom manifestations between veterans with and without posttraumatic stress disorder suggest a tailored approach is required to meet each veteran's unique biopsychosocial needs. IMPACT Classifying behavioural symptoms with their triggers rather than solely by behaviours provides important new information for developing person-centred, non-pharmacological interventions to improve outcomes for veterans with dementia. Multi-level interventions should be considered to meet veteran's needs that account for their earlier life history and current life circumstances.
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Affiliation(s)
- Bada Kang
- School of Nursing, Duke University, Durham, NC, USA.,Mo-Im Kim Nursing Research Institute, Yonsei University College of Nursing, Seoul, South Korea
| | - Michele J Karel
- Office of Mental Health and Suicide Prevention, Department of Veterans Affairs, Washington, DC, USA
| | - Kirsten N Corazzini
- School of Nursing, Duke University, Durham, NC, USA.,School of Nursing, University of Maryland, College Park, MD, USA
| | - Eleanor S McConnell
- School of Nursing, Duke University, Durham, NC, USA.,Geriatric Research, Education and Clinical Center, Durham Department of Veterans Affairs Medical Center, Durham, NC, USA
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5
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Vocally disruptive behaviour in nursing home residents in Ireland: a descriptive study. Ir J Psychol Med 2020:1-11. [PMID: 33323141 DOI: 10.1017/ipm.2020.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Vocally disruptive behaviour (VDB) is relatively common in nursing home residents but difficult to treat. There is limited study on prevalence and treatment of VDB. We hypothesise that VDB is a result of complex interaction between patient factors and environmental contributors. METHODS Residents of nursing homes in south Dublin were the target population for this study. Inclusion criteria were that the residents were 65 years or over and exhibited VDB significant enough for consideration in the resident's care plan. Information on typology and frequency of VDB, Interventions employed and their efficacy, diagnoses, Cohen-Mansfield Agitation Inventory scores, Mini-Mental State Examination scores, and Barthel Index scores were obtained. RESULTS Eight percent of nursing home residents were reported to display VDB, most commonly screaming (in 39.4% of vocally disruptive residents). VDB was associated with physical agitation and dementia; together, these two factors accounted for almost two-thirds of the variation in VDB between residents. One-to-one attention, engaging in conversation, redirecting behaviour, and use of psychotropic medication were reported by nurses as the most useful interventions. Analgesics were the medications most commonly used (65.7%) followed by quetiapine (62.9%), and these were reportedly effective in 82.6% and 77.2% of residents respectively. CONCLUSIONS VDB is common, challenging, and difficult to manage. The study of VDB is limited by a variety of factors that both contribute to this behaviour and make its treatment challenging. Issues relating to capacity and ethics make it difficult to conduct randomised controlled trials of treatments for VDB in the population affected.
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6
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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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7
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The effect of PARO robotic seals for hospitalized patients with dementia: A feasibility study. Geriatr Nurs 2020; 42:37-45. [PMID: 33221556 DOI: 10.1016/j.gerinurse.2020.11.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 11/03/2020] [Accepted: 11/05/2020] [Indexed: 01/14/2023]
Abstract
Robotic seals have been studied in long-term care settings; though, no studies of patients with dementia in the acute care setting have been reported. The purpose of this study was to evaluate the feasibility of PARO interventions for hospitalized patients with dementia, determine physiological effects and describe social-affective interactions. Using a prospective descriptive design with pre-post PARO intervention physiological measurements, we studied 55 participants who received up to five 15-min PARO interventions. The PARO was favorably accepted for 212 (95%) of the 223 PARO interventions. Differences in pre- and post-physiological measures for mean arterial pressure, pulse, respiration, oxygenation, stress, and pain levels were evaluated using Wilcoxon Signed Rank test with statistically significant pre and post differences (p=<0.05); however, the differences were not clinically significant. Participants (95%) demonstrated beneficial PARO interactions with the most frequent interactions being speaking and petting. The PARO shows promise for enhancing social and affective responses for hospitalized patients with dementia.
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8
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Sefcik JS, Ersek M, Libonati JR, Hartnett SC, Hodgson NA, Cacchione PZ. Heart Rate of Nursing Home Residents with Advanced Dementia and Persistent Vocalizations. HEALTH AND TECHNOLOGY 2020; 10:827-831. [PMID: 32467819 DOI: 10.1007/s12553-019-00397-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Persistent vocalizations (PVs) are a common behavioral symptom of dementia. There are currently no known studies examining physiological measurement in nursing home (NH) residents with dementia exhibiting PVs. Measures of heart rate (HR) could provide objective evidence of a person's response to a disruption in their internal or external environment. This was a two-case observational study involving NH residents with advanced dementia. HRs were collected via a sensor belt. We found a 39-45 bpm increase in HRs in both participants when comparing a day without PVs to a day exhibiting PVs. This is the first study to demonstrate a change in HR associated with PVs and potential evidence of stress in the person in response to either an internal or external stimuli.
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Affiliation(s)
- Justine S Sefcik
- Drexel University College of Nursing and Health Professions, 1601 Cherry St., Room 230, Philadelphia, PA 19102
| | - Mary Ersek
- Department of Veterans Affairs, Philadelphia, PA
| | - Joseph R Libonati
- University of Pennsylvania School of Nursing, 418 Curie Blvd, Philadelphia, PA, 19104
| | - Sasha C Hartnett
- University of Pennsylvania School of Nursing, 418 Curie Blvd, Philadelphia, PA, 19104
| | - Nancy A Hodgson
- University of Pennsylvania School of Nursing, 418 Curie Blvd, Philadelphia, PA, 19104
| | - Pamela Z Cacchione
- University of Pennsylvania School of Nursing, 418 Curie Blvd, Philadelphia, PA, 19104
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9
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Lee SJ, Park MS, Choi YR, Chang SO. Concept Development of Identification of Discomfort for Nursing Home Patients With Advanced Dementia. Int J Nurs Knowl 2020; 32:274-285. [PMID: 31957245 DOI: 10.1111/2047-3095.12277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 12/31/2019] [Accepted: 01/09/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE The aim of this study is to clarify the concept of discomfort identification by concept development in the nursing home. METHODS The Schwartz-Barcott and Kim's hybrid model was used. FINDINGS The identification of discomfort can be explained as an interactive and confirmative process of sympathetically responding to patients with dementia's problem behavior expressions that communicate unmet needs. CONCLUSIONS The identification of discomfort has the potential to improve the detection of multidimensional discomfort related to nursing diagnosis as a holistic and patient-centered approach. IMPLICATION FOR NURSING PRACTICE The findings could help nursing home nurses have a better understanding of identification of discomfort and can improve nurses and interdisciplinary caregivers' knowledge for developing appropriate comfort caring activities.
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Affiliation(s)
- Su Jung Lee
- Korea University College of Nursing, Seoul, Republic of Korea
| | - Min Sun Park
- Korea University College of Nursing, Seoul, Republic of Korea
| | - Young-Rim Choi
- Korea University College of Nursing, Seoul, Republic of Korea
| | - Sung Ok Chang
- Korea University College of Nursing, Seoul, Republic of Korea
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10
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Lee KH, Lee JY, Boltz M, McConnell ES. Emotional Expression of Persons with Dementia: An Integrative Review with Implications for Evidence-Based Practice. Worldviews Evid Based Nurs 2019; 16:344-351. [PMID: 31397542 DOI: 10.1111/wvn.12395] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND The ability to express emotion typically is preserved longer than language and cognitive function in persons living with dementia. Emotional expression may be an important indicator of underlying individual needs and feelings and may therefore facilitate person-centered care. AIMS This review aimed to examine how emotional expression has been described, measured, and utilized in empirical studies. METHODS The design of this study was an integrative literature review. A systematic search was conducted through electronic databases using defined search terms. Articles published up to March 2018 were included. The method proposed by Whittemore and Knafl was used for data synthesis and review integration. Quality appraisal of the selected articles was evaluated by the Mixed Methods Assessment Tool. RESULTS Most of the articles used feeling-related terms without specific definitions. Less frequently, terms such as affect, emotion, and mood were defined. Although these terms were used interchangeably in the articles, affect, which was defined as expressed emotion in general, was a comprehensive term to encompass other terms. Measurement of emotional expression was performed using observational methods, with direct observation or video recording using a hand-held camera. In both cases, observed emotion was coded with diverse methods or tools. In studies, the emotional expression was utilized as (a) an outcome to demonstrate the effect of interventions, (b) a factor to show relationship with other variables, or (c) an observed value itself. LINKING EVIDENCE TO ACTION This review provides insights about measurement options for emotional expressions among persons with dementia in long-term care. Long-term care staff should pay attention to emotional expression of persons with dementia to understand underlying unmet needs. Development of adequate measurement of emotional expression could facilitate development of emotion-oriented intervention program to improve psychological well-being and the behavioral and functional health of persons living with dementia.
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Affiliation(s)
- Kyung Hee Lee
- Yonsei University College of Nursing, Seoul, Korea.,Mo-Im Nursing Research Institute, Seoul, Korea
| | - Ji Yeon Lee
- Yonsei University College of Nursing, Seoul, Korea
| | - Marie Boltz
- College of Nursing, The Pennsylvania State University, University Park, PA, USA
| | - Eleanor S McConnell
- School of Nursing, Duke University, Durham, NC, USA.,Geriatric Research, Education and Clinical Center (GRECC), Department of Veterans Affairs (VA) Medical Center, Durham, NC, USA
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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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12
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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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13
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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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14
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Woods DL, Buckwalter K. Taking Another Look: Thoughts on Behavioral Symptoms in Dementia and Their Measurement. Healthcare (Basel) 2018; 6:healthcare6040126. [PMID: 30360369 PMCID: PMC6316419 DOI: 10.3390/healthcare6040126] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 10/12/2018] [Accepted: 10/16/2018] [Indexed: 11/16/2022] Open
Abstract
This article proposes taking another look at behavioral symptoms of dementia (BSDs) both from a theoretical perspective that informs research and practice and from a measurement perspective. We discuss why this rethinking of behaviors impacts current models of care and our ability to better detect outcomes from interventions. We propose that BSDs be viewed from a pattern perspective and provide some suggestions for how to identify and measure these patterns that can influence the timing and type of intervention. Evidence suggests that BSDs are complex, sequential, patterned clusters of behavior recurring repeatedly in the same individual and escalate significantly without timely intervention. However, BSDs are frequently viewed as separate behaviors rather than patterns or clusters of behaviors, a view that affects current research questions as well as the choice, timing, and outcomes of interventions. These symptoms cause immense distress to persons with the disease and their caregivers, trigger hospitalizations and nursing home placement, and are associated with increased care costs. Despite their universality and that symptoms manifest across disease etiologies and stages, behaviors tend to be underrecognized, undertreated, and overmanaged by pharmacological treatments that may pose more harm than benefit.
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Affiliation(s)
- Diana Lynn Woods
- School of Nursing, Azusa Pacific University, Azusa, CA 91702, USA.
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15
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A cross-sectional examination of the prevalence of psychotropic medications for people living with dementia in Australian long-term care facilities: issues of concern. Int Psychogeriatr 2018; 30:1019-1026. [PMID: 29198287 DOI: 10.1017/s1041610217002447] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
UNLABELLED ABSTRACTBackground:Behavioral and psychological symptoms of dementia (BPSD) are a common problem in long-term care facilities (LTC). Clinical guidelines dictate that first-line treatments for BPSD are psychosocial and behavioral interventions; if these are unsuccessful, psychotropic medications may be trialed at low doses and their effects can be monitored. METHODS There have previously been no studies with nationally representative samples to investigate psychotropic administration in LTCs in Australia. This study determines the prevalence of psychotropic administration in a representative stratified random sample of 446 residents living with dementia from 53 Australian LTCs. Questionnaire and medical chart data in this study is drawn from a larger cross-sectional, mixed methods study on quality of life in Australian LTCs. RESULTS It was found that 257 (58%) residents were prescribed psychotropic medications including: antipsychotics (n = 160, 36%), benzodiazepines (n = 136, 31%), antidepressants (n = 117, 26%), and anti-dementia medications (n = 9, 2%). BPSD were found to be very common in the sample, with 82% (n = 364) of participants experiencing at least one BPSD. The most prevalent BPSD were depression (n = 286, 70%) and agitation (n = 299, 67%). CONCLUSIONS Although detailed background information was not collected on individual cases, the prevalence found is indicative of systematic industry-wide, over-prescription of psychotropic medications as a first-line treatment for BPSD. This study highlights a clear need for further research and interventions in this area.
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16
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Bourbonnais A, Ducharme F, Landreville P, Michaud C, Gauthier MA, Lavallée MH. An Action Research to Optimize the Well-Being of Older People in Nursing Homes: Challenges and Strategies for Implementing a Complex Intervention. J Appl Gerontol 2018; 39:119-128. [DOI: 10.1177/0733464818762068] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Few studies have been conducted on strategies to promote the implementation of complex interventions in nursing homes (NHs). This article presents a pilot study intended to assess the strategies that would enable the optimal implementation of a complex intervention approach in NHs based on the meanings of screams of older people living with Alzheimer’s disease. An action research approach was used with 19 formal and family caregivers from five NHs. Focus groups and individual interviews were held to assess different implementation strategies. A number of challenges were identified, as were strategies to overcome them. These latter included interactive training, intervention design, and external support. This study shows the feasibility of implementing a complex intervention to optimize older people’s well-being. The article shares strategies that may promote the implementation of these types of interventions in NHs.
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Affiliation(s)
- Anne Bourbonnais
- Université de Montréal, Québec, Canada
- Institut universitaire de gériatrie de Montréal, Québec, Canada
| | - Francine Ducharme
- Université de Montréal, Québec, Canada
- Institut universitaire de gériatrie de Montréal, Québec, Canada
| | | | | | - Marie-Andrée Gauthier
- Centre intégré de santé et de services sociaux de la Montérégie-Ouest, Châteauguay, Québec, Canada
| | - Marie-Hélène Lavallée
- Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l’Île-de-Montréal, Québec, Canada
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17
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Utility of the Aggressive Behavior Risk Assessment Tool in long-term care homes. Geriatr Nurs 2017; 38:417-422. [DOI: 10.1016/j.gerinurse.2017.02.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Revised: 02/06/2017] [Accepted: 02/07/2017] [Indexed: 10/20/2022]
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18
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Teipel S, Heine C, Hein A, Krüger F, Kutschke A, Kernebeck S, Halek M, Bader S, Kirste T. Multidimensional assessment of challenging behaviors in advanced stages of dementia in nursing homes-The insideDEM framework. ALZHEIMER'S & DEMENTIA: DIAGNOSIS, ASSESSMENT & DISEASE MONITORING 2017; 8:36-44. [PMID: 28462388 PMCID: PMC5403785 DOI: 10.1016/j.dadm.2017.03.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Assessment of challenging behaviors in dementia is important for intervention selection. Here, we describe the technical and experimental setup and the feasibility of long-term multidimensional behavior assessment of people with dementia living in nursing homes. METHODS We conducted 4 weeks of multimodal sensor assessment together with real-time observation of 17 residents with moderate to very severe dementia in two nursing care units. Nursing staff received extensive training on device handling and measurement procedures. Behavior of a subsample of eight participants was further recorded by videotaping during 4 weeks during day hours. Sensors were mounted on the participants' wrist and ankle and measured motion, rotation, as well as surrounding loudness level, light level, and air pressure. RESULTS Participants were in moderate to severe stages of dementia. Almost 100% of participants exhibited relevant levels of challenging behaviors. Automated quality control detected 155 potential issues. But only 11% of the recordings have been influenced by noncompliance of the participants. Qualitative debriefing of staff members suggested that implementation of the technology and observation platform in the routine procedures of the nursing home units was feasible and identified a range of user- and hardware-related implementation and handling challenges. DISCUSSION Our results indicate that high-quality behavior data from real-world environments can be made available for the development of intelligent assistive systems and that the problem of noncompliance seems to be manageable. Currently, we train machine-learning algorithms to detect episodes of challenging behaviors in the recorded sensor data.
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Affiliation(s)
- Stefan Teipel
- Department of Psychosomatic Medicine, University of Rostock, Rostock, Germany.,DZNE, German Center for Neurodegenerative Diseases, Rostock, Germany
| | - Christina Heine
- Department of Psychosomatic Medicine, University of Rostock, Rostock, Germany
| | - Albert Hein
- Department of Computer Science, University of Rostock, Rostock, Germany
| | - Frank Krüger
- Department of Computer Science, University of Rostock, Rostock, Germany
| | | | - Sven Kernebeck
- DZNE, German Center for Neurodegenerative Diseases, Witten, Germany
| | - Margareta Halek
- DZNE, German Center for Neurodegenerative Diseases, Witten, Germany.,Faculty of Health, School of Nursing Science, Witten/Herdecke University, Witten, Germany
| | - Sebastian Bader
- Department of Computer Science, University of Rostock, Rostock, Germany
| | - Thomas Kirste
- Department of Computer Science, University of Rostock, Rostock, Germany
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19
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Multiple perspectives on quality of life for residents with dementia in long term care facilities: protocol for a comprehensive Australian study. Int Psychogeriatr 2015; 27:1739-47. [PMID: 25899853 DOI: 10.1017/s1041610215000435] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Dementia is a chronic illness without cure or effective treatment, which results in declining mental and physical function and assistance from others to manage activities of daily living. Many people with dementia live in long term care facilities, yet research into their quality of life (QoL) was rare until the last decade. Previous studies failed to incorporate important variables related to the facility and care provision or to look closely at the daily lives of residents. This paper presents a protocol for a comprehensive, multi-perspective assessment of QoL of residents with dementia living in long term care in Australia. A secondary aim is investigating the effectiveness of self-report instruments for measuring QoL. METHODS The study utilizes a descriptive, mixed methods design to examine how facility, care staff, and resident factors impact QoL. Over 500 residents with dementia from a stratified, random sample of 53 facilities are being recruited. A sub-sample of 12 residents is also taking part in qualitative interviews and observations. CONCLUSIONS This national study will provide a broad understanding of factors underlying QoL for residents with dementia in long term care. The present study uses a similar methodology to the US-based Collaborative Studies of Long Term Care (CS-LTC) Dementia Care Study, applying it to the Australian setting.
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20
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Rose K, Specht J, Forch W. Correlates among nocturnal agitation, sleep, and urinary incontinence in dementia. Am J Alzheimers Dis Other Demen 2014; 30:78-84. [PMID: 24670931 DOI: 10.1177/1533317514524814] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Family caregivers of elders with dementia often face the challenging behaviors of nighttime agitation, sleep disturbances, and urinary incontinence. To date, no study has examined the interrelationships of these behaviors in community-dwelling persons. This single group, descriptive study employs wireless body sensors to objectively collect data on nighttime agitation, sleep, and urinary incontinence in patients with dementia in their homes over a 5- to 7-day period. The aims are to (1) examine the feasibility and acceptability of the use of body sensors in community-dwelling persons with dementia; (2) describe patterns of nocturnal agitation, sleep continuity and duration, and nighttime urinary incontinence; and (3) examine the relationships among nocturnal agitation, sleep continuity and duration, and nighttime urinary incontinence. Data collection is in early stages and is still in progress. Challenges and advantages from preliminary data collection are reported.
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Affiliation(s)
- Karen Rose
- University of Virginia, School of Nursing, Charlottesville, VA, USA
| | - Janet Specht
- The University of Iowa, College of Nursing, Iowa City, IA, USA
| | - Windy Forch
- University of Virginia, School of Nursing, Charlottesville, VA, USA
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21
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Whall AL, Kim H, Colling KB, Hong GR, DeCicco B, Antonakos C. Measurement of aggressive behaviors in dementia: comparison of the physical aggression subscales of the Cohen-Mansfield Agitation Inventory and the Ryden Aggression Scale. Res Gerontol Nurs 2013; 6:171-7. [PMID: 23550812 DOI: 10.3928/19404921-20130321-01] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2012] [Accepted: 03/18/2013] [Indexed: 11/20/2022]
Abstract
One of the central issues in the development of research-based interventions for aggressive behavior (AB) in late-stage dementia is the provision of precise measurement of the major dependent variable, in this case, AB levels. To advance the nursing goal of evidence-based practice, this article presents the characteristics of two research instruments: the Cohen-Mansfield Agitation Inventory (CMAI) aggressive behavior subscale (CMAI-ABS) and the Ryden Aggression Scale (RAS) physically aggressive behavior subscale (RAS-PABS). A total of 282 shower bath events (which are most associated with AB) were observed for 107 nursing home residents with dementia in nine randomly selected nursing homes. Then, we compared the psychometric properties of the CMAI-ABS and the RAS-PABS. Moderate to substantial agreements between the two instruments were identified using Cohen's Kappa. A similar percentage of AB was found on both subscales. Similar items on both subscales, such as hitting and pushing, were moderately correlated. Overall, the study results support that the CMAI-ABS and RAS-PABS measure a single but multifaceted construct-physically aggressive behavior in dementia.
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Affiliation(s)
- Ann L Whall
- Oakland University, School of Nursing, Rochester, MI 48309, USA.
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22
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Young HM, Sikma SK, Reinhard SC, McCormick WC, Cartwright JC. Strategies to promote safe medication administration in assisted living settings. Res Gerontol Nurs 2013; 6:161-70. [PMID: 23350535 DOI: 10.3928/19404921-20130122-01] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Accepted: 01/10/2013] [Indexed: 11/20/2022]
Abstract
Assisted living (AL) provides lower cost, less institutional environments than skilled nursing facilities, yet less professional oversight, despite the high prevalence of chronic conditions among residents. Unlicensed staff administer large quantities of medications daily, and medication management is one of the three top quality issues in AL, with error rates ranging from 10% to 40%. This qualitative study described AL provider views on medication safety and strategies used to promote safety in medication administration. The sample included 96 participants representing all parties involved in medication administration (i.e., medication aides, administrators, RNs, consulting pharmacists, primary care providers) in 12 AL settings in three states. Core themes were the importance of medication safety, unique contextual factors in AL, and strategies used to promote medication safety. This study has implications for research on interventions to improve medication safety at the individual, facility, and policy levels.
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Affiliation(s)
- Heather M Young
- Betty Irene Moore School of Nursing, University of California Davis, Sacramento, CA 95817, USA.
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23
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Garre-Olmo J, López-Pousa S, Turon-Estrada A, Juvinyà D, Ballester D, Vilalta-Franch J. Environmental determinants of quality of life in nursing home residents with severe dementia. J Am Geriatr Soc 2012; 60:1230-6. [PMID: 22702541 DOI: 10.1111/j.1532-5415.2012.04040.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To determine the relationship between quality of life (QOL) and environmental factors of temperature, noise, and lighting in nursing home residents with severe dementia. DESIGN Cross-sectional, observational, analytical. SETTING Eight public, long-term care nursing homes in the province of Girona, Spain. PARTICIPANTS Random sample of 160 nursing home residents with severe dementia. MEASUREMENTS Functional and cognitive impairment, pain, neuropsychiatric disturbances, and QOL were determined using standardized instruments. Temperature, noise, and lighting in bedrooms, dining rooms, and living rooms were measured in the morning and afternoon using a multifunction environment meter in a standardized manner. RESULTS Adjusted multivariate linear regression models demonstrated that environmental measures were independently associated with QOL and related factors. High temperature in the bedroom was associated with lower QOL (standardized β = 0.184), high noise levels in the living room were associated with low behavioral signs of social interactions (β = 0.196), and low lighting levels in the bedroom were associated with number of signs of negative affective mood (β = -0.135). CONCLUSION The QOL of nursing home residents with severe dementia was related to environmental factors such as temperature, noise, and lighting. The monitoring of these environmental factors may improve these individuals' QOL.
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Affiliation(s)
- Josep Garre-Olmo
- Research Unit, Institut d'Assistència Sanitària, Girona, Spain; Department of Psychology, University of Girona, Girona, Spain.
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A Research Agenda for Nursing Homes. J Am Med Dir Assoc 2011; 12:393-4. [DOI: 10.1016/j.jamda.2011.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Accepted: 04/05/2011] [Indexed: 11/19/2022]
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