Caring for older people with dementia reliving past trauma

Experiences managing behavioral symptoms among Latino caregivers of Latino older adults with dementia and memory problems: a qualitative study

BACKGROUND

Latinos are more likely than non-Latino Whites to develop dementia and be prescribed antipsychotics for dementia-related behavioral symptoms. Antipsychotics have significant risks yet are often overprescribed. Our understanding of how Latino caregivers of Latino older adults living with dementia perceive and address behavioral issues is limited, impeding our ability to address the root causes of antipsychotic overprescribing.

METHODS

We interviewed Latino older adults' caregivers and community-based organization workers serving older adults with cognitive impairment (key informants), focusing on the management of behavioral symptoms and experiences with health services.

RESULTS

We interviewed 8 caregivers and 2 key informants. Caregivers were the spouses, children, or grandchildren of the older adult living with cognitive impairment; their ages ranged from 30 to 95. We identified three categories of how caregivers learned about, managed, and coped with behavioral symptoms: caregivers often faced shortcomings with dementia care in the medical system, receiving limited guidance and support; caregivers found community organizations and senior day centers to be lifelines, as they received relevant, timely advice and support, caregivers often devised their own creative strategies to manage behavioral symptoms.

CONCLUSION

In-depth interviews suggest that the healthcare system is failing to provide support for behavioral symptoms from dementia; caregivers of Latino older adults rely on community organizations instead.

Trauma-informed care within residential aged care settings: A systematic scoping review

OBJECTIVES

The importance of trauma-informed care (TIC) within residential aged care (RAC) settings has been increasingly recognised. TIC would ensure that older people who have experienced trauma over their lifetime have their needs better understood and accommodated. This scoping review examined the extent to which TIC has been applied within RAC settings.

METHODS

A scoping review was conducted according to Cochrane recommendations and the PRISMA-ScR checklist. A systematic search of six databases (Embase, Emcare, CENTRAL, CINAHL, PsychInfo and Medline) was performed in July 2022 and March 2023 and peer-reviewed primary research, in English and involved RAC staff or residents (aged 65 years and over) providing or receiving TIC were eligible for inclusion. Studies focused on trauma intervention, assessment, screening, or treatment were excluded. Thematic synthesis was performed to extract themes relating to trauma-informed practice, barriers and enablers to TIC, and outcomes from the application of TIC approaches.

RESULTS

Five articles were included. There was little evidence of the implementation of TIC interventions in RAC settings. Only one study examined the application of a TIC framework in a RAC setting. However, there was some evidence that approaches that consider resident's experience of trauma have emerged from practice experience and been used in RAC as an extension of person-centred care.

CONCLUSIONS

Whilst trauma-informed approaches to resident care are emerging through practice experience, and despite policy recommendations to do so, there is little evidence that formal TIC interventions or frameworks have been applied to RAC internationally. This study highlights a gap in research and practice and makes several recommendations for further research and implementation of TIC in RAC.

Care aides' perceptions of caring for residents with a history of psychological trauma in Western Canadian care homes

OBJECTIVE

To explore care aide perceptions of caring for residents who aides perceived had past psychological trauma.

METHODS

Through cognitive interviews, we developed a definition of trauma for four survey questions about caring for residents with psychological trauma. We added these questions to our routine care aide survey in 91 care homes in Western Canada (September 2019 to February 2020). We asked if care aides perceived that they were caring for residents with trauma, how often, types of trauma experienced, and what indication led them to perceive a resident had experienced trauma. We analyzed data using content analysis (open-ended questions) and regression analyses (closed-ended questions).

RESULTS

Three thousand seven hundred and sixty five care aides responded (70% response rate) to the survey, and 53% perceived caring for one or more residents with a history of psychological trauma in the previous 2 weeks. Within six categories of traumatic events, abuse (35%) and war exposure (26%) were most common. Most common indications of trauma reported by care aides (five categories) were reliving the experience or having intrusive symptoms (28%) and avoidant behaviors (24%). Care aides were more likely to report caring for a resident who they perceived had experienced past psychological trauma if they were younger, spoke English as their first language, self-reported experiencing more aggression from residents, or who worked in not-for-profit homes.

CONCLUSIONS

This preliminary study supports the need for further study of care aides' perceptions and experiences of caring for residents with past trauma, and the effects of caring for these residents on quality of work life.

‘Rekindling couplehood’ using a multisensory suitcase of memories: a pilot study of people living with moderate dementia and their partners

Creating individualised activities in partnership with people who have moderate dementia and their partners at home has rarely been achieved, as such interventions are usually pre-planned by researchers or professionals. The academic gap is in the activity design being led by the person who has dementia and their partner and how to engage them in a meaningful manner which rekindles positive joint memories and improves the quality of their current relationship. This article explores the meaning and significance of recalling shared holiday memories for people living with moderate dementia and their partners, using multisensory reminiscence. A sensory ethnography research methodology was employed which enhanced co-design of the activity over five home visits. The research culminated in the creation of a digital story, sharing of food and drink, and re-enactment through exploration of their holiday memorabilia: forming their suitcase of memories (SOM). The study extends the current academic debate of co-produced interventions and identifies the critical themes of ‘holidays as life’, ‘freedom’, ‘view seen, viewpoint heard’ and ‘strengthened self-identity with younger self’ which emerged from the research. Such areas of sensory reminiscence have supported positive recollections, discourse and, when combined, resulted in a beneficial impact on the partner's shared relationship. A significant research outcome was the transition from a negative life view dominated by dementia to rekindling their relationship positively as a result of the SOM intervention and sensory methodology. Future research to continue the work with new couples to see if similar results are achieved with more case studies is needed.