Social interaction among people with dementia

The Role of Bedroom Privacy in Social Interaction among Elderly Residents in Nursing Homes: An Exploratory Case Study of Hong Kong

Privacy is often overlooked in Hong Kong nursing homes with the majority of elderly residents living in shared bedrooms of three to five people. Only a few studies have used Bluetooth low energy indoor positioning systems to explore the relationship between privacy and social interaction among elderly residents. The study investigates the social behavioural patterns of elderly residents living in three-bed, four-bed, and five-bed rooms in a nursing home. Location data of 50 residents were used for the identification of mobility and social interaction patterns in relation to different degrees of privacy and tested for statistical significance. Privacy is found to have a weak negative correlation with mobility patterns and social behaviour, implying that the more privacy there is, the less mobility and more formal interaction is found. Residents who had more privacy did not spend more time in social space. Residents living in bedrooms that opened directly onto social space had higher social withdrawal tendencies, indicating the importance of transitional spaces between private and public areas. Friends’ rooms were used extensively by residents who had little privacy, however, the concept of friends’ rooms have rarely been discussed in nursing homes. There is evidence supporting the importance of privacy for social interaction. Future study directions include considering how other design factors, such as configuration and social space diversity, work with privacy to influence social interaction.

Does Social Interaction Matter Psychological Well-Being in Persons With Dementia?

BACKGROUND

Social interaction between residents and staff is an important factor influencing sense of well-being. This study examined the relationship between staff-resident interactions and psychological well-being of persons with dementia.

METHODS

A total of 831 observations of 110 persons with dementia in 17 nursing homes and 6 assisted living facilities were included. Psychological well-being was measured by observed displays of positive and negative emotional expressions. Social interaction was determined by the type of social interaction (ie, verbal interaction, nonverbal interaction, and both verbal and nonverbal interactions) and the quality of interaction (ie, positive, negative, and neutral).

RESULTS

Verbal or both verbal and nonverbal interactions showed significant relationship with positive and negative emotional expressions. Positive interaction was significantly associated with more positive emotional expression, whereas negative interaction was not.

CONCLUSION

Staff-resident interactions are important to promote the psychological well-being of persons with dementia in residential care.

The relationship between social interaction and characteristics of aggressive, cognitively impaired nursing home residents

The extent of social interaction of aggressive, cognitively impaired nursing home residents and the relationship between social interaction and selected resident characteristics were explored in this study, which was part of a larger experimental study of the effect of dementia education for staff on the aggressive behavior of cognitively impaired residents. Staff rated residents using the Social Interaction Scale (SIS),which has two subscales: Institutional Interaction and Family/Community Interaction. Mean SIS scores were low; institutional interaction scores were higher than family/community scores. Marital status, morale, degree of cognitive impairment, dependency, and sexual aggression were significantly associated with social interaction, but gender and age were not.

Dementia and friendship: the quality and nature of the relationships that remain

Friendships are an integral part of the human experience. Yet, dementia often takes a toll on social relationships, and many friends withdraw. This research, however, focuses on friendships that remain, despite a diagnosis of dementia. It examines the quality of the friendships of people with dementia and long-term friendships. Data were collected through focus group interviews with people with early stage dementia and their care partners, and through interviews with designated friends. The findings show that people with dementia do have friends that remain and they have a wide variety of friendships, from those based on one shared activity to those of multifaceted deep relationships. The long-term friendships, which last across the various stages of dementia, appear to fall into two types: one, where the person with dementia has become more like a family member than a friend (suffusion); and the other where the diagnosis of dementia was the impetus for the relationship to become closer (progressive friendship).

Factors influencing quality of life for people with dementia: a qualitative perspective

OBJECTIVES

An exploration and understanding of quality of life (QOL) can help to enhance understanding and respect for people with dementia and assist in improving care and treatment of this population. This study sought to understand the factors that influence QOL for people living with dementia in long-term care (LTC), including an understanding of how they perceived they were valued.

METHODS

In-depth interviews were conducted with 32 older people with dementia from one service provider and across four large care settings, in two Australian states.

RESULTS

While these residents were either satisfied or dissatisfied with elements of their life, the factors influencing a positive QOL were related to their relationship with family and other people, and 'things' such as needing some control over their life and, more importantly, needing to contribute to their community. Participants reported feeling of little use and therefore of limited value to society.

CONCLUSION

This study proposes a need to understand how relationships might be maintained and strengthened following a move into LTC and highlights the importance of control and its influence on feeling valued.

Informal social interaction among residents with dementia in special care units: Exploring the role of the physical and social environments

Despite a continued recognition of the importance of relational aspects of quality of life for people with dementia, little research has examined environmental influences on informal social interaction in dementia care settings. The purpose of this ethnographic study was to identify and explore key elements of the physical and social environments that act as facilitators or barriers for social interaction among people with dementia living in special care units. We conducted in-depth interviews with staff members and completed a series of resident observations. Findings suggest that social factors such as staff work roles and resident group size, and physical factors such as a non-institutional character, the nursing station location, and adequate seating and sightlines are influential for prompting or supporting informal social interactions. Design recommendations are provided with the intent to create physical environments that foster informal social interactions among people in dementia care environments.

Friendships among people with dementia in long-term care

Despite the growing literature on social interactions in dementia settings, few studies have investigated ‘friendships’ in people with dementia living in long-term care. ‘Social interactions’ describe communicating, verbally and/or non-verbally, at least once with another person while ‘friendship’ suggests a deeper, more meaningful connection that may include reciprocity, intimacy, and shared trust. During a 6-month, mixed-methods study, we investigated friendships among 31 assisted living residents with moderate to advanced dementia. Results revealed no correlation between test scores or demographic characteristics (except gender) and friendship dyads identified by staff. Staffs’ perceptions of residents’ friendships were not supported through our observations. We did observe friendships among residents characterized by voluntary participation and accommodation in conversation, and recognition of the uniqueness of the other. Findings suggest staff perceptions of residents’ friendships are not sufficient and that more research on this topic is needed.

Management of person with dementia with aggressive and violent behaviour: a systematic literature review

AIM

Studies indicate that physical and pharmacological restraints are still often in the frontline of aggression management in a large number of nursing homes. In the present literature review the aim was to describe, from a nursing perspective, aggressive and violent behaviour in people with dementia living in nursing home units and to find alternative approaches to the management of dementia related aggression as a substitute to physical and chemical restraints.

METHODS

A systematic literature review in three phases, including a content analysis of 21 articles published between 1999 and August 2009 has been conducted.

RESULTS

The results could be summarised in two themes: 'origins that may trigger violence' and 'activities that decrease the amount of violent behaviour'. Together, the themes showed that violence was a phenomenon that could be described as being connected to a premorbid personality and often related to the residents' personal care. It was found that if the origin of violent actions was the residents' pain, it was possible to minimise it through nursing activities. This review also indicated that an organisation in special care units for residents who exhibit aggressive and violent behaviour led to the lesser use of mechanical restraints, but also an increased use of non-mechanical techniques.

CONCLUSION

The optimal management of aggressive and violent actions from residents with dementia living in nursing homes was a person-centred approach to the resident. Qualitative studies focusing on violence were sparsely found, and this underlines the importance of further research in this area to elucidate how violence and aggressiveness is experienced and understood by both staff and patients.

RELEVANCE TO CLINICAL PRACTICE

To communicate with people with dementia provides a challenge for nurses and other health caregivers. To satisfy the needs of good nursing care, an important aspect is therefore to get knowledge and understanding about aggressive and violent behaviour and its management.

The Effect of A Feeding Skills Training Program for Nursing Assistants Who Feed Dementia Patients in Taiwanese Nursing Homes

A quasi-experimental 2-group repeated-measures design was used to test the impact of a feeding skills training program on 67 nursing assistants (treatment group n = 31; control group n = 36) regarding their knowledge, attitudes, perceived behavior control, intentions, and behaviors in feeding dementia patients. The treatment group received a feeding skills training program. Nursing assistants' knowledge, attitudes, perceived behavior control, and intentions were measured before (Pretest) and after the program (Posttest 1), and again 4 weeks later (Posttest 2). Nursing assistants (treatment group n = 20; control group n = 16) and the same number of dementia patients were measured on feeding behaviors during mealtimes before and after the training. The treatment group had significantly more knowledge (P < .001), greater intention to feed (P = .05), and better behaviors toward feeding dementia patients (P = .009) than the control group. There were no significant differences between the groups in attitude (P = .85), intention beliefs (P = .11) or perceived behavior control (P = .99). Thus, the intervention was effective at changing knowledge, intention, and behaviors among nursing assistants.

Evaluating best practices for social model programs for adults with Alzheimer's disease in South Carolina

Our study has two objectives. First, we reviewed the literature, and identified best practices for social model day programs providing care for adults with Alzheimer's disease (AD). Second, in-depth telephone interviews were conducted with directors in all social model day programs (n = 21) dedicated to serving adults with AD in South Carolina to compare practices to those identified. Programs implemented many best practices, despite their rural location and small size. All programs assessed clients' activity preferences, and reassessed activity effectiveness regularly. Most programs provided volunteers and staff with AD-focused training. Many programs incorporated innovative programming such as intergenerational activities. Most programs were offered in a setting not designed for adult day services; thus many programs did not provide suggested environmental features such as extra lighting or walking paths. Most programs evaluated activities from caregivers' perspectives. All programs provided support for caregivers. Practice and policy recommendations are described.

Respite for caregivers. A community-based model in a rural setting

Currently in the United States, 4 million Americans suffer from Alzheimer's disease (AD), and projections are that this population will increase to 7 million by the year 2040. Traditionally, care for these clients is provided by family, relatives, and friends--an informal caregiver network (ICN). Changing demographics in the United States are threatening this caring network. When these factors are coupled with the recent emphasis on cost containment in health care, caring for this client population has become a significant political, economic, and societal issue. Strategies must be developed to meet the needs of both the clients and their caregivers. Respite services have been identified as an effective strategy in the ongoing management of clients with AD. A model is proposed to provide community-based respite services in a rural setting in northeast Georgia. The need for respite services, along with barriers to the use of such services by clients and their caregivers, is described. Strategies to overcome barriers and provide needed services in a cost effective and sensitive manner are presented. Implications for nursing and related disciplines are discussed.