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Goh AMY, Polacsek M, Malta S, Doyle C, Hallam B, Gahan L, Low LF, Cooper C, Livingston G, Panayiotou A, Loi SM, Omori M, Savvas S, Burton J, Ames D, Scherer SC, Chau N, Roberts S, Winbolt M, Batchelor F, Dow B. What constitutes 'good' home care for people with dementia? An investigation of the views of home care service recipients and providers. BMC Geriatr 2022; 22:42. [PMID: 35016640 PMCID: PMC8751242 DOI: 10.1186/s12877-021-02727-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 12/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Our objective was to explore what people receiving and providing care consider to be 'good' in-home care for people living with dementia. METHODS We conducted 36 in-depth interviews and two focus groups with key stakeholders in Australia in the first quarter of 2018. Participants included those receiving care (4 people living with dementia, 15 family carers) or providing care (9 case managers, 5 service managers, 10 home care workers). Qualitative thematic analysis was guided by Braun and Clarke's six-step approach. RESULTS Consensus was reached across all groups on five themes considered as important for good in-home dementia care: 1) Home care workers' understanding of dementia and its impact; 2) Home care workers' demonstrating person-centred care and empathy in their care relationship with their client; 3) Good relationships and communication between care worker, person with dementia and family carers; 4) Home care workers' knowing positive practical strategies for changed behaviours; 5) Effective workplace policies and workforce culture. The results contributed to the co-design of a dementia specific training program for home care workers. CONCLUSIONS It is crucial to consider the views and opinions of each stakeholder group involved in providing/receiving dementia care from home care workers, to inform workforce training, education program design and service design. Results can be used to inform and empower home care providers, policy, and related decision makers to guide the delivery of improved home care services. TRIAL REGISTRATION ACTRN 12619000251123 .
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Affiliation(s)
- Anita M Y Goh
- National Ageing Research Institute, Parkville, VIC, Australia. .,The University of Melbourne, Parkville, VIC, Australia. .,Melbourne Neuropsychiatry Centre, Parkville, VIC, Australia. .,Royal Melbourne Hospital, PO Box 2127, Melbourne, VIC, 3050, Australia.
| | | | - Sue Malta
- The University of Melbourne, Parkville, VIC, Australia
| | - Colleen Doyle
- National Ageing Research Institute, Parkville, VIC, Australia
| | - Brendan Hallam
- Institute of Epidemiology & Health Care, University College London, London, UK
| | - Luke Gahan
- National Ageing Research Institute, Parkville, VIC, Australia.,LaTrobe University, Melbourne, VIC, Australia
| | - Lee Fay Low
- University of Sydney, Sydney, NSW, Australia
| | - Claudia Cooper
- Division of Psychiatry, University College London, London, United Kingdom
| | - Gill Livingston
- Division of Psychiatry, University College London, London, United Kingdom
| | - Anita Panayiotou
- National Ageing Research Institute, Parkville, VIC, Australia.,Safer Care, Melbourne, VIC, Australia
| | - Samantha M Loi
- The University of Melbourne, Parkville, VIC, Australia.,Melbourne Neuropsychiatry Centre, Parkville, VIC, Australia.,Royal Melbourne Hospital, PO Box 2127, Melbourne, VIC, 3050, Australia
| | - Maho Omori
- Monash University, Clayton, VIC, Australia
| | - Steven Savvas
- National Ageing Research Institute, Parkville, VIC, Australia
| | - Jason Burton
- dementia360, Perth, Western Australia, Australia
| | - David Ames
- National Ageing Research Institute, Parkville, VIC, Australia.,Academic Unit for Psychiatry of Old Age, Kew, VIC, Australia
| | | | - Nadia Chau
- National Ageing Research Institute, Parkville, VIC, Australia
| | - Stefanie Roberts
- The University of Melbourne, Parkville, VIC, Australia.,Royal Melbourne Hospital, PO Box 2127, Melbourne, VIC, 3050, Australia
| | | | | | - Briony Dow
- National Ageing Research Institute, Parkville, VIC, Australia.,The University of Melbourne, Parkville, VIC, Australia
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du Toit SHJ, Fitch SJ, Jessup GM, Low LF. The residential environment impact scale: Benefits and barriers to implementation in the Australian residential aged care facility context. Aust Occup Ther J 2021; 68:477-489. [PMID: 34312878 DOI: 10.1111/1440-1630.12757] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 04/28/2021] [Accepted: 06/11/2021] [Indexed: 12/01/2022]
Abstract
The organisational, physical and social environment within residential aged care settings greatly influence its residents' sense of autonomy, choice and control and their ability to engage in meaningful occupations. Identifying to what extent these environmental contexts are supportive and well-coordinated could assist with promoting meaningful engagement of residents. The Residential Environment Impact Scale (REIS) was developed to measure the impact of the physical and social environment on residents. This study examined the benefits and barriers to implementing the REIS in four Australian Residential Aged Care Facilities (RACFs) and factors to consider during implementation. METHOD A multisite sequential mixed-methods study was conducted. Research participants included occupational therapists conducting the REIS and leadership staff examining the REIS reports in four facilities. Data consisted of formal observations of the REIS assessment process, an online survey of all participants and two research consensus groups. Qualitative findings were generated from field notes, open-ended survey questions and group discussions. Close-ended survey questions provided quantitative data. FINDINGS The REIS was considered a useful audit tool, generating a holistic overview of the RACF. It highlighted the quality of person-centred care and the potential role of occupational therapists to promote opportunities for meaningful occupational engagement. Barriers included administration time, personal characteristics of residents and limited resources to action recommendations. CONCLUSION The REIS has potential to be an audit tool for a whole-environment approach to facility assessment of residents' sense of autonomy, occupational choice and meaningful engagement. As such, it provides occupational therapists with scope to support RACFs meeting national quality standards.
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Affiliation(s)
- Sanetta H J du Toit
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Sarah Jane Fitch
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Glenda Madeleine Jessup
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Lee Fay Low
- Ageing and Health, NHMRC Boosting Dementia Leadership Fellow, Head of Discipline of Behavioural and Social Sciences in Health, Faculty of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
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Low LF, Carroll S, Merom D, Baker JR, Kochan N, Moran F, Brodaty H. We think you can dance! A pilot randomised controlled trial of dance for nursing home residents with moderate to severe dementia. Complement Ther Med 2016; 29:42-44. [PMID: 27912955 DOI: 10.1016/j.ctim.2016.09.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 05/11/2016] [Accepted: 09/02/2016] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To evaluate the feasibility of a dance program for people with moderate to severe dementia living in nursing homeswith regards to recruitment and retention, assessment tools, intervention safety, attendance and engagement. DESIGN Pilot randomised controlled trial with assessments at weeks 0, 16 and 32. SETTING A nursing home in Sydney, Australia. INTERVENTIONS Experienced dance teachers conducted dance groups (intervention) or music appreciation and socialisation groups (control) for 45min, three times a week for 16 weeks. MAIN OUTCOME MEASURES Descriptive statistics for recruitment and retention, adverse events and attendance and engagement. RESULTS Recruitment was smooth, attrition was17% over 32 weeks. Engagement during the sessions was high, and no serious falls or behavioural incidents occurred. Average attendance was poorer than anticipated for dance groups (67%) in comparison to music groups (89%). A ceiling effect on the Severe Impairment Battery and the logistical challenges of the Clinical Global Impression of Change meant they may not be optimal tools. CONCLUSIONS It is feasible to conduct a study of group dance for people with moderate to severe dementia in residential care. Choice of attention control condition should be reconsidered.
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Affiliation(s)
- L F Low
- Faculty of Health Sciences, University of Sydney, Australia.
| | - S Carroll
- Arts Health Institute, Newcastle, Australia
| | - D Merom
- School of Science and Health, University of Western Sydney, Australia
| | - J R Baker
- Psychiatry Research and Teaching Unit, University of New South Wales, Australia
| | - N Kochan
- Centre for Health Brain Ageing, University of New South Wales, Australia
| | - F Moran
- School of Science and Health, University of Western Sydney, Australia; The George Institute for Global Health, Australia
| | - H Brodaty
- Centre for Health Brain Ageing, University of New South Wales, Australia; Dementia Collaborative Research Centre, Assessment and Better Care, University of New South Wales, Australia
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Brodaty H, Draper B, Saab D, Low LF, Richards V, Paton H, Lie D. Psychosis, depression and behavioural disturbances in Sydney nursing home residents: prevalence and predictors. Int J Geriatr Psychiatry 2001; 16:504-12. [PMID: 11376467 DOI: 10.1002/gps.382] [Citation(s) in RCA: 184] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND There is wide variation in the rates of behavioural and psychological symptoms of dementia (BPSD) reported in nursing homes. AIMS This study aimed to investigate: (1) the prevalence of BPSD in nursing home residents using the BEHAVE-AD; (2) the relationships of BPSD with (a) demographic, (b) dementia, (c) diurnal and (d) nursing home variables; and (3) the inter-relationships between different types of BPSD, as measured by subscales of the BEHAVE-AD. RESULTS Over 90% of residents exhibited at least one behavioural disturbance. Specifically, there was evidence of psychosis in 60%, depressed mood in 42% and activity disturbances or aggression in 82% of residents. Younger, more functionally impaired residents with a chart diagnosis of psychosis had higher BPSD rates, as did those residing in larger nursing homes. Individual BPSD were significantly intercorrelated. CONCLUSIONS BPSD are ubiquitous in nursing home residents. Behavioural disturbances are frequently associated with psychosis and/or depression. The findings suggest the need for psychogeriatric services to nursing homes and smaller facilities.
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Affiliation(s)
- H Brodaty
- School of Psychiatry, University of New South Wales, Australia.
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Draper B, Brodaty H, Low LF, Saab D, Lie D, Richards V, Paton H. Use of psychotropics in Sydney nursing homes: associations with depression, psychosis, and behavioral disturbances. Int Psychogeriatr 2001; 13:107-20. [PMID: 11352328 DOI: 10.1017/s1041610201007505] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The purpose of this study was to determine the prevalence of psychotropic use in nursing home residents, the extent to which psychotropic dosage is consistent with published guidelines, and the relationships between psychotropic class and psychiatric and behavioral disturbances. Six hundred forty-seven subjects, mean age 82.3 years, residing in 11 nursing homes in the eastern suburbs of Sydney, Australia, were assessed using the Behavioral Pathology in Alzheimer's Disease Rating Scale (BEHAVE-AD), the Abbreviated Mental Test Scale, and the Even Briefer Assessment Scale for Depression (EBAS-DEP). Details of psychotropic prescription and diagnoses of depression, dementia, and psychosis were obtained from nursing home charts. Psychotropics were prescribed for 333 (51.5%) residents, 381 (58.9%) if "as required" (PRN) use is included. Prescription of multiple psychotropics was present in 148 (22.7%) residents. Antidepressants were prescribed for 19.8% of residents, with subtherapeutic doses less likely in residents on selective serotonin reuptake inhibitors. On logistic regression, the use of antidepressants was predicted by the affective disturbances subscale on the BEHAVE-AD. Only 30.4% of residents with significant depressive symptoms on the EBAS-DEP were prescribed antidepressants. Antipsychotics were prescribed for 21.3% residents at a mean dosage of 73 mg chlorpromazine equivalence. Residents on antipsychotics had significantly higher scores on the delusions, hallucinations, activity disturbance, and aggressiveness subscales of the BEHAVE-AD. On logistic regression, only the activity disturbance subscale and chart diagnoses of dementia and psychosis were significant predictors. Psychosis (58.8%) and behavioral disturbances (91.9%) were more prevalent in residents prescribed antipsychotics than in residents not prescribed antipsychotics (42.5% and 76.6%, respectively). High rates of behavioral and psychological symptoms of dementia remained in residents prescribed antipsychotics and high rates of depressive symptoms in residents prescribed antidepressants, suggesting a role for nonpharmacological strategies.
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Affiliation(s)
- B Draper
- Schools of Psychiatry and Community Medicine, University of New South Wales, Sydney, Australia.
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