An audit of dementia education and training in UK health and social care

Smith, S. et al. | An audit of dementia education and training in UK health and social care: a comparison with national benchmark standards | BMC Health Services Research | volume 19, Article number 711 (2019)

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Abstract

Background

Despite people living with dementia representing a significant proportion of health and social care users, until recently in the United Kingdom (UK) there were no prescribed standards for dementia education and training. This audit sought to review the extent and nature of dementia education and training offered to health and social care staff in the UK against the standards described in the 2015 Dementia Training Standards Framework, which describes the knowledge and skills required of the UK dementia workforce.

Methods

This audit presents national data concerning the design, delivery, target audience, length, level, content, format of training, number of staff trained and frequency of delivery within existing dementia training programmes offered to health and social care staff. The Dementia Training Standards Framework was used as a reference for respondents to describe the subjects and learning outcomes associated with their training.

Results

The findings are presented from 614 respondents offering 386 training packages, which indicated variations in the extent and quality of training. Many training packages addressed the subjects of ‘person-centred care’, ‘communication’, ‘interaction and behaviour in dementia care’, and ‘dementia awareness’. Few training packages addressed subjects concerning ‘pharmacological interventions in dementia care’, ‘leadership’ and ‘end of life care’. Fewer than 40% of The Dementia Training Standards Framework learning outcomes targeted to staff with regular contact with people with dementia or in leadership roles were covered by the reported packages. However, for training targeted at increasing dementia awareness more than 70% of the learning outcomes identified in The Dementia Training Standards Framework were addressed. Many training packages are not of sufficient duration to derive impact; although the majority employed delivery methods likely to be effective.

Conclusions

The development of new and existing training and education should take account of subjects that are currently underrepresented and ensure that training reflects the Training Standard Framework and evidence regarding best practice for delivery. Lessons regarding the limitations of training in the UK serve as a useful illustration of the challenge of implementing national dementia training standards; particularly for countries who are developing or have recently implemented national dementia strategies.

Full article: An audit of dementia education and training in UK health and social care: a comparison with national benchmark standards

Person-centered dementia care in acute hospital wards

Anthony Scerri et al. | Person-centered dementia care in acute hospital wards—The influence of staff knowledge and attitudes | Geriatric Nursing | available online 17 October 2019

Highlights

  • Achieving person-centered dementia care in hospitals is challenging for staff partly due to their lack of educational preparation.
  • Only 40% of participants (hospital staff) had previous training in dementia.
  • The more the staff were knowledgeable about dementia, the more critical they were about the level of person-centered care they delivered.
  • The more positive were the attitudes of the staff towards persons with dementia, the more they perceived were individualizing their care.

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Abstract

Person-centered dementia care practices in acute hospital wards are suboptimal and not commonly measured. Although previous research has indicated that the work environment of staff influences their perceptions of person-centeredness, few studies have examined how their personal attributes, such as their level of dementia knowledge and attitudes, influence their person-centered dementia care practices.

A questionnaire was distributed to test the relationship between staff perceptions of person-centered dementia care and their dementia knowledge and attitudes in general medical wards.

The results showed that staff with better dementia knowledge were significantly more critical about the extent they were using evidence-based guidelines and external expertise. Staff with better attitudes perceived themselves as using more individualized care practices.

The findings demonstrate that to enhance person-centered dementia care in acute hospitals, staff training programs should develop both their intellectual and interpersonal skills to improve their knowledge and attitudes.

Full detail at ScienceDirect

Sundowning (changes in behaviour at dusk)

As the clocks go back this weekend, and with evenings becoming darker earlier, Helen Green who works on Dementia UK’s Admiral Nurse Dementia Helpline talks about how she united one family troubled by sundowning 

Sundowning is a term used for the changes in behaviour that occur in the evening, around dusk. Some people who have been diagnosed with dementia experience a growing sense of agitation or anxiety at this time.

Sundowning symptoms might include a compelling sense that they are in the wrong place. The person with dementia might say they need to go home, even if they are home; or that they need to pick the children up, even if that is not the case. Other symptoms might include shouting or arguing, pacing, or becoming confused about who people are or what’s going on.

This article at Dementia UK explains how the Dementia Helpline supported one family troubled by sundowning

See also Dementia UK’s leaflet on Good habits for bedtime

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Practical tips on preventing sundowning

  • Follow a routine during the day that contains activities the person enjoys
  • Going outside for a walk or visiting some shops is good exercise
  • Limit the person’s intake of caffeinated drinks. Consider stopping the person from drinking alcohol altogether. Caffeine-free tea, coffee and cola are available, as is alcohol-free beer and wine
  • Try and limit the person’s naps during the day to encourage them to sleep well at night instead
  • Close the curtains and turn the lights on before dusk begins, to ease the transition into nighttime
  • If possible, cover mirrors or glass doors. Reflections can be confusing for someone with dementia
  • Once you are in for the evening, speak in short sentences and give simple instructions to the person, to try and limit their confusion
  • Avoid large meals in the evening as this can disrupt sleep patterns
  • Introduce an evening routine with activities the person enjoys, such as: watching a favourite programme, listening to music, stroking a pet etc. However, try to keep television or radio stations set to something calming and relatively quiet—sudden loud noises or people shouting can be distressing for a person with dementia.

Monthly phone check-in may mean less depression for families of patients with dementia

A monthly, 40-minute phone call from a non-clinical professional may suppress or reverse the trajectory of depression so frequently experienced by family members caring for patients with dementia at home, according to a new study | story via ScienceDaily

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A number of studies have pointed to the high incidence of depression in caregivers of patients with dementia This study, published in JAMA found that a simple, relatively inexpensive intervention, with a “care team navigator” operating on the frontline with support from clinicians, may improve the wellbeing of caregivers whose role may be crucial to the patient’s survival and quality of life.

Researchers tracked quality of life and depression for 12 months in 780 patient-plus-caregiver pairs, of whom 86 percent were the spouse or daughter. These pairs included 512 caregivers in the intervention group and 268 caregivers in the “usual care” control group, in which support was limited to a standard list of resources and services and a quarterly newsletter.

The researchers found a drop from 13.4 percent to 7.9 percent in the number of caregivers with moderate-to-severe depression in the intervention group over the course of the year, versus an upswing from 8 percent to 11.1 percent in the number of caregivers with moderate-to-severe depression in the usual care cohort.

Full story at ScienceDaily

Full research: Possin KL et al. | Effect of Collaborative Dementia Care via Telephone and Internet on Quality of Life, Caregiver Well-being, and Health Care Use: The Care Ecosystem Randomized Clinical Trial |  JAMA Internal Medicine. Published online September 30, 2019