Needs and experiences of people with dementia living in nursing homes

Kate Shiells, Lara Pivodic, Iva Holmerová & Lieve Van den Block | Self-reported needs and experiences of people with dementia living in nursing homes: a scoping review | Aging & Mental Health | Published online 4th June 2019 

Objectives: With rates of dementia continuing to rise, the impetus on improving care for people with dementia is growing. Unmet needs of people with dementia living in nursing homes have been linked with worsening neuropsychiatric symptoms, higher levels of depression, and reduced quality of life. Furthermore, proxy accounts exploring the needs of people with dementia have frequently been shown to be unreliable. Therefore, this literature review aims to explore the self-reported needs and experiences of people with dementia in nursing homes.

Method: A scoping review of the literature was carried out using the databases PubMed and PsycINFO to search for relevant articles according to PRISMA guidelines. Search terms were designed to include both quantitative and qualitative study designs. Thematic synthesis was used to categorise findings into themes related to self-reported needs and experiences.

Results: A total of 41 articles met the eligibility criteria. An analysis of study characteristics revealed more than half of studies used a qualitative design. Thematic synthesis resulted in eight themes: activities, maintaining previous roles, reminiscence, freedom and choice, appropriate environment, meaningful relationships, support with grief and loss, end-of-life care.

Conclusion: Whilst the voice of people with dementia has previously been neglected in research, this review has shown that people with dementia in nursing homes are able to describe their experiences and communicate their needs. The findings in this review have provided a contribution towards guiding evidence-based practice that is tailored to the needs of nursing home residents with dementia.

Full article available at Aging & Mental Health 

Managing behaviours that challenge in dementia

Charlotte Mallon, Janet Krska & Shivaun GammieViews and experiences of care home staff on managing behaviours that challenge in dementia: a national survey in England, Aging & Mental Health | 2019 Vol 23: no.6  p698-705

Aim: To determine the views of care home (CH) staff in relation to experiencing and managing behaviour that challenges (BtC) in dementia and their experiences of training.

Method: Cross-sectional survey using a self-report questionnaire, distributed to staff employed in a 20% sample of all registered dementia-specialist CHs in England, either by postal or direct distribution.

Results: Questionnaires were returned from 352 care staff (25%), representing 5% of all dementia-specialist CHs, half were CH without nursing. Respondents estimated caring for 14,585 residents, 9,361 with dementia and 5,258 with BtC. 30.2% of residents with dementia were estimated as being prescribed a medicine to control BtC. BtC reported as experienced by most respondents were: shouting (96.6%), verbal aggression (96.3%) and physical aggression (95.7%), with physical aggression viewed as most difficult to manage. Top behaviours experienced every shift were: wandering (77.8%), perseveration (68.2%) and restlessness (68.2%).

Approaches such as assessing residents, knowing them and treating them as individuals, identifying triggers, having time for them and using an appropriate style of communication, were viewed as key to managing BtC, rather than guideline-specific interventions such as massage, aromatherapy and animal-assisted therapy.

Only 38% agreed/strongly agreed medicines were useful to control BtC, which was related to the extent to which they were prescribed. Training was available, but variable in quality with on-line training being least useful and on-the job training most desirable.

Conclusion: BtC are commonly and frequently experienced by care staff, who consider individual approaches, having time and good communication are key to successful management.

Full detail at Aging & Mental Health

Factors influencing the transition experience of carers for persons with dementia, when the person with dementia moves into residential care

Beth Pritty, Danielle De Boos & Nima Moghaddam | Factors influencing the transition experience of carers for persons with dementia, when the person with dementia moves into residential care: systematic review and meta-synthesis | Aging & Mental Health | 2019 | published online 12 April 2019

Abstract
Aims: To understand factors influencing the experience of carers for people with dementia, when that person moves from living in the community to living in residential care. Specifically, we aimed to identify facilitators and inhibitors of carer adjustment during this transition.

Method: A systematic search of CINAHL, EMBASE, PubMed, and PsycINFO databases was conducted. Nine qualitative articles published between 2001 and 2017, based on the experiences of 141 carers, were included. Thematic analysis was applied to the data, with the concepts of transition inhibitors and facilitators being used to structure the analytic process.

Results: Analysis produced five themes, representing factors that could affect carer experiences of the focal transition-process: modifying the difficulty of this process according to their presence or absence. The themes were (1) Connection, pertaining to the carer feeling connected to the person with dementia and professionals during this transition; (2) Informed & Informing, relating to exchange of information between the carer and facility staff or health professionals; (3) The facility: welcoming & skilful, dealing with carer perceptions of the facility and their confidence in the staff; (4) It’s What You Make of It, discussing the meaning the carer made of the admission and the impact this had; and (5) Sharing Responsibility, addressing how carers were affected by the perceived sharing of responsibility for care-provision.

Conclusions: A supportive network has a significant role to play in facilitating this transition for carers. However, further research into what carers would find useful during this time is needed.

Full detail at Aging & Mental Health

Interventions maintaining eating independence in nursing home residents

Palese, A. et al. | Interventions maintaining eating Independence in nursing home residents: a multicentre qualitative study | BMC Geriatrics | 2018 18:292 | published online 27 November 2018

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Background
Despite 32 years of research and 13 reviews published in the field, no intervention can be considered a gold standard for maintaining eating performance among residents with dementia. The study aim was to highlight the interventions derived from tacit knowledge and offered daily in assisting eating by healthcare professionals (HCPs) in nursing homes (NHs).

Method
A multicentre descriptive qualitative study was performed in 2017. Thirteen NHs admitting residents with moderate/severe functional dependence in eating mainly due to dementia, were approached. A purposeful sample of 54 HCPs involved on a daily basis in assisting residents during mealtime were interviewed in 13 focus groups. Data analysis was conducted via qualitative content analysis.

Results
The promotion and maintenance of eating performance for as long as possible is ensured by a set of interventions targeting three levels: (a) environmental, by ‘Ritualising the mealtime experience by creating a controlled stimulated environment’; (b) social, by ‘Structuring effective mealtime social interactions’; and (c) individual, by ‘Individualising eating care’ for each resident.

Conclusions
In NHs, the eating decline is juxtaposed with complex interventions regulated on a daily basis and targeting the environment, the social interactions, and the residents’ needs. Several interventions that emerged as effective, according to the experience of participants, have never been documented before; while others are in contrast to the evidence documented. This suggests the need for further studies in the field; as no conclusions regarding the best interventions have been established to date.

Full document: Interventions maintaining eating Independence in nursing home residents: a multicentre qualitative study

Exercise instructors to support mobility and independence in dementia care setting

Care staff at a dementia care setting in Wigan identified that the introduction of a qualified exercise instructor, ready to deliver regular exercise plans, would improve the quality of service and outcomes for residents at their site. To facilitate the introduction of this new service an exercise instructor role was developed.

The exercise instructors provide education, offer support and encouragement to each individual to participate in exercise as well as being a resource for staff. With full access to medical information and multi-disciplinary team, the exercise instructor designs bespoke individual exercise programmes in collaboration with residents and these are monitored and updated in accordance with the resident’s progress and changing health needs. The exercise instructor also works closely with resident’s families to support the development of exercise plans and support any risk assessments and specific support needs.

The new service and role has been well received by residents especially in cases of residents with limited social interactions, with residents reporting an increased quality of life.

Full story: Introduction of the exercise instructor role to support mobility and independence for elderly residents in a dementia care setting | Atlas of Shared Learning | NHS England

Nursing home builds real-life 1950s memory lane to help dementia patients

The Telegraph | October 2018 | Nursing home builds real-life 1950s memory lane to help dementia patients

Starting this week (3 October) residents at the Five Rise Nursing Home in Bingley can take a stroll down an artificial street designed to resemble how the West Yorkshire town looked in the 1950s.

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The new-build home which cost £6m, is an innovation from twin brothers Danny and Damien Holt.

Damien, a psychiatric nurse, said: “People with advanced dementia can have very complex needs and we know how vital it is to provide plenty of mental stimulation in a safe, modern environment.

“Many of our residents have lived around Bingley for years.

“They remember it as it was.

“The purpose of our memory lane is to provide an attractive and interesting destination for the people we care for, offering reminiscence therapy to improve the psychological well being and quality of life for our residents.”( Source: The Telegraph)

 

News story from The Telegraph 

The views of care home staff in relation to experiencing and managing behaviour that challenges in dementia

Aim: To determine the views of care home (CH) staff in relation to experiencing and managing behaviour that challenges (BtC) in dementia and their experiences of training.

Method: Cross-sectional survey using a self-report questionnaire, distributed to staff employed in a 20% sample of all registered dementia-specialist CHs in England, either by postal or direct distribution.

Results: Questionnaires were returned from 352 care staff (25%), representing 5% of all dementia-specialist CHs, half were CH without nursing. Respondents estimated caring for 14,585 residents, 9,361 with dementia and 5,258 with BtC. 30.2% of residents with dementia were estimated as being prescribed a medicine to control BtC. BtC reported as experienced by most respondents were: shouting (96.6%), verbal aggression (96.3%) and physical aggression (95.7%), with physical aggression viewed as most difficult to manage. Top behaviours experienced every shift were: wandering (77.8%), perseveration (68.2%) and restlessness (68.2%).

Approaches such as assessing residents, knowing them and treating them as individuals, identifying triggers, having time for them and using an appropriate style of communication, were viewed as key to managing BtC, rather than guideline-specific interventions such as massage, aromatherapy and animal-assisted therapy.

Only 38% agreed/strongly agreed medicines were useful to control BtC, which was related to the extent to which they were prescribed. Training was available, but variable in quality with on-line training being least useful and on-the job training most desirable.

Conclusion: BtC are commonly and frequently experienced by care staff, who consider individual approaches, having time and good communication are key to successful management.

Full reference:
Charlotte Mallon, Janet Krska & Shivaun Gammie | 2018 | Views and experiences of care home staff on managing behaviours that challenge in dementia: a national survey in England |  Aging & Mental Health |  Published online: 25 May 2018