Improving outcomes for people with dementia following a fall

Bamford, C. et al. |  Equipping staff with the skills to maximise recovery of people with dementia after an injurious fall |  Aging & Mental Health | published online: 15 Nov 2018

Abstract
Objectives: People with dementia are more likely to fall and less likely to recover well after a fall than cognitively intact older people. Little is known about how best to deliver services to this patient group. This paper explores the importance of compensating for cognitive impairment when working with people with dementia.

Methods: Qualitative methods – interviews, focus groups and observation – were used to explore the views and experiences of people with dementia, family carers and professionals providing services to people with dementia following an injurious fall. A thematic, iterative analysis was undertaken in which emerging themes were identified from each individual dataset, prior to an integrative analysis.

Results: A key theme across all datasets was the need to deliver services in ways that compensate for cognitive impairment, such as negotiating meaningful activities that can be embedded into the routines of people with dementia. Professionals varied in their ability to adapt their practice to meet the needs of people with dementia. Negative attitudes towards dementia, a lack of knowledge and understanding of dementia limited the ability of some professionals to work in person-centred ways.

Conclusion: Improving outcomes for people with dementia following a fall requires the principles of person-centred care to be enacted by professionals with a generic role, as well as specialist staff. This requires additional training and support by specialist staff to address the wide variability in current practice.

Full document available here

New person-centred service being developed by Alzheimer’s Society

Alzheimer’s Society | September 2018 | Keeping connected: The right support at the right time

Dementia Connect, is a new service being developed  by the Alzheimer’s Society to keep in touch with and support people affected by dementia. The service, currently available in Penine Lancashire- where it is being piloted- involves specialist dementia advisers assessing and addressing the needs of people who either contact the service themselves or who are referred to Dementia Connect.

 

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The new service provides a combination of  face-to-face support with telephone and online advice, so people can access the help that they need, when they need it. It is part of The Alzheimer’s Society  strategy New Deal on Dementia,  which aims by 2022,  for everyone affected by the condition to be offered information, advice and support (Source: Alzheimer’s Society).

Full details and to read about the impact of the service on  people affected by dementia visit Alzheimer’s Society 

Person-centred care improves quality of life for care home residents with dementia

A person-centred care intervention for people with dementia living in care homes improved their quality of life, reduced agitation and improved interactions with staff. It may also save costs compared with usual care | National Institute for Health Research 

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Image source: discover.dc.nihr.ac.uk

The WHELD intervention involves training staff in person-centred care, with a focus on improving social interactions and appropriate use of antipsychotic medications. An early study suggested it could halve antipsychotic use.

This larger-scale NIHR trial conducted across 69 UK nursing homes focused on exploring the effects on quality of life and other symptoms. WHELD gave small-scale, but important improvements. It didn’t reduce antipsychotic use, as this was low to start with, which is in line with policy to limit use.

It supports the feasibility of the intervention, but there is a need to understand which components are most effective and could be implemented on a wide scale with sustainable effects.

Further detail at National Institute for Health Research

Full reference: Ballard C, Corbett A, Orrell M, et al. | Impact of person-centred care training and person-centred activities on quality of life, agitation, and antipsychotic use in people with dementia living in nursing homes: A cluster-randomised controlled trial. | PLoS Med. 2018;15 (2)

Are physiotherapists employing person-centred care for people with dementia?

Hall, A et al. | Are physiotherapists employing person-centred care for people with dementia? An exploratory qualitative study examining the experiences of people with dementia and their carers | BMC Geriatrics | 2018 18:63

Abstract
Background
People with dementia may receive physiotherapy for a variety of reasons. This may be for musculoskeletal conditions or as a result of falls, fractures or mobility difficulties. While previous studies have sought to determine the effectiveness of physiotherapy interventions for people with dementia, little research has focused on the experiences of people receiving such treatment. The aim of this study was to gain an in-depth understanding of people’s experiences of receiving physiotherapy and to explore these experiences in the context of principles of person-centred care.

Methods
Semi-structured interviews were undertaken with people with dementia or their carers between September 2016 and January 2017. A purposive sampling strategy recruited participants with dementia from the South West of England who had recently received physiotherapy. We also recruited carers to explore their involvement in the intervention. Thematic analysis was used to analyse the data.

Results
A total of eleven participants were recruited to the study. Six people with dementia were interviewed and five interviews undertaken separately with carers of people with dementia. Three themes were identified. The first explores the factors that enable exercises to be undertaken successfully, the second deals with perceived resource pressures, and the final theme “the physiotherapy just vanished” explores the feeling of abandonment felt when goals and expectations of physiotherapy were not discussed. When mapped against the principles of person-centred care, our participants did not describe physiotherapy adopting such an approach.

Conclusion
Lack of a person-centred care approach was evident by ineffective communication, thus failing to develop a shared understanding of the role and aims of physiotherapy. The incorporation of person-centred care may help reduce the frustration and feelings of dissatisfaction that some of our participants reported.

Full reference available at BMC Geriatrics

Impact of person-centred care training and person-centred activities on quality of life, agitation, and antipsychotic use in people with dementia living in nursing homes

Researchers from the University of Exeter in conjunction with King’s College London and Oxford Health NHS Foundation Trust aimed to  evaluate the efficacy of  person-centred care and psychosocial intervention incorporating an antipsychotic review on 800 patients with dementia. 

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The study  tested the WHELD programme, (Improving Wellbeing and Health for People with Dementia), the largest non-pharmacological randomised control trial in people with dementia living in care homes to date.

  • The programme combined staff training, social interaction, and guidance on use of antipsychotic medications, in 69 UK care homes  in a 9-month clinical trial.
  • It demonstrates that care homes receiving the WHELD programme saw improvements in quality of life as well as other important symptoms including agitation, behaviour, and pain in people with dementia.
  • For the care homes in the study, the WHELD programme was also shown to be cost-effective

The key findings include:

  • The WHELD approach is beneficial for people with dementia living in care homes.
  • WHELD could be provided in an affordable way to improve the lives of these individuals, who often do not receive the care they need.
  • They also suggest suggest that the WHELD intervention confers benefits in terms of  quality of life (QoL), agitation, and neuropsychiatric symptoms, albeit with relatively small effect sizes,

The full text article can be accessed through the PLOS Medicine website

Download it from PLOS here 

The full story is at Science Daily 

An Innovative Approach to Managing Behavioral and Psychological Dementia

The older adult population in long-term care is experiencing significant growth, which includes an increased number of minority admissions. An estimated 48% of long-term care patients are admitted with a diagnosis of dementia | The Journal for Nurse Practitioners

Highlights: 

  • Nurse practitioners are in a key position to provide culturally appropriate care in older adults with BPSD
  • Personalized music is an evidence-based, patient centered intervention to reduce BPSD
  • Regulatory agencies are closely monitoring the management of BPSD in long-term care facilities.
  • Personalized music can be an interdisciplinary approach in the management of BPSD

Patient-centered, culturally appropriate care is critical in the management of dementia and treatment of associated behavior and psychological symptoms of dementia (BPSD). The use of personalized music playlists has shown promise in the interdisciplinary treatment of BPSD. Regulatory agencies are closely monitoring the management of BPSD. Accurate diagnosis and treatment of BPSD is an increasingly important skill for the provider.

Full reference: Long, E.M. (2017) An Innovative Approach to Managing Behavioral and Psychological Dementia. The Journal for Nurse Practitioners. Vol. 13 (Issue 7) pp. 475-481

“I’m Still Here”: Personhood and the Early-Onset Dementia Experience

The current study examined the lived experience from the point of view of four adults younger than 65 with dementia, particularly how they perceive their personhood | Journal of Gerontological Nursing

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Using interpretative phenomenological analysis as the research approach, findings revealed that the EOD experience can be incorporated into six themes: (a) A Personal Journey, (b) Navigating the System, (c) The Stigma of Dementia, (d) Connecting to the World, (e) A Story Worth Telling, and (f) I’m Still Here. Participants’ stories, as presented via these six thematic threads, reveal that individuals with EOD can have a strong sense of personhood. Findings are discussed and situated within the current EOD body of knowledge, and new knowledge is presented. Implications for practice and recommendations for future research are discussed.

Full reference: Sakamoto, M.L. et al. (2017) “I’m Still Here”: Personhood and the Early-Onset Dementia Experience. Journal of Gerontological Nursing. 43(5) pp. 12-17