Managing challenging behavior

Holle, D. et al. Aging & Mental Health. Published online: 3 November 2016

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Objective: Individualized formulation-led interventions offer a promising approach for analyzing and managing challenging behaviors in people with dementia. Little is known about which individualized formulation-led interventions exist and what effects these interventions have on people with dementia and their caregivers. Therefore, the review aims to describe and examine existing interventions and to review their evidence.

Methods: An integrative review of individualized formulation-led interventions for managing challenging behavior in people with dementia was conducted. PUBMED, PsycINFO [EBSCO] and CINAHL [EBSCO] databases were searched between February and April 2014 using key terms related to dementia, challenging behavior and individualized formulation- led interventions. The literature search was limited to German and English publications published from 1995. No limitations were placed on the type of paper, type of study design and stage of disease or setting. 37 relevant papers that met the inclusion criteria were included in this review.

Results: The literature review provided 14 different individualized formulation-led interventions. The effects on people with dementia were diverse, as only half of the studies showed a significant reduction in behaviors compared with the control group. Family caregivers felt less upset about the challenging behavior and more confident in their ability to manage the behavior.

Conclusion: There is a clear need for further research on individualized formulation-led interventions. The results of this review have the potential for developing interventions and for designing methodological robust evaluation studies that take into account the effectiveness of individualized formulation-led interventions on patient and caregiver outcomes.

Read the full article here

A new person-centered approach for dementia-friendly emergency department care

Parke, B. & Hunter, K.F. Know me – A new person-centered approach for dementia-friendly emergency department care. Dementia. Published online before print November 3, 2016

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Image source: Scott & White Healthcare – Flickr // CC BY-NC-ND 2.0

A visit to an emergency department can be a disorientating experience for someone with dementia. Empowered caregivers can mitigate harm stemming from communication issues to support a successful emergency department visit.

A qualitative study determined the feasibility of the structure, format, and content of eight hospital-readiness communication tools. Data collection involved English and French-language caregiver focus groups in two Canadian provinces.

Study findings have the potential to (a) improve safety in emergency care to older people with dementia and their caregivers, and (b) offer cost-effective communication tools for web-based knowledge translation activity in acute care.

 

 

Mood, activity, and interaction in long-term dementia care

Hanneke C. Beerens et al. The relation between mood, activity, and interaction in long-term dementia care   Aging & Mental Health Published online: 13 Sep 2016
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Objective: The aim of the study is to identify the degree of association between mood, activity engagement, activity location, and social interaction during everyday life of people with dementia (PwD) living in long-term care facilities.

Method: An observational study using momentary assessments was conducted. For all 115 participants, 84 momentary assessments of mood, engagement in activity, location during activity, and social interaction were carried out by a researcher using the tablet-based Maastricht Electronic Daily Life Observation-tool.

Results: A total of 9660 momentary assessments were completed. The mean age of the 115 participants was 84 and most (75%) were women. A negative, neutral, or positive mood was recorded during 2%, 25%, and 73% of the observations, respectively. Positive mood was associated with engagement in activities, doing activities outside, and social interaction. The type of activity was less important for mood than the fact that PwD were engaged in an activity. Low mood was evident when PwD attempted to have social interaction but received no response.

Conclusion: Fulfilling PwD’s need for occupation and social interaction is consistent with a person-centred dementia care focus and should have priority in dementia care

Costs of formal and informal care at home for people with dementia

Giebel, C.M. et al. Costs of formal and informal care at home for people with dementia: ‘Expert panel’ opinions from staff and informal carers. Dementia. Published online before print August 22, 2016

Abstract:

Effective home support in dementia is key in delaying nursing home admission. However, home support is frequently not tailored to the individual needs of people with dementia. Staff allocating home support services may not identify important care needs, which only be recognised by informal carers.

The purpose of this study was to explore the balance of informal and formal home support and their associated costs from the perspectives of both informal carers and paid staff. Five case vignettes of people with dementia were designed based on an existing English data set from a European study into transition into long-term care (the RightTimePlaceCare programme), representing 42 per cent of the English sample. In total, 14 informal carers and 14 paid staff were consulted in separate groups, as expert panels, regarding their recommendations for home care services for each vignette.

Care recommendations of carers and staff were costed based on nationally available unit costs and compared. Informal carers allocated fewer hours of care than staff. Personal and domestic home care and day care centres were the most frequently recommended formal services by both groups, and some vignettes of people with dementia were recommended for care home admission. The ratio of costs of informal versus formal support was relatively equal for paid staff, yet unbalanced from the perspectives of informal carers with a greater proportion of formal care costs. Recommendations from this study can help shape dementia care to be more tailored to the individual needs of people with dementia and their carers.

person-centred care and QOL

Mami Yasuda & Hisataka Sakakibara Care staff training based on person-centered care and dementia care mapping, and its effects on the quality of life of nursing home residents with dementia Aging & Mental Health Published online: 01 Jun 2016

Objectives: To assess the effects of care staff training based on person-centered care (PCC) and dementia care mapping (DCM) on the quality of life (QOL) of residents with dementia in a nursing home.

Methods: An intervention of staff training based on PCC and DCM was conducted with 40 care staff members at a geriatric nursing home. The effects of the staff training on the QOL of residents with dementia were evaluated by the DCM measurements of 40 residents with dementia three times at about one-month intervals (first, baseline; second, pre-intervention; third, post-intervention).

Results: The well-being and ill-being values (WIB values) of the residents with dementia measured by DCM were not different between the first and second rounds before the staff training (p = 0.211). Meanwhile, the WIB values increased from the first and second rounds to the third post-intervention round (p = 0.035 and p < 0.001, respectively); over 50% of the residents had better WIB values. The behavior category ‘interactions with others’ in DCM also demonstrated a significant increase in the third round compared to the first round (p = 0.041).

Conclusion: Staff training based on PCC and DCM could effectively improve the QOL of residents with dementia.

 

 

Workforce development to provide person-centered care

Person-centered care can be effectively implemented by well-trained CCAs in the community.

Abstract:

Objectives: Describe the development of a competent workforce committed to providing patient-centered care to persons with dementia and/or depression and their caregivers; to report on qualitative analyses of our workforce’s case reports about their experiences; and to present lessons learned about developing and implementing a collaborative care community-based model using our new workforce that we call care coordinator assistants (CCAs).

Method: Sixteen CCAs were recruited and trained in person-centered care, use of mobile office, electronic medical record system, community resources, and team member support. CCAs wrote case reports quarterly that were analyzed for patient-centered care themes.

Results: Qualitative analysis of 73 cases using NVivo software identified six patient-centered care themes: (1) patient familiarity/understanding; (2) patient interest/engagement encouraged; (3) flexibility and continuity of care; (4) caregiver support/engagement; (5) effective utilization/integration of training; and (6) teamwork. Most frequently reported themes were patient familiarity – 91.8% of case reports included reference to patient familiarity, 67.1% included references to teamwork and 61.6% of case reports included the theme flexibility/continuity of care. CCAs made a mean number of 15.7 (SD = 15.6) visits, with most visits for coordination of care services, followed by home visits and phone visits to over 1200 patients in 12 months.
Full reference: Mary Guerriero Austrom et. al. Workforce development to provide person-centered care Aging & Mental Health Volume 20, Issue 8, 2016.

Dementia post diagnostic support planning

London Clinical Networks. Published online: 10 May 2106

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Image source: London Clinical Networks

Guidance for commissioners and providers to meet the NICE Quality Standard on Dementia (QS1), which states that people with dementia should have an assessment and an ongoing personalised care plan, agreed across health and social care.

This is a guide for »

  • Commissioners
  • Service providers, including health, social care, voluntary and charitable organisations

This guide will be of interest to »

  • People living with dementia
  • Their families and friends
  • Practitioners in dementia care

The purpose of this guidance is to »

  • Describe the key elements of person-centred support planning
  • Describe how to write a new support plan
dementia toolkit
Image source: London Clinical Networks

A support plan should capture what is important to the person living with dementia.

Once a support plan is put in place it needs to be reviewed regularly, to reflect changes in needs, wishes and circumstances.

The professional who helps putting the support plan together should assume the person with dementia has capacity and use clinical judgement, using the Mental Capacity Act when needed.

Find the full toolkit here
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Living positively with dementia

Aging & Mental Health Volume 20, Issue 7, 2016

Objective: Little is known about how and to what extent people with dementia live positively with their condition. This study aimed to review and carry out a synthesis of qualitative studies where accounts of the subjective experiences of people with dementia contained evidence of positive states, experiences or attributes.

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image source: Adrian Cousins,  Wellcome images//CC BY-NC-ND 4.0

Methods: A meta-synthesis was undertaken to generate an integrated and interpretive account of the ability of people with dementia to have positive experiences. A methodological quality assessment was undertaken to maximize the reliability and validity of this synthesis and to contextualize the findings with regard to methodological constraints and epistemological concepts.

Findings: Twenty-seven papers were included. Three super-ordinate themes relating to positive experiences and attributes were identified, each with varying and complementing sub-themes. The first super-ordinate theme related to the experience of engaging with life in ageing rather than explicitly to living with dementia. The second theme related to engaging with dementia itself and comprised the strengths that people can utilize in facing and fighting the condition. The third theme captured how people with dementia might transcend the condition and seek ways to maintain identity and even achieve personal growth.

Conclusions: This review provides a first step towards understanding what conceptual domains might be important in defining positive outcomes for people who live with dementia. Highlighting the potential for people to have positive experiences in spite of or even because of their dementia has important implications for de-stigmatizing dementia and will enhance person-centred approaches to care.

Full reference:  Wolverson, E.L. et al. Living positively with dementia: a systematic review and synthesis of the qualitative literature  Aging & Mental Health. Volume 20, Issue 7, 2016 p. 676-699

 

Horticultural therapy for dementia patients

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Image source: Wellcome Library// CC BY-NC-ND 4.0

Fourteen people attending an adult day programme were recruited to a structured horticultural therapy programme which took place over 10 weeks. The effects were assessed using Dementia Care Mapping and questionnaires completed by family carers.

High levels of wellbeing were observed while the participants were engaged in horticultural therapy, and these were sustained once the programme was completed. This study adds to the growing evidence on the benefits of horticultural therapy for people with dementia who have enjoyed gardening in the past.

Full reference: Hall, J.  et al.  Effect of horticultural therapy on wellbeing among dementia day care programme participants: A mixed-methods study published online before print. Dementia April 11, 2016

Person-centred dementia care

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Image source: http://www.tandfonline.com/

In the latest editorial of Aging & Mental Health,  Myrra Vernooij-Dassen & Esme Moniz-Cook argue that person-centred care should not only be directed at compensating for what people with dementia cannot do, but also at facilitating their interests, pleasure and use of their capacities.

 

Full reference :Myrra Vernooij-Dassen & Esme Moniz-Cook (2016): Personcentred dementia care: moving beyond caregiving, Aging & Mental HealthDOI: 10.1080/13607863.2016.1154017