Dementia and agitation in nursing home residents: how are they related?

Factors Associated with Home Care Outcomes among Community-Dwelling Older Adult Patients with Dementia

Background

With the increase in the proportion of people with dementia (PWD), it is necessary to address dementia-related issues among older adults who live at home; however, there is no integrative review on this issue.

Objectives

To describe and analyze quantitative and qualitative studies from primary sources in order to identify the factors which impact home care outcomes among PWD.

Methods

A computer search of PsycINFO, MEDLINE (PubMed), and the Cumulative Index of Nursing and Allied Health Literature (CINAHL) was performed. This study was guided by Whittemore and Knafl's integrative review method.

Results

This review of the literature identified 3 main factors related to home care outcomes among PWD. These factors are environmental factors, caregiver-related factors, and social network factors.

Conclusions

Further research is required to investigate the impacts of multiple social and environmental factors on home care outcomes among PWD; which can eventually be used by nurses and family caregivers when providing care for older adult PWD.

[The Determination of Agitation Behaviors among the Elderly People Receiving Long-Term Institutional Care and the Influencing Factors]

AIM

Agitation is common among elderly people staying at nursing homes. It is a significant problem particularly for patients with dementia. This study aims to determine the agitation behaviors of elderly people receiving long-term institutional care in a city and influencing factors.

METHOD

The population of this descriptive and analytical study consisted of elderly individuals in three institutional care centers. 178 elderly individuals aged 60 and above were taken into the sample group. Approval was taken from them and their relatives. The study data were collected between September-November 2018 using the socio-demographic question form, the Cohen-Mansfield Agitation Inventory (CMAI), the Mini-Cog Brief Cognitive Assessment Form, the Barthel Index for Activities of Daily Living (ADL) and the Lawton&Brody Instrumental Activities of Daily Living Scale (IADL).

RESULTS

The mean age of the participants was 75.58±8.77 and 56.7% were males. The duration of stay at the institution was 23.48±24.46 months. Although 50.6% of the participants had psychiatric diagnoses. The mean score for the CMAI for the patients with dementia was 46.26±15.10, which was significantly higher than those without dementia (Z=-2.132, p=0.033).

CONCLUSIONS

The results show agitation is high among patients with dementia and cognitive impairment affects agitation significantly.

The Cognitive Daisy - A novel method for recognising the cognitive status of older adults in residential care: Innovative Practice

The Cognitive Daisy is an innovative assessment system created to provide healthcare staff with an instant snapshot of the cognitive status of older adults in residential care. The Cognitive Daisy comprises a flower head consisting of 15 colour coded petals depicting information about: visual-spatial perception, comprehension, communication, memory and attention. This study confirmed the practicality of the Cognitive Daisy protocol for assessing cognition in a sample of 33 older adults living in residential care and endorsed the use of the Cognitive Daisy as a tool for recognising the cognitive status of care home residents.

Foot massage and physiological stress in people with dementia: a randomized controlled trial

BACKGROUND

The anxiety associated with unfamiliar surroundings, the disorientation and mental confusion, and the social isolation that accompanies dementia can often create increased stress for people living in long-term care settings. Such a response is thought to affect the autonomic nervous system and result in emotional and physical symptoms of distress that may be manifested as agitation. There is the potential for such distress to influence the physiological response and in particular Blood Pressure and Heart Rate. A relaxation intervention such as massage may influence the physiological stress response.

METHODS

This randomized controlled trial aimed to compare the effect of foot massage (FM) versus a control activity (quiet presence, QP) on physiological stress response (i.e., blood pressure [BP] and heart rate [HR]) in people living with moderate-to-severe dementia in long-term-care settings.

RESULTS

Fifty-three residents were randomized to intervention (10-minute FM) or control group (QP). While the FM group experienced a greater reduction in HR than the control group, these reductions were not significantly different between groups (p=0.83; see Table 1 ), or across time (p=0.46). Both groups experienced a reduction in systolic BP and diastolic BP, while the mean reduction in systolic BP was greater for those in the FM group.

CONCLUSIONS

While the findings do not provide strong support for FM, the finding that both conditions allowed the person with dementia to rest in the presence of another human being is of importance in the care of people with dementia. The close presence of another person may in fact promote relaxation and therefore improve BP and HR measures.

Differential diagnosis of behavioral variant of fronto-temporal dementia (bvFTD)

Background

The aim of the paper is the differential diagnosis of various types of Fronto-Temporal Dementia (FTD), with the focus on its behavioural variant (bvFTD).

Material/Method

Material and Method. Screening was done in order to assess the depth of dementia with the short version of MMSE, while evaluation of various variants of FTD was performed with the use of such neuropsychological tests as Newcomb and Chicago Fluency Tests, Wechsler Memory Scale - III (WMS-III), Western Aphasia Battery (WAB-R), and the Boston Naming Test (BNT). Behaviour was evaluated with a Polish version of the Frontal Behavioral Inventory (FBInv). The inventory consists of 24 questions which enable an evaluation of social behaviour disorders. The study included 112 patients - 68 men and 46 women treated in the Reintegrative -Training Centre of the Foundation for Persons with Brain Dysfunctions in Kraków and in the Clinic for Developmental Psychiatry, Psychotic Disorders and Old Age Psychiatry, of the Medical University at Gdańsk, who were suffering from various types of dementia.

Results

It was found that FTD patients scored the highest, while the VAD patients scored somewhat lower in the FBInv. At the same time the scores obtained by PPA patients were higher in comparison to the control groups, but not as high as in the case of patients with FTD. In the process of the neurotherapy of FTD patients we found a reduction of the behavioral disturbances, despite the progression of the illness.

Conclusions

The results obtained in the present study confirmed the diagnostic value of FBInv in the differential diagnosis of various types of FTD and in the evaluation of neurotherapy efficacy.

Resident-to-resident aggression in long-term care facilities: insights from focus groups of nursing home residents and staff

OBJECTIVES

To more fully characterize the spectrum of resident-to-resident aggression (RRA).

DESIGN

A focus group study of nursing home staff members and residents who could reliably self-report.

SETTING

A large, urban, long-term care facility.

PARTICIPANTS

Seven residents and 96 staff members from multiple clinical and nonclinical occupational groups.

MEASUREMENTS

Sixteen focus groups were conducted. Content was analyzed using nVivo 7 software for qualitative data.

RESULTS

Thirty-five different types of physical, verbal, and sexual RRA were described, with screaming or yelling being the most common. Calling out and making noise were the most frequent of 29 antecedents identified as instigating episodes of RRA. RRA was most frequent in dining and residents' rooms, and in the afternoon, although it occurred regularly throughout the facility at all times. Although no proven strategies exist to manage RRA, staff described 25 self-initiated techniques to address the problem.

CONCLUSION

RRA is a ubiquitous phenomenon in nursing home settings, with important consequences for affected individuals and facilities. Further epidemiological research is necessary to more fully describe the phenomenon and identify risk factors and preventative strategies.