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Berkovic D, Macrae A, Gulline H, Horsman P, Soh SE, Skouteris H, Ayton D. The Delivery of Person-Centered Care for People Living With Dementia in Residential Aged Care: A Systematic Review and Meta-Analysis. THE GERONTOLOGIST 2024; 64:gnad052. [PMID: 37144737 PMCID: PMC11020247 DOI: 10.1093/geront/gnad052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Person-centered care is the gold standard of care for people living with dementia, yet few systematic reviews have detailed how it is delivered in practice. This mixed-methods review aimed to examine the delivery of person-centered care, and its effectiveness, for people living with dementia in residential aged care. RESEARCH DESIGN AND METHODS A systematic review and meta-analysis. Eligible studies were identified across 4 databases. Quantitative and qualitative studies containing data on person-centered care delivered to people with dementia living in residential aged care were included. Meta-analysis using a random-effects model was conducted where more than 3 studies measured the same outcome. A narrative meta-synthesis approach was undertaken to categorize verbatim participant quotes into representative themes. Risk of bias was undertaken using quality appraisal tools from the Joanna Briggs Institute. RESULTS 41 studies were identified for inclusion. There were 34 person-centered care initiatives delivered, targeting 14 person-centered care outcomes. 3 outcomes could be pooled. Meta-analyses demonstrated no reduction in agitation (standardized mean difference -0.27, 95% confidence interval [CI], -0.58, 0.03), improvement in quality of life (standardized mean difference -0.63, 95% CI: -1.95, 0.70), or reduced neuropsychiatric symptoms (mean difference -1.06, 95% CI: -2.16, 0.05). Narrative meta-synthesis revealed barriers (e.g., time constraints) and enablers (e.g., staff collaboration) to providing person-centered care from a staff perspective. DISCUSSION AND IMPLICATIONS The effectiveness of person-centered care initiatives delivered to people with dementia in residential aged care is conflicting. Further high-quality research over an extended time is required to identify how person-centered care can be best implemented to improve resident outcomes.
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Affiliation(s)
- Danielle Berkovic
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Ann Macrae
- Mission & Corporate Development, Baptcare, Melbourne, Victoria, Australia
| | - Hannah Gulline
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Phillipa Horsman
- Service Strategy Manager, Baptcare, Melbourne, Victoria, Australia
| | - Sze-Ee Soh
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Physiotherapy, School of Primary and Allied Health Care, Monash University, Melbourne, Victoria, Australia
| | - Helen Skouteris
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Monash Warwick Professor in Health and Social Care Improvement and Implementation Science, Melbourne, Victoria, Australia
| | - Darshini Ayton
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Capezuti E, Sagha Zadeh R, Pain K, Basara A, Jiang NZ, Krieger AC. A systematic review of non-pharmacological interventions to improve nighttime sleep among residents of long-term care settings. BMC Geriatr 2018; 18:143. [PMID: 29914382 PMCID: PMC6006939 DOI: 10.1186/s12877-018-0794-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 04/27/2018] [Indexed: 12/21/2022] Open
Abstract
Background Disturbances in sleep and circadian rhythms are common among residents of long-term care facilities. In this systematic review, we aim to identify and evaluate the literature documenting the outcomes associated with non-pharmacological interventions to improve nighttime sleep among long-term care residents. Methods The Preferred Reporting Items for Systematic Reviews guided searches of five databases (MEDLINE, Embase, CINAHL, Scopus, and Cochrane Library) for articles reporting results of experimental or quasi-experimental studies conducted in long-term care settings (nursing homes, assisted-living facilities, or group homes) in which nighttime sleep was subjectively or objectively measured as a primary outcome. We categorized each intervention by its intended use and how it was administered. Results Of the 54 included studies evaluating the effects of 25 different non-pharmacological interventions, more than half employed a randomized controlled trial design (n = 30); the others used a pre-post design with (n = 11) or without (n = 13) a comparison group. The majority of randomized controlled trials were at low risk for most types of bias, and most other studies met the standard quality criteria. The interventions were categorized as environmental interventions (n = 14), complementary health practices (n = 12), social/physical stimulation (n = 11), clinical care practices (n = 3), or mind-body practices (n = 3). Although there was no clear pattern of positive findings, three interventions had the most promising results: increased daytime light exposure, nighttime use of melatonin, and acupressure. Conclusions Non-pharmacological interventions have the potential to improve sleep for residents of long-term care facilities. Further research is needed to better standardize such interventions and provide clear implementation guidelines using cost-effective practices. Electronic supplementary material The online version of this article (10.1186/s12877-018-0794-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Elizabeth Capezuti
- Hunter College School of Nursing and the Graduate Center, City University of New York, 425 E. 25th Street, New York, NY, 10011, USA.
| | - Rana Sagha Zadeh
- Design and Environmental Analysis, Cornell University, 170 Martha Van Rensselaer Hall, Ithaca, NY, 14853-4401, USA
| | - Kevin Pain
- Weill Cornell Medicine, Samuel J. Wood Library & C.V. Starr Biomedical Information Center, 1300 York Avenue Room, C-115, New York, NY, 10065-4896, USA
| | - Aleksa Basara
- Department of Economics, Cornell University, 170 Martha Van Rensselaer Hall, Ithaca, NY, 14853-4401, USA
| | - Nancy Ziyan Jiang
- Health Design Innovations Lab, Department of Design & Environmental Analysis, Cornell University, 170 Martha Van Rensselaer Hall, Ithaca, NY, 14853-4401, USA
| | - Ana C Krieger
- Departments of Medicine, Neurology and Genetic Medicine, Weill Cornell Medical College, Cornell University, 425 E. 61st St., 5th Floor, New York, NY, 10065, USA
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Li J, Grandner MA, Chang YP, Jungquist C, Porock D. Person-Centered Dementia Care and Sleep in Assisted Living Residents With Dementia: A Pilot Study. Behav Sleep Med 2017; 15:97-113. [PMID: 26681411 PMCID: PMC6230474 DOI: 10.1080/15402002.2015.1104686] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The sleep of people with dementia living in long-term care is known to be disturbed. This pre-post controlled pilot study examined the effects of a person-centered dementia care intervention on sleep in assisted living residents with dementia. The three-month intervention included in-class staff training plus supervision and support in practice. The sleep-wake patterns were measured using actigraphy for three consecutive days at baseline and postintervention. Sixteen residents from the intervention and six from the control groups completed the study. The intervention group had significantly more nighttime sleep at posttest. After adjusting for baseline, the intervention group exhibited significantly less daytime sleep and more nighttime sleep. Person-centered dementia care may be effective for improving sleep of residents with dementia.
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Affiliation(s)
- Junxin Li
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, Pennsylvania, UB Institute for Person-Centered Care, Buffalo, New York
| | - Michael A. Grandner
- Sleep and Health Research Program, Department of Psychiatry, University of Arizona School of Medicine, Tucson, Arizona
| | - Yu-Ping Chang
- School of Nursing, University of Buffalo, Buffalo, New York, UB Institute for Person-Centered Care, Buffalo, New York
| | | | - Davina Porock
- Vice Provost, Lehman College, City University of New York, New York
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Bird M, Anderson K, MacPherson S, Blair A. Do interventions with staff in long-term residential facilities improve quality of care or quality for life people with dementia? A systematic review of the evidence. Int Psychogeriatr 2016; 28:1937-1963. [PMID: 27439660 DOI: 10.1017/s1041610216001083] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Common sense suggests and research indicates relationships between staff factors in residential dementia care and quality of life (QOL) for residents, with poor care increasing suffering. However, we do not have a coherent picture of which staff interventions have an impact on quality of care (QOC) or resident QOL. METHODS A comprehensive search of 20 years' peer-reviewed literature using Medline, PsycINFO, Embase, PubMed, CINAHL, and the Cochrane, Campbell Collaboration identified 4,760 studies meriting full text review. Forty-six met the inclusion criteria, namely interventions in long-term facilities helping staff develop their capacity to provide better care and/or QOL for residents with dementia. Thirty-five other papers comprised an associated predictor review. RESULTS Conclusions from these limited data are further compromised because nine studies failed to measure effects on residents and only half assessed effects after the project team withdrew. Of these, excellent studies produced change over the medium (3-4 months) or longer term, including reduction in challenging behavior and restraint use but this applied only to a minority. A number of studies failed to measure effects on QOC, limiting conclusions about mechanisms underlying change. CONCLUSION In general, level of intervention required depended on the target. For outcomes like restraint use, structured education sessions with some support appear adequate. Programs to reduce pain require more support. For complicated issues like challenging behavior and increasing co-operation in showering, detailed, supportive, on-site interventions are required. Improvements in restraint and staff/resident interactions were the most promising findings. (Review registration number: PROSPERO 2014:CRD42014015224).
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Affiliation(s)
- Mike Bird
- Dementia Services Development Centre,Bangor University,Bangor,Gwynedd,UK
| | - Katrina Anderson
- NHMRC Cognitive Decline Partnership Centre,Sydney,New South Wales,Australia
| | - Sarah MacPherson
- NHMRC Cognitive Decline Partnership Centre,Sydney,New South Wales,Australia
| | - Annaliese Blair
- NHMRC Cognitive Decline Partnership Centre,Sydney,New South Wales,Australia
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Li J, Porock D. Resident outcomes of person-centered care in long-term care: A narrative review of interventional research. Int J Nurs Stud 2014; 51:1395-415. [DOI: 10.1016/j.ijnurstu.2014.04.003] [Citation(s) in RCA: 107] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Revised: 02/28/2014] [Accepted: 04/04/2014] [Indexed: 11/16/2022]
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Farrell GA, Shafiei T, Chan SP. Patient and visitor assault on nurses and midwives: an exploratory study of employer 'protective' factors. Int J Ment Health Nurs 2014; 23:88-96. [PMID: 23279321 DOI: 10.1111/inm.12002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/27/2012] [Indexed: 11/29/2022]
Abstract
Most Australian public health-care services have established a range of initiatives designed to help 'protect' nurses and midwives from patient and visitor assault (PVA); however, few studies have specifically examined their effectiveness. The present study is part of a larger survey that explored nurses' and midwives' experiences of PVA using the Department of Human Services, Victoria (2007) definition of occupational violence and bullying. Participants were asked about the presence of 'protective' factors in their workplace and the importance of having these factors to prevent and manage workplace aggression. Binary logistic regression was applied to ascertain the association between 'protective' factors and the occurrence of PVA, with adjusted odds ratios and their reported 95% confidence intervals for ascertaining the significance of the associations. The study found more 'protection' from assault when there was a high standard of patient facilities, sufficient staffing, effective enforcement of policies, and when staff were provided with personal protective equipment. Working in private health care, and being a registered nurse, also conferred 'protection'. A higher occurrence of staff assault was associated with specific clinical settings, and being on rotation and on night duty. Findings point to important insights into factors associated with 'protection' for PVA.
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Affiliation(s)
- Gerald A Farrell
- School of Nursing and Midwifery, La Trobe University, Melbourne, Victoria, Australia
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Desrosiers J, Viau-Guay A, Bellemare M, Trudel L, Feillou I, Guyon AC. Relationship-based care and behaviours of residents in long-term care facilities. Curr Gerontol Geriatr Res 2014; 2014:949180. [PMID: 24523731 PMCID: PMC3913456 DOI: 10.1155/2014/949180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Revised: 12/04/2013] [Accepted: 12/10/2013] [Indexed: 11/17/2022] Open
Abstract
Introduction. In long-term care (LTC), person-centred approaches are encouraged. One such approach, relationship-based care (RBC), aims among other things to reduce residents' agitated behaviours. RBC has been used in numerous Quebec LTC facilities over the past decade but it has never been studied. Objective. Explore correlations between use of RBC by trained caregivers and the frequency of agitated and positive behaviours of residents with cognitive impairments. Methods. Two independent raters observed fourteen caregiver/resident dyads in two LTC facilities during assistance with hygiene and dressing. Checklists were used to quantify caregivers' RBC use and residents' agitated and positive behaviours. Results. Scores for RBC use were high, suggesting good application of the approach by caregivers. Correlation analyses showed that offering residents realistic choices and talking to them during care were associated with both positive and agitated behaviours (P from 0.03 to 0.003). However, many other components of RBC were not associated with residents' behaviours during care. Conclusions. There were only a few quantitative links between the RBC checklist items and the frequency of agitated or positive behaviours. Other studies with a more rigorous research design are needed to better understand the impact of relationship-based care on residents' behaviours.
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Affiliation(s)
- Johanne Desrosiers
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001 12th Avenue North Sherbrooke, Sherbrooke, QC, Canada J1H 5N4
- Research Centre on Aging, CSSS-IUGS, Sherbrooke, QC, Canada
| | - Anabelle Viau-Guay
- Département d'études sur l'Enseignement et l'Apprentissage, Université Laval, QC, Canada
- Centre de Recherche et d'Intervention sur la Réussite Scolaire (CRIRES), QC, Canada
| | - Marie Bellemare
- Département des Relations Industrielles, Université Laval, QC, Canada
- Chaire de Recherche en Gestion de la Santé et de la sécurité du travail, Université Laval, QC, Canada
| | - Louis Trudel
- Chaire de Recherche en Gestion de la Santé et de la sécurité du travail, Université Laval, QC, Canada
- Département de Réadaptation, Université Laval, QC, Canada
| | - Isabelle Feillou
- Département des Relations Industrielles, Université Laval, QC, Canada
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Person-centered care training in long-term care settings: usefulness and facility of transfer into practice. Can J Aging 2013; 32:57-72. [PMID: 23339880 DOI: 10.1017/s0714980812000426] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The person-centered approach is increasingly recommended in long-term care facilities to increase quality of care. In Quebec, Canada,. caregivers were specifically trained in "relationship-based care. "This study analyzed caregivers' assessment of this approach's usefulness and their capacity, after training, to apply it to care practices. Questionnaires with open-ended questions were administered to caregivers (n= 392) one month after training. Caregivers' answers were categorized using a qualitative approach. Respondents perceive some features of this approach are beyond their reach or in opposition to their beliefs. They reported feeling pressure related to time constraints, their peers and the families of residents. These results indicate that training itself is insufficient to transform practice. Institutions wishing to implement such an approach must also act upon the beliefs of individuals, as well as upon work situations.
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The controversial promises of cholinesterase inhibitors for Alzheimer's disease and related dementias: A qualitative study of caregivers' experiences. J Aging Stud 2011. [DOI: 10.1016/j.jaging.2011.03.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Abstract
Agitation is a widespread and challenging problem among aged care residents with dementia. This article draws on empirical and theoretical literature to propose a model for preventing and treating agitation non-pharmacologically. A literature review finds agreed, coherent definition and measurement of agitation to be absent despite numerous agitation remedies having been suggested, yet sufficient material to support evidence-based care planning. Agitation is revealed as resulting from a resident’s interactions with the environment or their internal state, giving rise to unmet needs that attentive care can treat. Agitation treatments are reviewed to find no single effective remedy and a lack of quality evaluation. A higher-order, problem-solving approach is proposed. The described system consists of sequential diagnosis, decision making and treatment options, commencing with individualized and institutional preventative measures removing environmental triggers, followed by individual remediation, with residents’ unmet needs receiving priority consistent with patient-centred care.
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High versus Low Density Special Care Units: Impact on the Behaviour of Elderly Residents with Dementia. Can J Aging 2010. [DOI: 10.1017/s0714980800009235] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
RÉSUMÉL'ouverture d'une nouvelle unité de soins spéciaux a permis d'étudier l'effet de la densité sociale réduite (moins de résidents) et de la densité spatiale (plus d'espace par personne) sur le comportement de résidents avec démence. Deux groupes (N = 64) ont été observés pendant trois périodes espacées de six mois chacune. Tel que théorisé, il y a eu plus d'amélioration dans le comportement perturbateur et non perturbateur du groupe expérimental (passant de haute à basse densité) par rapport au groupe de comparaison (haute densité constante). Les résultats indiquent que la densité de l'unité résidentielle est un déterminant important pour le comportement des résidents âgés avec démence.
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White DL, Newton-Curtis L, Lyons KS. Development and Initial Testing of a Measure of Person-Directed Care. THE GERONTOLOGIST 2008; 48 Spec No 1:114-23. [DOI: 10.1093/geront/48.supplement_1.114] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Koch S, Haesler E, Tiziani A, Wilson J. Effectiveness of sleep management strategies for residents of aged care facilities: findings of a systematic review. J Clin Nurs 2006; 15:1267-75. [PMID: 16968431 DOI: 10.1111/j.1365-2702.2006.01385.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES The objectives of this systematic review were to determine the most effective tools for the assessment and diagnosis of sleep problems, as well as identify the most effective strategies for the promotion of sleep within this population. BACKGROUND Experiencing reduced sleep quality is often associated with normal ageing, however this may be exacerbated for residents of aged care facilities. External factors such as noise, light and night-time nursing may impact negatively upon sleeping patterns. METHODS Eleven electronic databases and the reference lists and bibliographies of included studies were searched. Papers were grouped according to type of intervention or assessment tool and presented in a narrative summary. CONCLUSIONS The review identified many interventions to promote sleep. Multidisciplinary strategies such as combining a reduction in environmental noise, reduction of night-time nursing care and promotion of daytime activity, are likely to be most effective for promoting sleep in the population of interest. The use of sedating medications is cautioned, as their long-term efficacy in promoting sleep is questionable. Wrist actigraphy was found to be the most accurate objective sleep assessment tool. RELEVANCE TO CLINICAL PRACTICE Lack of sleep, disturbed sleep and the overuse of medications especially sedations reduce the quality of life for older people. Effective, safe sleep interventions should be promoted and practised by nurses.
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Affiliation(s)
- Susan Koch
- Gerontic Nursing Clinical School, La Trobe University, Bundoora, Australia.
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Lanari A, Amenta F, Silvestrelli G, Tomassoni D, Parnetti L. Neurotransmitter deficits in behavioural and psychological symptoms of Alzheimer's disease. Mech Ageing Dev 2005; 127:158-65. [PMID: 16297434 DOI: 10.1016/j.mad.2005.09.016] [Citation(s) in RCA: 124] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2005] [Revised: 05/17/2005] [Accepted: 09/15/2005] [Indexed: 11/28/2022]
Abstract
Behavioural and psychological symptoms of dementia (BPSD) occur in 50-90% of Alzheimer's disease (AD) patients. Imbalance of different neurotransmitters (acetylcholine, dopamine, noradrenaline and serotonin), involvement of specific brain regions responsible for emotional activities (parahippocampal gyrus, dorsal raphe and locus coeruleus) and cortical hypometabolism have been proposed as neurobiological substrate of BPSD. Compared to with respect to the neurochemical component, the cholinergic dysfunction seems to play a major role in contributing to BPSD occurrence. This view is also supported by the findings of recent trials with cholinesterase inhibitors, showing that these drugs are effective in controlling and/or improving BPSD, independent on effects on cognitive dysfunction. On the site of psychotropic drugs, atypical or novel antipsychotics represent the reference drugs for treating BPSD, whereas classic antipsychotic drugs for their profile and the potential side effects should be avoided.
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Affiliation(s)
- Alessia Lanari
- Dipartimento di Neuroscienze, Università di Perugia, Perugia, Italy
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Reimer MA, Slaughter S, Donaldson C, Currie G, Eliasziw M. Special Care Facility Compared with Traditional Environments for Dementia Care: A Longitudinal Study of Quality of Life. J Am Geriatr Soc 2004; 52:1085-92. [PMID: 15209645 DOI: 10.1111/j.1532-5415.2004.52304.x] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To compare the effect of a specialized care facility (SCF) on quality of life (QoL) for residents with middle- to late-stage dementia over a 1-year period with residence in traditional institutional facilities. DESIGN A prospective, matched-group design with assessments of QoL every 3 months for 1 year. SETTING Twenty-four long-term care centers and four designated assisted living environments in an urban center in western Canada. PARTICIPANTS One hundred eighty-five residents with Global Deterioration Scores of 5 or greater were enrolled: 62 in the intervention SCF group and 123 in the traditional institutional facilities groups. INTERVENTION The SCF is a 60-bed purpose-built facility with 10 people living in six bungalows. The facility followed an ecologic model of care that is responsive to the unique interplay of each person and the environment. This model encompasses a vision of long-term care that is more comfortable, more like home, and offers more choice, meaningful activity, and privacy than traditional settings. MEASUREMENTS QoL outcomes were assessed using the Brief Cognitive Rating Scale, Functional Assessment Staging, Cohen-Mansfield Agitation Inventory, Pleasant Events Scale-Alzheimer's disease, Multidimensional Observation Scale of Elderly Subjects, and Apparent Affect Rating Scale. RESULTS The intervening SCF group demonstrated less decline in activities of daily living, more sustained interest in the environment, and less negative affect than residents in the traditional institutional facilities. There were no differences between groups in concentration, memory, orientation, depression, or social withdrawal. CONCLUSION The present study suggests that QoL for adults with middle- to late-stage dementia is the same or better in a purpose-built and staffed SCF than in traditional institutional settings.
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Affiliation(s)
- Marlene A Reimer
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada.
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Haesler EJ. Effectiveness of strategies to manage sleep in residents of aged care facilities. ACTA ACUST UNITED AC 2004. [DOI: 10.1111/j.1479-6988.2004.00010.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
The aim of this study was to explore the relationship between self-destructive behaviour and nursing home environment. We performed a cross-sectional study comprising 647 residents in 11 nursing homes in Sydney, Australia using the Harmful Behaviours Scale (HBS), Abbreviated Mental Test Scale and the Resident Classification Index. The Directors of Nursing completed a questionnaire that rated physical design, staff and resident characteristics and demographics were obtained from nursing home records. On regression analysis a greater number of design features for frail and residents with dementia in general, and increased security measures were associated with greater HBS total score and risk-taking and passive self-harm subscales. A residential environment in which the residents were more functionally dependent and more likely to be in a shared room, managerial policies less geared towards managing difficult behaviour and less staff availability and training were associated with the 'uncooperativeness' factor. There were no significant predictors of the other two factors. The relationship between nursing home environment and self-destructive behaviours and the environment is complex and there needs to be an individualized approach to placement.
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Affiliation(s)
- L-F Low
- Department of Old Age Psychiatry, Prince of Wales Hospital, Sydney, NSW, Australia
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Haesler EJ. Effectiveness of strategies to manage sleep in residents of aged care facilities. ACTA ACUST UNITED AC 2004; 2:1-107. [PMID: 27820000 DOI: 10.11124/01938924-200402040-00001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND The promotion of sleep in older adults is a significant issue in high-level residential aged care facilities, with as many as 67% of residents experiencing disruptions to their sleep patterns. Not only do health concerns such as cognitive impairment, pain and incontinence impact upon this population's sleep quality and quantity, but environmental factors including noise, light and night-time nursing care also affect sleep of those residing in institutions. In order to address the issue of sleep disruption, assessment and diagnosis of sleep problems and implementation of interventions that are effective in promoting sleep are essential. OBJECTIVES The objective of this review was to determine the most effective tools for the assessment and diagnosis of sleep in older adults in high-level aged care. The review also sought to determine the most effective strategies for the promotion of sleep in this population. Outcome measures for this review were: indicators of improved sleep quality and quantity, including an improvement in daytime functioning and improved night-time sleep; reduction in use of hypnotics and sedatives; and increased satisfaction with sleep. SEARCH STRATEGY A literature search was performed using the following databases for the years 1993-2003: AgeLine, APAIS Health, CINAHL, Cochrane Library, Current Contents, Dissertation Abstracts International, Embase, Medline, Proquest, PsycInfo, Science Citations Index. A second search stage was conducted through review of reference lists of studies retrieved during the first search stage. The search was limited to published and unpublished material in English language. SELECTION CRITERIA The review was limited to papers addressing sleep diagnosis, assessment and/or management in adults aged 65 or over who were residing in high-level aged care. The review included randomised controlled trials (RCTs) and, due to the limited number of RCTs available, non-RCTs, cohort and case control studies and qualitative research were also considered for inclusion. Research was included if it addressed the assessment, diagnosis or management of sleep using outcome measure of improved night-time sleep or daytime function, improvements in resident satisfaction with sleep or reduction in medication use associated with sleep. The types of interventions considered by this review were alternative therapies including massage, aromatherapy and medicinal herbs; behavioural or cognitive interventions; biochemical interventions; environmental interventions; pharmacological interventions and related nocturnal interventions such as continence care. Instruments and strategies to diagnose and assess the sleep of older high-level care residents, including objective and subjective assessment tools, were considered by this review. DATA COLLECTION AND ANALYSIS All retrieved papers were critically appraised for eligibility for inclusion and methodological quality independently by two reviewers, and the same reviewers collected details of eligible research. Papers were grouped according to the type of intervention or type of assessment tool used and findings were presented in a narrative summary. FINDINGS Wrist actigraphy was found to be the most accurate objective sleep assessment tool for use in the population of interest, and issues surrounding its use are presented. Although no subjective sleep assessment tools were identified in this review, the evidence suggested that subjective reports of sleep quality are an important consideration in sleep assessment. Evidence suggested that behavioural observations may be an effective assessment strategy when conducted on a frequent basis. The review found no evidence on the effectiveness of any assessment tools for the diagnosis of specific sleep problems in older adults. The use of multidisciplinary strategies including reduction of environmental noise, reduction of night-time nursing care that disrupts sleep and daytime activity is likely to be the most effective strategy for the promotion of sleep in older high-level care residents. The use of sedating medications did not appear to have a substantial effect in promoting sleep, and health practitioners in high-level aged care should consider their use cautiously.
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Affiliation(s)
- Emily J Haesler
- Australian Centre for Evidence Based Aged Care (a collaborating centre of the Joanna Briggs Institute), La Trobe University, Melbourne, Victoria, Australia
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21
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Abstract
Older adults represent an ever-growing proportion of the population of the industrialised nations, with a corresponding increase in the numbers of patients with dementing disorders. A common complaint in both normal aging and the dementias is that of significant sleep disturbance. The major causes of sleep disruption in aging and dementia include: (i) physiological changes that arise as part of normal, 'nonpathological' aging; (ii) sleep problems due to one of many physical or mental health conditions and their treatments; (iii) primary sleep disorders; (iv) poor 'sleep hygiene', that is, sleep-related practices and habits; and (v) some combination of these factors. Disrupted sleep in patients with dementia is a significant cause of stress for caregivers and frequently leads to institutionalisation of patients. It should be a target of clinical management when the goal is sustained home care, and when it is associated with disturbances of mood or behaviour. While the neuropathology of dementia can directly disrupt sleep, sleep disturbances in patients with dementia often have multiple causes that require systematic evaluation. Thorough assessment of associated psychopathology, day-time behaviour, medical disorders, medications, pain and environmental conditions is needed for optimal management. Differential diagnosis of a sleep problem in dementia is the basis of rational pharmacotherapy. However, patients with dementia are likely to be more sensitive than elderly persons without dementia to adverse cognitive and motor effects of drugs prescribed for sleep. Clinicians need to: (i) evaluate sleep outcomes when treating medical, psychiatric and behavioural disorders in older adults; (ii) be alert to emerging behavioural and environmental approaches to treatment; (iii) combine nonpharmacological strategies with drug therapies, when required, for added value; and (iv) avoid use of multiple psychotropic medications unless they prove essential to the adequate management of sleep disturbances.
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Affiliation(s)
- M V Vitiello
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, Washington 98195-6560, USA.
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22
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Neville CC, Byrne GJA. Behaviour rating scales for older people with dementia: Which is the best for use by nurses? Australas J Ageing 2001. [DOI: 10.1111/j.1741-6612.2001.tb00381.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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23
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Edberg A, Hallberg IR. Actions seen as demanding in patients with severe dementia during one year of intervention. Comparison with controls. Int J Nurs Stud 2001; 38:271-85. [PMID: 11245864 DOI: 10.1016/s0020-7489(00)00076-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Behaviours, viewed by nurses as demanding, performed by patients with severe dementia were investigated during one year of intervention. Supervised implementation of individually planned care and systematic clinical supervision were implemented on one experimental ward (EW) while another ward (CW) served as control. Each ward had 11 patients. At baseline and after 6 and 12 months of intervention structured interviews with the patients' assigned nurses were conducted based on the Demanding Behaviour Assessment Scale and Multi Dimensional Dementia Assessment Scale. At the EW there was a decreased frequency (p=0.000) and a reduced occurrence of physical behaviours (p=0.008), a decreased frequency (p=0.029) and a reduced occurrence of vocal behaviours (p=0.002). No significant changes were seen at the CW. Bearing the small sample size in mind, the findings indicate that individually planned care and systematic clinical supervision could be a means of reducing the frequency, and/or effect the nurses' attitude and interpretation of the patients' behaviour as demanding. The findings, however, can only be seen as indications for further research, but point to the importance of including effect variables related to patients when intervening in nursing care.
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Affiliation(s)
- A Edberg
- Department of Nursing, The Medical Faculty, Lund University, PO Box 198, SE-221 00, Lund, Sweden.
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24
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McCurry SM, Reynolds CF, Ancoli-Israel S, Teri L, Vitiello MV. Treatment of sleep disturbance in Alzheimer's disease. Sleep Med Rev 2000; 4:603-628. [PMID: 12531038 DOI: 10.1053/smrv.2000.0127] [Citation(s) in RCA: 109] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The prevalence of Alzheimer's disease (AD) is rapidly increasing as growing numbers of people around the world are living to old age. Sleep disturbances are a common, and often highly disruptive, behavioral symptom associated with AD. Nevertheless, the study of sleep in AD is relatively new. Little is known about the moderating factors that may alter a given patient's risk for developing sleep problems, or that may influence severity of presentation and persistence. Current treatments for improving sleep in AD fall into three broad categories: (i) pharmacological; (ii) cognitive-behavioral or psycho-educational strategies; and (iii) biological/circadian therapies. There are few studies demonstrating the efficacy of these treatments with community-dwelling AD patients, although studies with persons in institutional settings are promising. In this review, it is suggested that sleep problems in AD are multi-factorial, and influenced by a variety of demographic, physical, psychiatric and situational factors. These factors vary in how readily they can be modified and in how relevant they are to any individual case. Thus, when developing a treatment plan for sleep problems in a dementia patient, it is important to evaluate the underlying causes as well as the context in which the problems are occurring, and to target the intervention accordingly.
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Affiliation(s)
- Susan M. McCurry
- University of Washington, Department of Psychosocial and Community Health, Seattle, WA, USA
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25
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Opie J, Rosewarne R, O'Connor DW. The efficacy of psychosocial approaches to behaviour disorders in dementia: a systematic literature review. Aust N Z J Psychiatry 1999; 33:789-99. [PMID: 10619204 DOI: 10.1046/j.1440-1614.1999.00652.x] [Citation(s) in RCA: 118] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE This paper provides a systematic review of research findings published between 1989 and 1998 concerning non-pharmacological strategies to alleviate behavioural disturbances in elderly persons with dementia. METHOD Data collection strategies included computer literature searches, manual searches of selected journals and checks of references listed in previous reviews. To warrant inclusion, studies were required to include some measure of behaviour before and after the introduction of an intervention. Papers were appraised in the following domains: design, sampling technique, setting, behaviours studied, measurement tools, data collection methods, type of interventions and feasibility. An overall validity rating was assigned to each article using predetermined rules. RESULTS Forty-three studies met criteria for inclusion including five randomised controlled trials. Validity ratings were as follows: one strong, 15 moderate, and 27 weak. Areas of scientific weakness included small numbers of subjects, inadequate descriptions of study participants, imprecise data collection methods, high attrition rates and insufficient statistical analysis. Despite this, there is evidence to support the efficacy of activity programs, music, behaviour therapy, light therapy, carer education and changes to the physical environment. The evidence in favour of multidisciplinary teams, massage and aromatherapy is inconclusive. CONCLUSIONS It was easier to interpret the results of rigorously designed studies that focused on a single behaviour or single intervention tailored to the needs of individuals and carers. Future studies should seek to replicate the findings outlined here, improving methodologies where necessary and including outcome measures that encompass the interests of people with dementia, family caregivers and health professionals.
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Affiliation(s)
- J Opie
- Aged Mental Health Research Group, Kingston Centre, Australia.
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26
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Edberg AK, Norberg A, Hallberg IR. Mood and general behavior of patients with severe dementia during one year of supervised, individualized planned care and systematic clinical supervision. Comparison with a similar control group. AGING (MILAN, ITALY) 1999; 11:395-403. [PMID: 10738856 DOI: 10.1007/bf03339819] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The aim of this study was to evaluate the effects of one year of systematic clinical supervision, and supervised individually planned care on the mood and general behavior of patients with dementia in relation to their cognitive function and level of confusion. The intervention was carried out in a ward devoted to the care of patients with severe dementia (EW), with a similar ward (CW) where no changes were made serving as a control. Each ward housed 11 patients, of whom 7 patients in each ward survived throughout the study time. Assessment of the patients' mood, general behavior, cognitive functions (MMSE), orientation and confusion (OBS) was made at baseline, and after 6 and 12 months of intervention. Significant deteriorations for the patients in CW were seen during the study period as regards the factor strength, functional performance and orientation in the ward, and speech performance and psychomotor slowing. For the patients in the EW, deterioration was seen only in the factor accessibility, and improvement was seen in the factor sensitivity and euphoria. The differences indicated that the development in the two wards went in opposite directions to the benefit of the patients in the EW. Because of the small sample size, the findings are more the result of a pilot trial, rather than generalizable. The intervention, however, seemed to have a positive effect on the secondary symptoms of the disease.
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Affiliation(s)
- A K Edberg
- Department of Health Sciences, Kristianstad University, Sweden.
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27
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McCurry SM, Logsdon RG, Teri L, Gibbons LE, Kukull WA, Bowen JD, McCormick WC, Larson EB. Characteristics of sleep disturbance in community-dwelling Alzheimer's disease patients. J Geriatr Psychiatry Neurol 1999; 12:53-9. [PMID: 10483925 DOI: 10.1177/089198879901200203] [Citation(s) in RCA: 172] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study examined the frequency, predictors, and impact of sleep problems in a population-based sample of 205 Alzheimer's disease (AD) patients. Sleeping more than usual and early morning awakenings were the most common sleep problems reported but were the least disturbing behaviors for caregivers. Night-time awakenings were less common but were most disturbing to caregivers. Using logistic regression analyses, the factors most strongly associated with night awakenings among patients were male gender, greater memory problems, and decreased functional status. Patient depression increased the risk for caregivers to rate patient sleep problems as more disturbing overall. Cluster analyses revealed three characteristic groups of patients who awakened caregivers: one group was inactive during the day but had few other behavior problems; one group had increased levels of fearfulness, fidgeting, and occasional sadness; and the third group had multiple behavior problems, including frequent episodes of sadness, fearfulness, inactivity, fidgeting, and hallucinations. These findings indicate that the nature of sleep problems in AD is multifaceted; future research on the occurrence and treatment of sleep disturbance in dementia patients should consider the patterns of individual differences that may influence its development.
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Affiliation(s)
- S M McCurry
- Department of Psychosocial and Community Health, University of Washington, Seattle 98195-7263, USA
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28
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Abstract
The Department of Veterans Affairs Medical Center in New York City expanded the role of a nurse manager to a manager and leader of the interdisciplinary team within a structure reorganized to focus on patients. As the literature noted the critical nature of the role of a middle manager, an interdisciplinary team reached the consensus that a registered nurse with progressive clinical and head nurse experience should be the first-line manager in a patient-centered care organization. The process of reengineering the role of a Patient Care Team Coordinator (PCTC), the support systems designed to develop the new leadership role, and the benefits associated with the changes implemented are discussed. The functional statement for the PCTC's position is included, as well as an organizational structure to show how staff are grouped to promote the continuity and coordination of care provided to patients.
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Affiliation(s)
- E Miller
- Department of Veterans Affairs Medical Center (DVAMC), New York, NY, USA
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