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Gutman G, Vashisht A, Kaur T, Karbakhsh M, Churchill R, Moztarzadeh A. A Novel Intervention for Management of Behavioral and Psychological Symptoms of Dementia in Nursing Home Communal Areas: Results of a Small-Scale Pilot Trial. J Alzheimers Dis Rep 2021; 5:847-853. [PMID: 35088034 PMCID: PMC8764626 DOI: 10.3233/adr-210054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 11/01/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Behavioral and psychological symptoms of dementia (BPSD) exhibited by persons with dementia (PwD) in nursing home communal areas are generally managed by segregation and/or pharmacological interventions. OBJECTIVE This study trialed MindfulGarden (MG), a novel digital calming device, in a Canadian nursing home. METHODS Participants were 15 PwD (mean age = 87.67; 5m,10f; mean MMSE = 11.64±7.85). Each was observed by a research assistant (RA) for an average of 8-10 hours on two separate days. The RA followed them during time spent in communal areas of the nursing home including their unit's dining space, lounges, and corridors and spaces shared with other units (e.g., gym and gift shop) and documented any BPSD exhibited. Day-1 provided baseline data; on Day-2, residents were exposed to MG if nursing staff considered their BPSD were sufficiently intense or sustained to warrant intervention. Staff rated the impact as positive, neutral, or negative. RESULTS On Day-1, 9 participants exhibited both aggressive and non-aggressive behaviors, 4 non-aggressive behaviors only, and 2 no BPSD. On Day-2, 7 exhibiting aggressive behaviors were exposed to MG. Staff reported MG as having distracting/calming effects and gave positive impact ratings to 6/13 exposures; there were no negative ratings. The most common aggressive BPSD on days of observation were pushing/shoving and screaming. CONCLUSION MG may have value as a "psychiatric crash cart" in de-escalating agitation and aggression in care home settings.
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Affiliation(s)
- Gloria Gutman
- Gerontology Research Centre, Simon Fraser University, Vancouver, BC, Canada
- Department of Gerontology, Simon Fraser University, Vancouver, BC, Canada
| | - Avantika Vashisht
- Biomedical Physiology and Kinesiology Department, Simon Fraser University, Vancouver, BC, Canada
| | - Taranjot Kaur
- Biology Department, Simon Fraser University, Vancouver, BC, Canada
| | - Mojgan Karbakhsh
- Gerontology Research Centre, Simon Fraser University, Vancouver, BC, Canada
| | - Ryan Churchill
- Department of Gerontology, Simon Fraser University, Vancouver, BC, Canada
| | - Amir Moztarzadeh
- Gerontology Research Centre, Simon Fraser University, Vancouver, BC, Canada
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Santagata F, Massaia M, D'Amelio P. The doll therapy as a first line treatment for behavioral and psychologic symptoms of dementia in nursing homes residents: a randomized, controlled study. BMC Geriatr 2021; 21:545. [PMID: 34641791 PMCID: PMC8507228 DOI: 10.1186/s12877-021-02496-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 09/16/2021] [Indexed: 11/30/2022] Open
Abstract
Background Patients living with dementia are severely affected by the development of behavioral and psychologic symptoms (BPSD) which represent a burden for patients and caregivers. The use of psychotropic drugs in the control of BPSD is widely diffused, however the use of a first line non-pharmacologic approach is highly recommended. Here we evaluate the effect of doll therapy (DT) in the management of BPSD, on the reduction of caregiver burden and delirium incidence in nursing home residents by a randomized controlled trial. Methods We enrolled fifty-two nursing homes residents living with dementia and BPSD. Subjects were randomized to DT (26) or standard treatment (ST, 26), we measured BPSD, caregiver burden and delirium with standard clinical scales at baseline, after 45 and 90 days. In order to evaluate the presence of BPSD we used Neuropsychiatric Inventory (NPI) scale and the A.Di.CO scale, the caregiver burden was measured by the Greutzner scale and delirium by the Confusion Assessment Method (CAM) scale. Results DT was more effective in reducing agitation and aggressiveness as respect to ST. Moreover DT globally reduced the presence of BPSD as dysphoria, wandering and apathy. We observed a significant reduction of the professional caregiver burden and the incidence of delirium was significantly reduced in subjects treated with DT. Conclusions We show that DT is more effective that ST in the control of BSPD in patients affected by moderate to severe dementia. Moreover we suggest that DT may effective in reducing the incidence of delirium. Trial registration Retrospectively registered in ClinicalTrials.gov the 10th June 2, 2021 trial registration number NCT04920591.
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Affiliation(s)
- Francesca Santagata
- Department of Medical Science, Geriatric and Bone Diseases Unit, University of Turin, corso Dogliotti 14, 10126, Torino, Italy
| | - Massimiliano Massaia
- Department of Medical Science, Geriatric and Bone Diseases Unit, University of Turin, corso Dogliotti 14, 10126, Torino, Italy
| | - Patrizia D'Amelio
- Department of Medical Science, Geriatric and Bone Diseases Unit, University of Turin, corso Dogliotti 14, 10126, Torino, Italy. .,Department of Medicine, Service of Geriatric Medicine & Geriatric Rehabilitation, University of Lausanne Hospital (CHUV), Lausanne, Switzerland.
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Maeda N, Tsutsumi Y, Niwa S. Development of a self-assessment behavioral and psychological symptoms of dementia competency scale for care teams at long-term geriatric care facilities. Geriatr Nurs 2021; 42:628-634. [PMID: 33823420 DOI: 10.1016/j.gerinurse.2021.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 03/08/2021] [Accepted: 03/10/2021] [Indexed: 10/21/2022]
Abstract
Understanding the behavioral and psychological symptoms of dementia (BPSD) is important for caregivers in long-term geriatric care facilities. In this study performed in 43 long-term care facilities, we evaluated the ability of caregivers to recognize BPSD through the development and validation of self-assessment scales. Reliability and validity of the scales were determined using Cronbach's alpha coefficient, the test/retest method, exploratory factor analysis, confirmatory factor analysis, criteria-related validity, and construct validity. We analyzed cross-sectional data from 310 participants. Factor analysis showed a positive correlation for all scale items (rs = .43-.73). Significant correlations arose from the test/retest method (rs = .48-.76). The α coefficient of all items except one was .70 or more, indicating sufficient reliability. Criteria-related validity (rs = .43-.73) and construct validity (rs = .13-.52) revealed a positive correlation. The BPSD Team Care Self-Assessment Scale is reliable and could ensure BPSD competency in caregivers.
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Affiliation(s)
- Noriko Maeda
- Department of Nursing Science, Faculty of Nursing, Kansai University of Nursing and Health Sciences, Hyogo 656-2131, Japan.
| | - Yumiko Tsutsumi
- The International University of Kagoshima, Kagoshima 891-0197, Japan
| | - Sayoko Niwa
- Course of Nursing, School of Health Sciences, Faculty of Medicine, Kagoshima University, Kagoshima, 890-0065, Japan
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Mallon C, Krska J, Gammie S. Views and experiences of care home staff on managing behaviours that challenge in dementia: a national survey in England. Aging Ment Health 2019; 23:698-705. [PMID: 29798693 DOI: 10.1080/13607863.2018.1452898] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
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.
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Affiliation(s)
- Charlotte Mallon
- a Musculoskeletal Research Unit , University of Bristol , Bristol , UK
| | - Janet Krska
- b Medway School of Pharmacy , Universities of Kent and Greenwich at Medway , Kent , UK
| | - Shivaun Gammie
- b Medway School of Pharmacy , Universities of Kent and Greenwich at Medway , Kent , UK
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Holle D, Köller L, Moniz-Cook E, Halek M. Translation and Linguistic Validation of the German Challenging Behavior Scale for Formal Caregivers of People With Dementia in Nursing Homes. J Nurs Meas 2018; 26:544-565. [DOI: 10.1891/1061-3749.26.3.544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background and Purpose: The Challenging Behavior Scale (CBS) measures the behavior of individuals with dementia. The study aims to translate the English CBS into German (CBS-G) and test its linguistic validity. Methods: The two-panel approach was used to translate the CBS. Nursing home staff reviewed the unambiguity and familiarity of the CBS-G items and the adequateness of the examples used to describe the items. Content validity indexes (CVI) and modified kappa (k) coefficients were calculated. Results: Most of the CBS-G items had excellent CVI and k values for both unambiguity and familiarity. All examples were viewed as adequate. Conclusion: A German version of the CBS that is linguistically equivalent to the original CBS is available but needs further testing of its psychometric properties.
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Massimo L, Kales HC, Kolanowski A. State of the Science: Apathy As a Model for Investigating Behavioral and Psychological Symptoms in Dementia. J Am Geriatr Soc 2018; 66 Suppl 1:S4-S12. [PMID: 29659001 PMCID: PMC5905718 DOI: 10.1111/jgs.15343] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 01/26/2018] [Accepted: 02/05/2018] [Indexed: 12/01/2022]
Abstract
Apathy is one of the most common and pervasive of the behavioral and psychological symptoms of dementia (BPSDs). Apathy has profound consequences for morbidity, mortality, and caregiver burden. Treatment of apathy has been hindered because of poor understanding of the mechanisms underlying this heterogeneous syndrome. Research has demonstrated that apathy is associated with disruption of the frontal-striatal system in individuals with neurodegenerative disease. As with other BPSDs, these neural mechanisms alone do not completely account for the syndrome; individual, caregiver, and environmental factors also contribute to apathy. In this article, we modify a current conceptual model of the factors contributing to BPSDs to examine determinants of apathy. This integrative model provides a more complete and theoretically informed understanding of apathy, allowing for greater insight into potential targets for research, intervention, and care. We end by proposing an agenda for moving the science of BPSDs in general, and apathy in particular, forward.
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Affiliation(s)
- Lauren Massimo
- College of Nursing, Pennsylvania State University, University Park, Pennsylvania
- Frontotemporal Degeneration Center, Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Helen C Kales
- Program for Positive Aging, Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
| | - Ann Kolanowski
- College of Nursing, Pennsylvania State University, University Park, Pennsylvania
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Harrison SL, Bradley C, Milte R, Liu E, Kouladjian O’Donnell L, Hilmer SN, Crotty M. Psychotropic medications in older people in residential care facilities and associations with quality of life: a cross-sectional study. BMC Geriatr 2018; 18:60. [PMID: 29478410 PMCID: PMC6389148 DOI: 10.1186/s12877-018-0752-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 02/19/2018] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Psychotropic medications have been associated with many adverse outcomes in older people living in residential care. Home-like models of residential care may be preferable to traditional models of care and we hypothesized that this model may impact on the prevalence of psychotropic medications. The objectives were to: 1) examine associations between psychotropic medications and quality of life in older adults living in residential care facilities with a high prevalence of cognitive impairment and dementia and 2) determine if there was a difference in prevalence of psychotropic medications in facilities which provide a small group home-like model of residential care compared to a 'standard model' of care. METHODS Participants included 541 residents from 17 residential aged care facilities in the Investigating Services Provided in the Residential Environment for Dementia (INSPIRED) study. Cross-sectional analyses were completed to examine the above objectives. Quality of life was measured with the dementia quality of life questionnaire (DEMQOL) and the EQ-5D-5L completed by the resident or a proxy. RESULTS Overall, 70.8% (n = 380) of the population had been prescribed/dispensed at least one psychotropic medication in the 100 days prior to recruitment. An increased number of psychotropic medications was associated with lower quality of life according to DEMQOL-Proxy-Utility scores (β (SE): - 0.012 (0.006), p = 0.04) and EQ-5D-5L scores (- 0.024 (0.011), p = 0.03) after adjustment for resident-level and facility-level characteristics. Analysis of the individual classes of psychotropic medications showed antipsychotics were associated with lower DEMQOL-Proxy-Utility scores (- 0.030 (0.014), p = 0.03) and benzodiazepines were associated with lower EQ-5D-5L scores (- 0.059 (0.024), p = 0.01). Participants residing in facilities which had a home-like model of residential care were less likely to be prescribed psychotropic medications (OR (95% CI): 0.24 (0.12, 0.46), p < 0.001). CONCLUSIONS An increased number of psychotropic medications were associated with lower quality of life scores. These medications have many associated adverse effects and the use of these medications should be re-examined when investigating approaches to improve quality of life for older people in residential care. Home-like models of residential care may help to reduce the need for psychotropic medications, but further research is needed to validate these findings.
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Affiliation(s)
- Stephanie L. Harrison
- Department of Rehabilitation, Aged and Extended Care, Faculty of Medicine, Nursing and Health Sciences, Flinders University, Level 4, Rehabilitation Building, Flinders Medical Centre, Flinders Drive, Bedford park, Adelaide, SA 5042 Australia
- NHMRC Cognitive Decline Partnership Centre, The University of Sydney, Sydney, NSW Australia
| | - Clare Bradley
- Department of Rehabilitation, Aged and Extended Care, Faculty of Medicine, Nursing and Health Sciences, Flinders University, Level 4, Rehabilitation Building, Flinders Medical Centre, Flinders Drive, Bedford park, Adelaide, SA 5042 Australia
- NHMRC Cognitive Decline Partnership Centre, The University of Sydney, Sydney, NSW Australia
- Infection & Immunity – Aboriginal Health, SAHMRI, PO Box 11060, Adelaide, SA 5001 Australia
| | - Rachel Milte
- Department of Rehabilitation, Aged and Extended Care, Faculty of Medicine, Nursing and Health Sciences, Flinders University, Level 4, Rehabilitation Building, Flinders Medical Centre, Flinders Drive, Bedford park, Adelaide, SA 5042 Australia
- NHMRC Cognitive Decline Partnership Centre, The University of Sydney, Sydney, NSW Australia
- Institute for Choice, University of South Australia, GPO Box 2471, Adelaide, SA 5001 Australia
| | - Enwu Liu
- Department of Rehabilitation, Aged and Extended Care, Faculty of Medicine, Nursing and Health Sciences, Flinders University, Level 4, Rehabilitation Building, Flinders Medical Centre, Flinders Drive, Bedford park, Adelaide, SA 5042 Australia
- NHMRC Cognitive Decline Partnership Centre, The University of Sydney, Sydney, NSW Australia
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC 3000 Australia
| | - Lisa Kouladjian O’Donnell
- NHMRC Cognitive Decline Partnership Centre, The University of Sydney, Sydney, NSW Australia
- Kolling Institute of Medical Research, University of Sydney and Royal North Shore Hospital, St Leonards, NSW 2065 Australia
| | - Sarah N. Hilmer
- NHMRC Cognitive Decline Partnership Centre, The University of Sydney, Sydney, NSW Australia
- Kolling Institute of Medical Research, University of Sydney and Royal North Shore Hospital, St Leonards, NSW 2065 Australia
| | - Maria Crotty
- Department of Rehabilitation, Aged and Extended Care, Faculty of Medicine, Nursing and Health Sciences, Flinders University, Level 4, Rehabilitation Building, Flinders Medical Centre, Flinders Drive, Bedford park, Adelaide, SA 5042 Australia
- NHMRC Cognitive Decline Partnership Centre, The University of Sydney, Sydney, NSW Australia
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Backhouse T, Killett A, Penhale B, Gray R. The use of non-pharmacological interventions for dementia behaviours in care homes: findings from four in-depth, ethnographic case studies. Age Ageing 2016; 45:856-863. [PMID: 27543054 DOI: 10.1093/ageing/afw136] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 06/17/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND antipsychotic medications have been used to manage behavioural and psychological symptoms of dementia (BPSD). Due to the potential risks associated with these medications for people with dementia, non-pharmacological interventions (NPIs) have been recommended as safer alternatives. However, it is unknown if, or how, these interventions are used in care homes to help people experiencing BPSD. AIM to explore the use of NPIs in care homes to manage BPSD. METHODS In-depth, ethnographic case studies were conducted in four care homes; in total, they included interviews with 40 care-home staff and 384 hours of participant observations. FINDINGS NPIs, some of which are the focus of efficacy research, were used in care homes but predominantly as activities to improve the quality of life of all residents and not identified by staff as meeting individual needs in order to prevent or manage specific behaviours. Socially relevant activities such as offering a cup of tea were used to address behaviours in the moment. Residents with high levels of need experienced barriers to inclusion in the activities. CONCLUSIONS there is a gap between rhetoric and practice with most NPIs in care homes used as social activities rather than as targeted interventions. If NPIs are to become viable alternatives to antipsychotic medications in care homes, further work is needed to embed them into usual care practices and routines. Training for care-home staff could also enable residents with high needs to gain better access to suitable activities.
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Affiliation(s)
- Tamara Backhouse
- School of Health Sciences, University of East Anglia, Norwich, Norfolk, UK
| | - Anne Killett
- School of Health Sciences, University of East Anglia, Norwich, Norfolk, UK
| | - Bridget Penhale
- School of Health Sciences, University of East Anglia, Norwich, Norfolk, UK
| | - Richard Gray
- Nurse Education and Research Department, Hamad Medical Corporation, Doha, Qatar
- Office Of Nursing And Midwifery, LaTrobe University, Melbourne, Australia
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Resnick B, Kolanowski A, Van Haitsma K, Boltz M, Galik E, Bonner A, Vigne E, Holtzman L, Mulhall PM. Pilot Testing of the EIT-4-BPSD Intervention. Am J Alzheimers Dis Other Demen 2016; 31:570-579. [PMID: 27609932 PMCID: PMC10852713 DOI: 10.1177/1533317516662337] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Behavioral and psychological symptoms of dementia are common in nursing home residents, and the Centers for Medicare and Medicaid Services now require that nonpharmacological interventions be used as a first-line treatment. Few staff know how to implement these interventions. The purpose of this study was to pilot test an implementation strategy, Evidence Integration Triangle for Behavioral and Psychological Symptoms of Dementia (EIT-4-BPSD), which was developed to help staff integrate behavioral interventions into routine care. The EIT-4-BPSD was implemented in 2 nursing homes, and 21 residents were recruited. A research nurse facilitator worked with facility champions and a stakeholder team to implement the 4 steps of EIT-4-BPSD. There was evidence of reach to all staff; effectiveness with improvement in residents' quality of life and a decrease in agitation; adoption based on the environment, policy, and care plan changes; and implementation and plans for maintenance beyond the 6-month intervention period.
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Affiliation(s)
- Barbara Resnick
- School of Nursing, University of Maryland, Baltimore, MD, USA
| | | | | | - Marie Boltz
- William F. Connell School of Nursing, Boston College, Boston, MA, USA
| | - Elizabeth Galik
- School of Nursing, University of Maryland, Baltimore, MD, USA
| | - Alice Bonner
- School of Nursing, Northeastern University, Boston, MA, USA
| | - Erin Vigne
- School of Nursing, University of Maryland, Baltimore, MD, USA
| | - Lauren Holtzman
- School of Nursing, University of Maryland, Baltimore, MD, USA
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Song JA, Oh Y. The Association Between the Burden on Formal Caregivers and Behavioral and Psychological Symptoms of Dementia (BPSD) in Korean Elderly in Nursing Homes. Arch Psychiatr Nurs 2015; 29:346-54. [PMID: 26397440 DOI: 10.1016/j.apnu.2015.06.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Revised: 06/10/2015] [Accepted: 06/11/2015] [Indexed: 10/23/2022]
Abstract
Behavioral and psychological symptoms of dementia (BPSD) are sources of psychological distress for caregivers who take care of people with dementia. The purpose of this study was to examine the association between BPSD and the burden on formal caregivers of nursing homes in South Korea. Results showed that the total severity score of BPSD had a statistically significant positive correlation with the total distress score. Agitation/Aggression was the most distressing symptom for registered nurses and care workers. These findings suggest that there is a need for improved treatments for BPSD, to help mitigate its burden on formal caregivers.
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Affiliation(s)
- Jun-Ah Song
- College of Nursing, Korea University, Republic of Korea.
| | - Younjae Oh
- Division of Nursing, College of Medicine, Hallym University, Hallymdaehak-gil 1, Chuncheon, Gangwon-do, Republic of Korea.
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