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Staff reports of behavioral expressions of persons with dementia in 250 assisted living communities
- Authors:
- DOBBS Debra, et al
- Journal article citation:
- Gerontologist, 62(2), 2022, pp.169-180.
- Publisher:
- Oxford University Press
Background and Objectives: Assisted living (AL) residents with dementia commonly exhibit behavioural expressions (BEs), yet no study has examined how AL staff perceive and respond to BEs in terms of the "ABC" model of antecedents, behaviours, and consequences, or how perceptions relate to organizational characteristics. Understanding staff perceptions may inform interventions. Research Design and Methods: A convergent, mixed methods design was used in a study of health care supervisors from 250 AL communities in 7 states who reported 366 cases of resident BEs (one successful and one unsuccessful case). Qualitative analysis identified antecedents, BEs, staff responses, resident outcomes, and disposition (aging in place or discharge). Content analysis identified themes and compared case types. Descriptive statistics examined organizational characteristics associated with identifying antecedents. Results: One quarter of cases recognized antecedents; slightly more were identified in successful (28%) compared to unsuccessful cases (20%); staff in dementia-only and smaller communities identified antecedents more often. Combativeness and anxiety were the most frequently reported BEs. The majority of both types of cases reported staff responses. Medication management was enacted as a response in 40% of cases compared to psychiatric assessment in 33% of cases. Discussion and Implications: Staff training is indicated to increase AL staff recognition of antecedents; doing so might reduce the use of antipsychotic medications. Psychiatric assessment plays an important role in dementia care in AL and warrants further examination. Results could be helpful for applied behavioural researchers interested in developing ways to improve the identification of antecedents of BEs of persons with dementia. (Edited publisher abstract)
Factors associated with residents’ responsive behaviours towards staff in long-term care homes: a systematic review
- Authors:
- SONG Yuting, et al
- Journal article citation:
- Gerontologist, early cite January 2022, p.gnac016.
- Publisher:
- Oxford University Press
Background and Objectives: When staff experience responsive behaviours from residents, this can lead to decreased quality of work-life and lower quality of care in long-term care homes. This study synthesised research on factors associated with resident responsive behaviours directed towards care staff and characteristics of interventions to reduce the behaviours. Research Design and Methods: conducted a mixed-methods systematic review with quantitative and qualitative research. Researcher searched 12 bibliographic databases and “grey” literature, using two keywords (long-term care, responsive behaviours) and their synonyms. Pairs of reviewers independently completed screening, data extraction, and risk of bias assessment. The researchers developed a coding scheme using the ecological model as an organising structure and prepared narrative summaries for each factor. Results: From 86 included studies (57 quantitative, 28 qualitative, 1 mixed methods), multiple factors emerged, such as staff training background (individual level); staff approaches to care (interpersonal level); leadership and staffing resources (institutional level); and racism and patriarchy (societal level). Quantitative and qualitative results each provided key insights, such as qualitative results pertaining to leadership responses to reports of behaviours, and quantitative findings on the impact of staff approaches to care on behaviours. Effects of interventions (n=14) to reduce the behaviours were inconclusive. Discussion and Implications: this study identified the need for enhanced understanding of the interrelationships among factors associated with resident responsive behaviours towards staff and processes leading to the behaviours. To address these gaps and to inform theory-based effective interventions for preventing or mitigating responsive behaviours, the authors suggest intervention studies with systematic process evaluations. (Edited publisher abstract)
Use of an ambient activity technology for long-term care residents with dementia
- Authors:
- LIGNOS Nicholas, et al
- Journal article citation:
- Journal of Gerontological Nursing, 48(1), 2022, pp.35-41.
- Publisher:
- Healio
The purpose of the current pilot study was to determine the impact of an ambient activity technology, ABBY, on responsive behavior and family visiting in a long-term care (LTC) home. We were also interested in family and staff perceptions of the technology. A mixed methods research study was conducted over a 6-month period and data were collected using standardized measures and focus groups. Although no significant differences were noted in responsive resident behaviours, focus group data showed the ABBY enriched the care environment and provided additional opportunities for families and staff to engage residents. Although the introduction of a new technology can create challenges for staff, with time, these challenges can be overcome. (Edited publisher abstract)
Does continuous trusted adult support in childhood impart life-course resilience against adverse childhood experiences - a retrospective study on adult health-harming behaviours and mental well-being
- Authors:
- BELLIS Mark A., et al
- Journal article citation:
- BMC Psychiatry, 17(110), 2017, Online only
- Publisher:
- BioMed Central
- Place of publication:
- London
Background: Adverse childhood experiences (ACEs) including child abuse and household problems (e.g. domestic violence) increase risks of poor health and mental well-being in adulthood. Factors such as having access to a trusted adult as a child may impart resilience against developing such negative outcomes. How much childhood adversity is mitigated by such resilience is poorly quantified. This study tests if access to a trusted adult in childhood is associated with reduced impacts of ACEs on adoption of health-harming behaviours and lower mental well-being in adults. Methods: Cross-sectional, face-to-face household surveys (aged 18–69 years, February-September 2015) examining ACEs suffered, always available adult (AAA) support from someone you trust in childhood and current diet, smoking, alcohol consumption and mental well-being were undertaken in four UK regions. Sampling used stratified random probability methods (n = 7,047). Analyses used chi squared, binary and multinomial logistic regression. Results: Adult prevalence of poor diet, daily smoking and heavier alcohol consumption increased with ACE count and decreased with AAA support in childhood. Prevalence of having any two such behaviours increased from 1.8% (0 ACEs, AAA support, most affluent quintile of residence) to 21.5% (≥4 ACEs, lacking AAA support, most deprived quintile). However, the increase was reduced to 7.1% with AAA support (≥4 ACEs, most deprived quintile). Lower mental well-being was 3.27 (95% CIs, 2.16–4.96) times more likely with ≥4 ACEs and AAA support from someone you trust in childhood (vs. 0 ACE, with AAA support) increasing to 8.32 (95% CIs, 6.53–10.61) times more likely with ≥4 ACEs but without AAA support in childhood. Multiple health-harming behaviours combined with lower mental well-being rose dramatically with ACE count and lack of AAA support in childhood (adjusted odds ratio 32.01, 95% CIs 18.31–55.98, ≥4 ACEs, without AAA support vs. 0 ACEs, with AAA support). Conclusions: Adverse childhood experiences negatively impact mental and physical health across the life-course. Such impacts may be substantively mitigated by always having support from an adult you trust in childhood. Developing resilience in children as well as reducing childhood adversity are critical if low mental well-being, health-harming behaviours and their combined contribution to non-communicable disease are to be reduced. (Edited publisher abstract)
Postintervention and follow-up changes in caregiving behavior and representations after individually or group delivered hybrid Circle of Security-intensive intervention with New Zealand caregiver-child dyads
- Authors:
- HUBER Anna, et al
- Journal article citation:
- Attachment and Human Development, 23(6), 2021, pp.931-952.
- Publisher:
- Taylor and Francis
The Circle of Security Intensive intervention (COS-I) aims to improve child attachment security and reduce disorganisation by improving caregiver capacities, including caregiving behavior and representations. Research on COS-I effectiveness with these goals is limited and none examines if positive changes are sustained. A recently revised hybrid COS-I protocol (COS-I-RH) incorporates Circle of Security-Parenting (COS-P) material and individual or group delivery options. This study examined (1) post intervention and follow-up changes in caregiving behavior and representations after COS-I-RH and (2) if individual or group delivery moderated changes. New Zealand parent-child dyads with relationship concerns (n=36; child age M =35 months) referred to a community-based program completed COS-I-RH. Four caregiver capacities (supportive and unsupportive parenting (CTNES), parenting self-efficacy and satisfaction (PSOC)) were measured pre- and post-treatment, and one year later. Regardless of delivery mode, after COS-I-RH, parents showed large improvements on all 4 indices of caregiving behavior and representations, maintained at one-year follow-up. (Edited publisher abstract)
The informal culture of a direct care staff team supporting people with intellectual disabilities who present with behaviours that challenge
- Authors:
- BANKS Faye, et al
- Journal article citation:
- Tizard Learning Disability Review, 26(3), 2021, pp.160-168.
- Publisher:
- Emerald
Purpose: Research into culture within intellectual disability services, has predominantly focussed on small group homes in Australia. The current investigation aimed to explore the transferability of the dimensions of culture identified in the literature, to a residential Intellectual Disability service in the UK. The purpose of this study was to better understand the impact of informal culture upon the behaviour of direct care staff, particularly around managing behaviour that challenges. Design/methodology/approach: Semi-structured interviews were conducted with direct care staff. Interview transcripts were analysed thematically using template analysis. Findings: Themes regarding leadership, perceptions of managers, team functioning, and relationships between direct care staff and service users, were identified, corroborating the existing literature. Additional themes relating to being aware of the risks posed by service users, and the emotional impact of behaviour that challenges, also emerged. Originality/value: To the best of the authors’ knowledge, this is the first qualitative study to explore informal culture within a community residential Intellectual Disability service in the UK. (Edited publisher abstract)
Staying ‘Covid-safe’: proposals for embedding behaviours that protect against Covid-19 transmission in the UK
- Authors:
- MICHIE Susan, et al
- Journal article citation:
- British Journal of Health Psychology, 26(4), 2021, pp.1238-1257.
- Publisher:
- Wiley
Objectives: The Scientific Pandemic Insights group on Behaviours (SPI-B) as part of England’s Scientific Advisory Group on Emergencies (SAGE), were commissioned by the UK Cabinet Office to identify strategies to embed infection control behaviours to minimize Covid-19 transmission in the long term. Methods: With minimal direct evidence available, three sources of information were used to develop a set of proposals: (1) a scoping review of literature on sustaining behaviour change, (2) a review of key principles used in risk and safety management, and (3) prior reports and reviews on behaviour change from SPI-B. The information was collated and refined through discussion with SPI-B and SAGE colleagues to finalize the proposals. Results: Embedding infection control behaviours in the long-term will require changes to the financial, social, and physical infrastructure so that people in all sections of society have the capability, opportunity, and motivation needed to underpin those behaviours. This will involve building Covid-safe educational programmes, regulating to ensure minimum standards of safety in public spaces and workspaces, using communications and social marketing to develop a Covid-safe culture and identity, and providing resources so that all sections of society can build Covid-safe behaviours into their daily lives. Conclusions: Embedding ‘Covid-safe’ behaviours into people’s everyday routines will require a co-ordinated programme to shape the financial, physical, and social infrastructure in the United Kingdom. Education, regulation, communications, and social marketing, and provision of resources will be required to ensure that all sections of society have the capability, opportunity, and motivation to enact the behaviours long term. (Edited publisher abstract)
Implementation in residential youth care: providers perspectives on effective leadership behavior
- Authors:
- VASKINN Linda, et al
- Journal article citation:
- Residential Treatment for Children and Youth, 38(4), 2021, pp.381-403.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
Considering the high prevalence of mental health challenges among the residential youth care (RYC) population, it is imperative that research-informed interventions are implemented in this setting. However, little research is available regarding RYC implementation practices. Leadership is a vital influencer of implementation success. Therefore, the aim of this study was to further the knowledge base concerning effective implementation in RYC by investigating implementation leadership behavior. Utilizing qualitative methods, RYC providers were asked about effective implementation leadership behaviors, with an emphasis on similarities and variations in behavior enacted by different leadership levels within the organization. The results indicate that relations-oriented and task-oriented leadership behavior are more important than change-oriented implementation leadership behavior among the providers interviewed. The reported behaviors differed in terms of leadership level. The top executive leadership was more involved in task-oriented leadership behavior (i.e., monitoring activities, resource procurement), while the facility management was more involved with relations-oriented behaviors (i.e., providing support, facilitating cooperation). Finally, the results are discussed in light of RYC characteristics and implementation stages. (Edited publisher abstract)
Strategies and interventions to reduce or manage refusals in personal care in dementia: a systematic review
- Authors:
- BACKHOUSE Tamara, et al
- Journal article citation:
- International Journal of Nursing Studies, 109, 2020, p.103640.
- Publisher:
- Elsevier
Background: Refusals of care in dementia are common and can create difficult situations for caregivers. Little is known about the best way to manage them. Aim: To identify possible strategies and interventions to reduce or cope with refusals of care in dementia, and determine the evidence for these. Methods: This study searched MEDLINE, CINAHL, PsycINFO, EMBASE, AMED and Cochrane Central Register of Controlled Trials databases August 2018, with an updated search August 2019. An additional lateral search was conducted. Two researchers screened all records for potential eligibility and quality. Narrative synthesis was used to combine the findings. Results: Out of the 5953 records identified, 36 articles, relating to 30 studies, met the eligibility criteria. Twenty-eight of the studies (93%) were set in long-term care facilities, one in a psychogeriatric unit and one with community dwelling people. Fourteen out of the 30 studies focussed on general or mixed care activities, 8 bathing, 4 mealtimes, 2 medication administration, and 2 mouth care. Strategies or interventions identified as potential ways to reduce refusals included: music interventions, interaction and communication style, caregiver approach, bathing techniques, abilities focussed approaches, distraction approaches, and video-simulated presence of a loved one. There was most evidence for music interventions and different bathing techniques, and interaction and communication styles were associated with reduced refusals. There was no evidence that slow-stroke massage (mixed care activities) or aromatherapy (mixed care activities and medication administration) reduced refusals of care. Conclusions: Some non-pharmacological interventions can reduce, but not eliminate, refusals of care, such as playing music during care or communicating positively without using elderspeak. More research evidence is needed to underpin strategies identified as encouraging such as Namaste Care or distraction techniques. Future research should address gaps identified such as, the absence of research examining non-pharmacological interventions for refusals of care in hospital settings and in community settings with home-care workers, and the limited research involving family carers. (Edited publisher abstract)
Promoting volunteering among older adults in Hong Kong: a randomized controlled trial
- Authors:
- JIANG Da, et al
- Journal article citation:
- Gerontologist, 60(5), 2020, pp.968-977.
- Publisher:
- Oxford University Press
Volunteering has consistently been associated with better mental, physical, and cognitive health in older adulthood. However, the volunteering rate of older adults in Hong Kong is much lower than in Western countries. Few studies have examined whether interventions can be effective in motivating older adults to volunteer in Hong Kong. To fill this gap, we conducted a randomized controlled trial to examine the impact of a theory-based social-cognitive intervention on volunteering. Research Design and Methods: A total of 264 community-dwelling older adults in Hong Kong (Mage = 69.95 years, SDage = 6.90 years, 81.06% female) were randomly assigned to either an experimental group or an active control group. Participants in the experimental group received 4 weekly 1-hr face-to-face volunteering intervention sessions. Those in the active control group received parallel sessions targeting physical activity instead of volunteering. The time spent on volunteering per month was self-reported and measured at baseline, 6 weeks, 3 months, and 6 months after the intervention. Self-efficacy, intention, action planning, and self-monitoring of volunteering were measured as mediators. Results: Monthly volunteering minutes increased among participants in the experimental group when compared with the active control group at 6-week, 3-month, and 6-month follow-ups. Self-efficacy, intention, and action planning consistently mediated the effect of the intervention on volunteering minutes. Discussion and Implications: The findings demonstrate the effectiveness of the intervention on volunteering behavior in older adults in Hong Kong through well-established behavior change techniques. (Publisher abstract)