International Journal of Geriatric Psychiatry, 31(9), 2016, pp.1056-1063.
Publisher:
Wiley
Background: Previous research shows that nonpharmacological strategies may effectively manage behavioural symptoms (agitation, wandering) in persons with dementia and improve caregiver wellbeing. However, strategies depend upon caregivers for their implementation. This study examines the impact of caregiver readiness to use nonpharmacological strategies on treatment outcomes.
Methods: Data were
(Edited publisher abstract)
Background: Previous research shows that nonpharmacological strategies may effectively manage behavioural symptoms (agitation, wandering) in persons with dementia and improve caregiver wellbeing. However, strategies depend upon caregivers for their implementation. This study examines the impact of caregiver readiness to use nonpharmacological strategies on treatment outcomes.
Methods: Data were from a randomized trial involving 110 family caregivers in the treatment group which received nonpharmacologic strategies for managing behavioural symptoms. Interventionists rated caregiver readiness to use nonpharmacologic strategies as pre-action (precontemplation, contemplation, preparation) or action at treatment initiation and conclusion. Caregivers in pre-action and action stages by treatment conclusion (16 weeks) were compared on proximal (frequency of, and caregiver upset and confidence with targeted behaviours) and more distal (caregiver burden and wellbeing) outcomes at 16 and 24-week follow-ups.
Results: By treatment conclusion, 28.2% (n = 31) and 71.8% (n = 79) of caregivers were rated at pre-action and action respectively. Means for proximal outcomes differed between the groups at 16 and 24 weeks; those at action showed greater improvement on all proximal and distal outcomes. Hierarchical regressions showed significant relationships of readiness to targeted outcomes. By 24 weeks, caregiver readiness predicted lower frequency estimates of targeted behaviours and higher confidence. Readiness was not a significant predictor of caregiver burden and wellbeing at 16 or 24 weeks.
Conclusion: By treatment conclusion, >25% of participants were not activated to use nonpharmacologic strategies. Activated caregivers reported greater decline in distressing behavioural symptoms, and more confidence than non-activated participants. Activation is needed to impact behavioural management but not other caregiver outcomes.
(Edited publisher abstract)
Journal of Alzheimer’s Disease, 62(1), 2018, pp.99-113.
Publisher:
IOS Press
Place of publication:
Amsterdam
... PsycINFO, EMBASE, and AMED databases. An additional lateral search including reference lists was conducted. Two researchers screened all records for potential eligibility. Narrative synthesis was used to bring together the findings. Results:Out of the 5,544 records identified, 24 articles (18 distinct studies) met the eligibility criteria. Aggression and agitation were the most common behaviors present or for referrals to psychiatric community services. Lack of consistency in assessment of behavior, and management of agitation/aggression in dementia crises were evident. Conclusion:Interventions to reduce the likelihood of people with dementia-related behaviors reaching crisis point need to focus on both family and care home settings and incorporate aggression and agitation management. Future research should
(Edited publisher abstract)
Background:Behavioral crises in dementia are represented by a wide variety of symptoms, regularly require external intervention from professionals, and are reported as a risk factor for hospital admission. Little is known about the factors that are associated with them. Objective:To determine the factors associated with dementia-related behavioral crises. Methods:We searched MEDLINE, CINAHL, PsycINFO, EMBASE, and AMED databases. An additional lateral search including reference lists was conducted. Two researchers screened all records for potential eligibility. Narrative synthesis was used to bring together the findings. Results:Out of the 5,544 records identified, 24 articles (18 distinct studies) met the eligibility criteria. Aggression and agitation were the most common behaviors present at crises. Delusions, wandering/absconding, and hallucinations were also key behaviors contributing to crises. Behavioral crises predominantly happened in the severe stages of dementia (according to MMSE scores), in people with dementia residing in their own homes and in long-term care, and were the catalyst for admissions to psychiatric inpatient settings, specialist-care units, long-term care settings, or for referrals to psychiatric community services. Lack of consistency in assessment of behavior, and management of agitation/aggression in dementia crises were evident. Conclusion:Interventions to reduce the likelihood of people with dementia-related behaviors reaching crisis point need to focus on both family and care home settings and incorporate aggression and agitation management. Future research should focus on determining the factors that could be addressed to prevent behavioral crises and the interventions and models of care that may help to prevent crises.
(Edited publisher abstract)
Dementia: the International Journal of Social Research and Practice, 16(6), 2017, pp.689-710.
Publisher:
Sage
Depression, agitation, and wandering are common behaviours associated with dementia and frequently observed among nursing home residents. Even with pharmacological treatment, behaviours often persist, hindering quality of life for elders, their family, and paid caregivers. This study examined the use of music therapy for treatment of these symptoms among 132 people with moderate to severe dementia in nursing homes. Participants were evaluated for depressive symptoms, agitation, and wandering to determine their predominate behaviour. There were two assessments, two weeks apart, prior to intervention, followed by a two-week intervention, and two follow-up assessments, also two weeks apart. A repeated measures ANOVA determined that after two weeks of music therapy, symptoms of depression and agitation were significantly reduced; there was no change for wandering. Multivariate analyses confirmed a relationship between music therapy and change in neuropsychiatric symptoms associated with dementia. Results suggest widespread use of music therapy in long-term care settings may be effective in reducing symptoms of depression and agitation.
(Edited publisher abstract)
Depression, agitation, and wandering are common behaviours associated with dementia and frequently observed among nursing home residents. Even with pharmacological treatment, behaviours often persist, hindering quality of life for elders, their family, and paid caregivers. This study examined the use of music therapy for treatment of these symptoms among 132 people with moderate to severe dementia in nursing homes. Participants were evaluated for depressive symptoms, agitation, and wandering to determine their predominate behaviour. There were two assessments, two weeks apart, prior to intervention, followed by a two-week intervention, and two follow-up assessments, also two weeks apart. A repeated measures ANOVA determined that after two weeks of music therapy, symptoms of depression and agitation were significantly reduced; there was no change for wandering. Multivariate analyses confirmed a relationship between music therapy and change in neuropsychiatric symptoms associated with dementia. Results suggest widespread use of music therapy in long-term care settings may be effective in reducing symptoms of depression and agitation.
(Edited publisher abstract)
... with their teams to implement STAR-VA with Veterans identified to have challenging dementia-related behaviours. The frequency and severity of target behaviours and symptoms of depression, anxiety, and agitation were evaluated at baseline and at intervention completion. Staff provided feedback regarding STAR-VA feasibility and impact.
Results: Seventy-one Veterans completed the intervention. Behaviours clustered into 6 types: care refusal or resistance, agitation, aggression, vocalisation, wandering, and other. Frequency and severity of target behaviours and symptoms of depression, anxiety, and agitation all significantly decreased, with overall effect sizes of 1 or greater. Staff rated both benefits for Veterans and program feasibility favourably.
Implications: This evaluation supports the feasibility
(Edited publisher abstract)
Purpose of the Study: Nonpharmacological, psychosocial approaches are first-line treatments for managing behavioural symptoms in dementia, but they can be challenging to implement in long-term care settings. The Veterans Health Administration implemented STAR-VA, an interdisciplinary behavioural approach for managing challenging dementia-related behaviours in its Community Living Center (CLCs, nursing home care) settings. This study describes how the programme was implemented and provides an evaluation of Veteran clinical outcomes and staff feedback on the intervention.
Design and Methods: One mental health professional and registered nurse team from 17 CLCs completed STAR-VA training, which entailed an experiential workshop followed by 6 months of expert consultation as they worked with their teams to implement STAR-VA with Veterans identified to have challenging dementia-related behaviours. The frequency and severity of target behaviours and symptoms of depression, anxiety, and agitation were evaluated at baseline and at intervention completion. Staff provided feedback regarding STAR-VA feasibility and impact.
Results: Seventy-one Veterans completed the intervention. Behaviours clustered into 6 types: care refusal or resistance, agitation, aggression, vocalisation, wandering, and other. Frequency and severity of target behaviours and symptoms of depression, anxiety, and agitation all significantly decreased, with overall effect sizes of 1 or greater. Staff rated both benefits for Veterans and program feasibility favourably.
Implications: This evaluation supports the feasibility and effectiveness of STAR-VA, an interdisciplinary, behavioural intervention for managing challenging behaviours among residents with dementia in CLCs.
(Edited publisher abstract)
Dementia: the International Journal of Social Research and Practice, 9(3), August 2010, pp.355-373.
Publisher:
Sage
... modelling was used to assess the impact of visiting a wander garden on monthly agitation levels of a group of elderly veterans diagnosed with dementia, with attention to their ambulatory ability. A sample of 34 veterans residing in a locked ward in a dementia unit was observed for a baseline period and for twelve months after a wander garden was opened in their facility. Results indicated that visiting the wander garden helped lower agitation levels in the dementia patients and that there was a differential effect based on the patient’s ability to walk unassisted.
An important area within the field of geriatrics is the long-term care of elderly people who have developed dementia disorders such as Alzheimer’s disease. Those who suffer from moderate to advance dementia with behavioural problems are often placed in locked wards where caregivers attempt to provide them with a safer environment. A growth model within the framework of hierarchical linear modelling was used to assess the impact of visiting a wander garden on monthly agitation levels of a group of elderly veterans diagnosed with dementia, with attention to their ambulatory ability. A sample of 34 veterans residing in a locked ward in a dementia unit was observed for a baseline period and for twelve months after a wander garden was opened in their facility. Results indicated that visiting the wander garden helped lower agitation levels in the dementia patients and that there was a differential effect based on the patient’s ability to walk unassisted.
Challenging behaviour is a catch-all term that, in the context of dementia, includes one or combinations of shouting, wandering, biting, throwing objects, repetitive talking, destroying personal possessions and other objects, agitation and general anger, physical attacks on others, and waking others at night. In short, this term describes any behaviour by patients that is deemed to be dangerous
Challenging behaviour is a catch-all term that, in the context of dementia, includes one or combinations of shouting, wandering, biting, throwing objects, repetitive talking, destroying personal possessions and other objects, agitation and general anger, physical attacks on others, and waking others at night. In short, this term describes any behaviour by patients that is deemed to be dangerous to themselves, their fellow patients, and staff, or is considered antisocial within environments where those patients have to coexist with others on a long term basis.
Subject terms:
residential care, social workers, staff, training, wandering, behaviour modification, challenging behaviour, children, conduct disorders, day services, dementia, agitation;