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Physical restraints and associations with neuropsychiatric symptoms and personal characteristics in residential care: a cross-sectional study
- Authors:
- KURONEN Marja, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 32(12), 2017, pp.1418-1424.
- Publisher:
- Wiley
Background: Physical restraints are widely used in residential care. The objective was to investigate restraint use and its associations with neuropsychiatric symptoms and personal characteristics in residential care. Methods: Data were collected in the South Savo Hospital District from 66 of 68 public or private institutions providing long-term residential care. Nurses assessed the use of physical restraints and neuropsychiatric symptoms (NPS) included in the symptom list of the Neuropsychiatric Inventory (NPI). Drug use was obtained from medical records, and activities of daily living (ADL) were assessed by the nurses according to the Barthel Index. Results: The total number of persons in residential care was 1386. Any restraint was used for 721 patients (52%) in the preceding 24 h. Bedrails were the most common restraints. In the multivariate analysis, psychotic symptoms (OR 1.94, 95% CI 1.14–3.31) and use of benzodiazepines (OR 1.69, 95% CI 1.18–2.41) were positively associated with restraint use, whereas antipsychotic (OR 0.62, 95% CI 0.44–0.87) and antidepressant drug use (OR 0.64, 95% CI 0.45–0.90) and higher ADL score (OR 0.9, 95% CI 0.92–0.93) were negatively associated. Concomitant use of at least two restraints was associated with high prevalence of hyperactivity NPS symptoms. Conclusions: More than half of the residents were exposed to some physical restraint, most frequently bedrails, within the last 24 h. Psychotic symptoms and benzodiazepine use increased while good ADL and antipsychotic or antidepressant use decreased the risk of restraint use. Bedridden persons were the most frequently restrained which may pose an ethical problem. (Publisher abstract)
Quality of care reported by proxies – does resident cognition count?
- Authors:
- KAHANPAA Anja, NORO Anja, PERALA Marja-Leena
- Journal article citation:
- Dementia: the International Journal of Social Research and Practice, 18(7-8), 2019, pp.2543-2555.
- Publisher:
- Sage
Resident self-reports are considered the primary source of quality of care information, but proxy reports by family or staff can also be used to supplement or substitute resident reports. This study analyses how the results of proxy reports vary according to residents’ cognition level. The data set used covers proxy reports of family (n = 558) and staff (n = 801), divided by the availability of resident self-reports (family yes n = 289, no n = 269; staff yes 393, no = 408). Family and staff proxies assessed residents’ quality of care as better when resident self-reports were also available, and quality of care tended to be assessed as poorer among those with higher cognitive decline. The results of this methodological study indicate the importance of using several proxy evaluations; however, these can only supplement resident self-reports, not replace them. The interpretation rules acknowledging dependency between residents’ cognition and proxy assessments could be used as a basis for future comparisons of quality improvement in long-term care and for painting a more comprehensive picture of service quality. (Edited publisher abstract)
Factors associated with the quality of life of people with dementia and with quality of life-improving interventions: scoping review
- Authors:
- HOLOPAINEN Arja, et al
- Journal article citation:
- Dementia: the International Journal of Social Research and Practice, 18(4), 2019, pp.1507-1537.
- Publisher:
- Sage
Objectives: To synthesise current research exploring the factors and interventions associated with the quality of life of people with dementia. Background: Dementia is a progressive condition affecting an estimated 40 million people worldwide. The illness has a significant impact on the lives of the persons affected and their loved ones, and may thus impair the quality of life of both. As it progresses, dementia weakens the patients’ ability to express their own views about their quality of life and the factors associated with it. Design: Scoping review. Data sources: Electronic database search of MEDLINE, CINAHL, PsycINFO, Joanna Briggs Institute Library, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects (DARE), EMBASE, Medic published up to March 2016; and incremental hand search. Review method: Systematic or other kinds of reviews and single studies were included for the review if they met the inclusion criteria. Results: A total of 20 reviews and 7 primary studies were retained for synthesis. Key findings were abstracted and a themes matrix was generated to identify patterns of meaning. The factors associated with the quality of life of people with dementia were sociodemographic factors, factors related to dementia and social and caring environment. Interventions supporting quality of life focused on the activation of people with dementia. Conclusions: This scoping review identified a large body of knowledge exploring the factors and interventions associated with the quality of life of people with dementia. The interventions were heterogeneous and the sample sizes small, which is why more research is needed. (Edited publisher abstract)
Cognitive mobile games for memory impaired older adults
- Authors:
- MERILAMPI Sari, et al
- Journal article citation:
- Journal of Assistive Technologies, 8(4), 2014, pp.207-223.
- Publisher:
- Emerald
Purpose: Cognitive self-rehabilitation lacks updated means and tools. The purpose of this paper is to evaluate the effect of cognitively simulating mobile games on the cognitive skills and recreation of older people with memory impairment. Design/methodology/approach: Mobile games that require cognitive skills were developed. The games were tested by memory-impaired older adults, average age of 90. Gaming interventions took place for three months on a daily basis. Game outcomes were automatically recorded and user feedback was collected by interviews. The progress of the testees was also evaluated by means of Trial Making Test A. Findings: Improvement in game scores was found. Other significant effects of game play were enhanced recreation and self-managed activity level. Game play did not have any effect on the traditional Trail Making Test results but the results of the Trail Making game showed improvement. The Trail Making game also showed a large variance in daily scores, which implies that performing just a single Trail Making Test might lead to misreading a person's condition. Research limitations/implications: The results are an encouragement for conducting further testing (on a larger test group, over a longer time) and continuing with game development for cognitively impaired older adults. A similar game trial will also be arranged for a younger population with better overall health condition. Practical implications: New business opportunities are also possible in game development and gaming services. Social implications: Games have the potential for self-rehabilitation and to support extending independent living at home. Originality/value: The paper provides a synopsis of novel cognitive recreation tools, an analysis of their effect and user feedback from professional staff as well as potential new ideas for game developers. (Publisher abstract)
Neuropsychiatric symptoms and quality of life in patients with very mild and mild Alzheimer's disease
- Authors:
- KARTTUNEN Kristina, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 26(5), May 2011, pp.473-482.
- Publisher:
- Wiley
The prevalence of neuropsychiatric symptoms (NPS) is believed to range from 50 to 90% in Alzheimer' s disease (AD). Studies suggest that a high proportion of subjects with mild cognitive impairment display clinically meaningful NPS. This study examined the prevalence and significance of NPS in very mild and mild AD patients focusing on their influence on the well-being of the patients and their caregivers. A total of 240 Finnish patient-caregiver dyads were enrolled. Assessment scales included three Quality of Life (QoL) instruments; generic 15D, disease-specific QoL-AD and Visual Analog Scale (VAS). NPS were present in 76.5% of patients with very mild AD and in 84.9% of patients with mild to moderate AD. The most frequent symptoms were apathy, depression, irritability, and agitation. The strongest predictor of self-reported QoL-AD scores was depressive symptoms whereas functional decline and presence of NPS predicted poor caregiver ratings of patients' QoL. However, caregiver depression also influenced their ratings. The authors conclude that NPS are common even in the early stages of AD. NPS were significantly associated with caregiver assessment of the patient's QoL but not with patients' self-assessed QoL. Depression decreases QoL, but may remain unrecognised in AD patients, emphasising the need for careful assessment of NPS before deciding on the treatment.