Aging and Mental Health, 25(8), 2021, pp.1442-1451.
Publisher:
Taylor and Francis
Objectives: We investigated the 2-week prevalence and correlates of very frequent physical aggression (PA) and vocalizations in nursing home (NH)-residents with dementia. Method/Design: This cross-sectional study used combined data of 2074 NH-residents from four studies, collected from 119 dementia special care units in 26 Dutch NH. Very frequent PA was defined as scoring 6 or 7 on the items...
(Edited publisher abstract)
Objectives: We investigated the 2-week prevalence and correlates of very frequent physical aggression (PA) and vocalizations in nursing home (NH)-residents with dementia. Method/Design: This cross-sectional study used combined data of 2074 NH-residents from four studies, collected from 119 dementia special care units in 26 Dutch NH. Very frequent PA was defined as scoring 6 or 7 on the items ‘hitting’, pushing’, ‘biting’ and ‘kicking’ of the Cohen Mansfield Agitation Inventory; very frequent vocalizations as scoring 6 or 7 on ‘screaming’ and ‘making strange noises’. We compared NH-residents with very frequent PA or vocalizations with residents with less frequent PA or vocalizations, assessing correlates using univariate and multivariate multilevel logistic regression analyses. Results: We found a 2-week prevalence of 2.2% (95% confidence interval (CI): 1.63–2.89) of very frequent PA and 11.5% of very frequent vocalizations (95% CI: 10.23–12.98). Very frequent PA was only associated with apathy (odds ratio (OR)=1.93, 95% CI: 1.04–3.61). Correlates of very frequent vocalizations were age (OR = 0.97, 95% CI: 0.951–0.998), dementia severity (overall p-value 0.020), antipsychotic drug use (OR = 1.56, 95% CI: 1.08–2.26), antiepileptic drug use (OR = 2.75, 95% CI: 1.34–5.68) and euphoria (OR = 2.01, 95% CI: 1.22–3.31). Conclusion: Characteristics of NH-residents with very frequent PA or very frequent vocalizations differ from those of NH-residents with less frequent PA or vocalizations. Frontal lobe damage, boredom, pain and/or external factors may explain several of the found associations, but further research is necessary. Our findings may contribute to better care for these residents and thereby to improving their quality of life.
(Edited publisher abstract)
Aging and Mental Health, 25(7), 2021, pp.1314-1319.
Publisher:
Taylor and Francis
Objectives: From the perspective of the nursing home (NH) practitioners, to gain understanding of (1) whether challenging behavior in NH residents changed during the COVID-19 measures, (2) whether the practitioners’ involvement in the treatment of challenging behavior changed, (3) what can be learned from the experience of NH staff. Methods: A mixed methods study with a survey in 323 NH practitioners (psychologists, elderly care physicians, nurse practitioners) in the Netherlands, and in-depth interviews in 16 NH practitioners. Nonparametric analyses were used to compare estimated proportions of residents with increased and with decreased challenging behavior. Content analyses were conducted for open-ended questions and in-depth interviews. Results: Participants reported changes in challenging behavior with slightly higher proportions for increased (Q1/Mdn/Q3: 12.5%, 21.7%, 30.8%) than for decreased (8.7%, 14.8%, 27.8%, Z = –2.35, p = .019) challenging behavior. Half of the participants reported that their work load increased and work satisfaction worsened during the measures. Different strategies were described to respond to the effects of COVID-19 measures, such as video calls, providing special areas for residents to meet their loved ones, adjusting activities, and reducing the exposure to negative news. Conclusions: Because COVID-19 measures resulted in both increased and decreased challenging behavior in NH residents, it is important to monitor for their potential long lasting effects. Increased work load and worsened work satisfaction of the NH staff, together with the changes in type of challenging behavior, indicate that the harmful effects of the anti-pandemic measures should be taken seriously.
(Edited publisher abstract)
Objectives: From the perspective of the nursing home (NH) practitioners, to gain understanding of (1) whether challenging behavior in NH residents changed during the COVID-19 measures, (2) whether the practitioners’ involvement in the treatment of challenging behavior changed, (3) what can be learned from the experience of NH staff. Methods: A mixed methods study with a survey in 323 NH practitioners (psychologists, elderly care physicians, nurse practitioners) in the Netherlands, and in-depth interviews in 16 NH practitioners. Nonparametric analyses were used to compare estimated proportions of residents with increased and with decreased challenging behavior. Content analyses were conducted for open-ended questions and in-depth interviews. Results: Participants reported changes in challenging behavior with slightly higher proportions for increased (Q1/Mdn/Q3: 12.5%, 21.7%, 30.8%) than for decreased (8.7%, 14.8%, 27.8%, Z = –2.35, p = .019) challenging behavior. Half of the participants reported that their work load increased and work satisfaction worsened during the measures. Different strategies were described to respond to the effects of COVID-19 measures, such as video calls, providing special areas for residents to meet their loved ones, adjusting activities, and reducing the exposure to negative news. Conclusions: Because COVID-19 measures resulted in both increased and decreased challenging behavior in NH residents, it is important to monitor for their potential long lasting effects. Increased work load and worsened work satisfaction of the NH staff, together with the changes in type of challenging behavior, indicate that the harmful effects of the anti-pandemic measures should be taken seriously.
(Edited publisher abstract)
Journal of Social Welfare and Family Law, 43(2), 2021, pp.143-152.
Publisher:
Taylor and Francis
Place of publication:
Philadelphia, USA
By analysing the 2016 Japanese Supreme Court case concerning family caregivers’ liability for damages caused by a person with dementia who was killed by a train while wandering, this article suggests how to address similar cases in the future, considering the rights of persons with dementia to live in the community. The Court absolved the deceased’s wife and son from liability and defined four...
(Edited publisher abstract)
By analysing the 2016 Japanese Supreme Court case concerning family caregivers’ liability for damages caused by a person with dementia who was killed by a train while wandering, this article suggests how to address similar cases in the future, considering the rights of persons with dementia to live in the community. The Court absolved the deceased’s wife and son from liability and defined four criteria to find a person liable for damages: (a) the caregiver’s living, mental, and physical conditions; (b) the conditions of the caregiver’s involvement with a person with a mental disability; (c) the nature and incidence of the problematic behaviours of the person with a mental disability; and (d) the circumstances surrounding their supervision and care. This was the Supreme Court’s first presentation of the criteria for establishing liability for a ‘Person Equivalent to a Supervisor’. To guarantee the rights of a person with dementia to live in the community, the burden on family caregivers must be reduced, and the range of caregivers broadened to include non-family providers. The Court sought to reduce the caregivers’ burden, and if these criteria are applied appropriately, the human rights of dementia patients and caregivers will be protected.
(Edited publisher abstract)
Journal of Applied Research in Intellectual Disabilities, 34(1), 2021, pp.28-35.
Publisher:
Wiley
Background: Therapeutic untruths (TU) are used in dementia services to de‐escalate distressing situations. The present authors explored the use of TU by care staff supporting people with an intellectual disability who displayed behaviours that challenged. Method: Data were collected from 126 staff (female = 72.2%; mean age = 41.9 years, SD = 10.7) via an online survey in relation to three areas...
(Edited publisher abstract)
Background: Therapeutic untruths (TU) are used in dementia services to de‐escalate distressing situations. The present authors explored the use of TU by care staff supporting people with an intellectual disability who displayed behaviours that challenged. Method: Data were collected from 126 staff (female = 72.2%; mean age = 41.9 years, SD = 10.7) via an online survey in relation to three areas: responses to three scenarios, reported use of different forms of TU and ratings of perceived effectiveness of, and level of comfort using, each type. Results: 96% of participants reported using TU themselves and observing their colleagues doing likewise. Models that included perceived effectiveness of, and level of staff comfort with using, different TU were significant, although only perceived effectiveness significantly independently contributed to the model. Conclusion: The use of TU was common, with levels consistent with those found in dementia services. The limitations and implications of the findings are discussed.
(Edited publisher abstract)
A short publication providing information the behaviour changes someone may see in relation to supporting a person with learning disabilities who is living with dementia. It covers common changed behaviours as dementia progresses, understanding that all behaviours are a form of communication, ways to support a person to understand their behaviour and of supporting staff within the workplace...
(Edited publisher abstract)
A short publication providing information the behaviour changes someone may see in relation to supporting a person with learning disabilities who is living with dementia. It covers common changed behaviours as dementia progresses, understanding that all behaviours are a form of communication, ways to support a person to understand their behaviour and of supporting staff within the workplace. It is part of the Wellbeing for Life toolkit created for the MacIntyre Dementia project in order to promote understanding about getting older with a learning disability and living well with dementia.
(Edited publisher abstract)
Aging and Mental Health, 21(12), 2017, pp.1229-1247.
Publisher:
Taylor and Francis
Objective: This review aims to describe and examine existing Individualised formulation-led interventions managing challenging behaviours in people with dementia and to review their evidence.
Methods: PUBMED, PsycINFO [EBSCO] and CINAHL [EBSCO] databases were searched between February and April 2014 using key terms related to dementia, challenging behaviour and individualised formulation- led...
(Edited publisher abstract)
Objective: This review aims to describe and examine existing Individualised formulation-led interventions managing challenging behaviours in people with dementia and to review their evidence.
Methods: PUBMED, PsycINFO [EBSCO] and CINAHL [EBSCO] databases were searched between February and April 2014 using key terms related to dementia, challenging behaviour and individualised formulation- led interventions. The literature search was limited to German and English publications published from 1995. No limitations were placed on the type of paper, type of study design and stage of disease or setting. 37 relevant papers that met the inclusion criteria were included in this review.
Results: The literature review provided 14 different individualised formulation-led interventions. The effects on people with dementia were diverse, as only half of the studies showed a significant reduction in behaviours compared with the control group. Family caregivers felt less upset about the challenging behaviour and more confident in their ability to manage the behaviour.
Conclusion: There is a clear need for further research on individualised formulation-led interventions. The results of this review have the potential for developing interventions and for designing methodological robust evaluation studies that take into account the effectiveness of individualised formulation-led interventions on patient and caregiver outcomes.
(Edited publisher abstract)
Subject terms:
dementia, challenging behaviour, literature reviews, intervention;
Objectives: To estimate incidence, identify consequences and potential risk factors for harm in people with dementia who got lost in one UK policing region.
Methods: In a retrospective observational study, data were extracted from missing-person records over a four-year period in one UK policing region (population of 2.1 million).
Results: Two hundred and eighty-one incidents of getting lost were...
(Edited publisher abstract)
Objectives: To estimate incidence, identify consequences and potential risk factors for harm in people with dementia who got lost in one UK policing region.
Methods: In a retrospective observational study, data were extracted from missing-person records over a four-year period in one UK policing region (population of 2.1 million).
Results: Two hundred and eighty-one incidents of getting lost were identified. Incidence of getting lost was estimated at 0.5% of the regional dementia population. Fifty-nine percent of reports came from domestic settings, 29% from care homes/hospitals, and 12% on excursions from home. Five percent (n = 15) sustained significant harm, including two deaths. Average age was 78 years. Harm was associated with older age, length of time missing, and season (9% winter, 2% summer). The length of time missing increased with delays in reporting to police, getting lost at night, driving themselves, and using public transport.
Conclusion: Incidence in this study suggests getting lost is a low-frequency event for people with dementia but for a small minority, the risks are considerable. Exploratory analyses suggest individual and environmental factors increase the risk of harm. Suitable methods need to be developed to replicate these findings in larger prospective samples. A focus on the predictors of harm may aid development of assessment protocols to ensure intervention is proportionate.
(Edited publisher abstract)
Staff from an acute assessment unit at Birmingham and Solihull Mental Health Foundation Trust (BSMHFT) describe how they used the Newcastle model to help them work with Stephen, a man living with frontotemporal dementia and complex needs. The approach was used to help to address a number of Stephens behaviour problems - such as foot tapping, socially and sexually inappropriate behaviours and poor
(Original abstract)
Staff from an acute assessment unit at Birmingham and Solihull Mental Health Foundation Trust (BSMHFT) describe how they used the Newcastle model to help them work with Stephen, a man living with frontotemporal dementia and complex needs. The approach was used to help to address a number of Stephens behaviour problems - such as foot tapping, socially and sexually inappropriate behaviours and poor personal hygiene. Staff used the model to come together, share their concerns and formulate a plan. The approach was successful, resulting in a better quality of life for Stephen and also allowing him to be discharged to a care home.
(Original abstract)
Subject terms:
dementia, challenging behaviour, intervention, case studies;
Only a few studies have specifically considered the role of caregiver characteristics in the presence of behavioral and psychological symptoms of dementia (BPSD). This study examines whether there were differences in the presence of BPSD between community-dwelling dementia care recipients with spouse caregivers and those with non-spouse caregivers. One hundred and nine care recipients
(Edited publisher abstract)
Only a few studies have specifically considered the role of caregiver characteristics in the presence of behavioral and psychological symptoms of dementia (BPSD). This study examines whether there were differences in the presence of BPSD between community-dwelling dementia care recipients with spouse caregivers and those with non-spouse caregivers. One hundred and nine care recipients and their primary caregivers were recruited from memory clinic outpatients at the public psychiatric hospital in Sapporo City, Japan. Data were collected by questionnaire. Relationship with the care recipient was categorized as either ‘spouse’ or ‘non-spouse.’ The frequency of BPSD occurrence observed by the caregiver was assessed using the Troublesome Behavior Scale (TBS). Logistic regression analyses were performed to examine whether there were differences with regard to each of the 14 TBS items between spouse and non-spouse caregivers. The number of spouse caregivers was 47 (43.1%). TBS items presented by >50% care recipients were ‘repetition and/or clinging’ and ‘ill-natured denial and/or distortion.’ After adjustment for the characteristics of caregivers and care recipients, non-spouse caregivers were found to be significantly associated with the presence of ‘hiding and/or losing things,’ ‘rummaging,’ ‘crying and/or screaming,’ and ‘interfering with a happy home circle,’ compared with spouse caregivers. The results suggest that non-spouse caregivers need more support with regard to certain symptoms of individual BPSD compared with spouse caregivers. Identifying caregiver characteristics that are independently associated with each individual BPSD may help customise interventions for caregivers with specific characteristics.
(Edited publisher abstract)
Aging and Mental Health, 16(7), September 2012, pp.836-844.
Publisher:
Taylor and Francis
This study investigated the influence of ‘cognitive busyness’ on residential care staff attributions of challenging behaviour (CB) related to dementia. It was hypothesised that care staff experiencing competing cognitive demands at the time of observing CBs linked with dementia would be more likely to make internal and controllable attributions regarding the causes of such behaviour. Thirty...
This study investigated the influence of ‘cognitive busyness’ on residential care staff attributions of challenging behaviour (CB) related to dementia. It was hypothesised that care staff experiencing competing cognitive demands at the time of observing CBs linked with dementia would be more likely to make internal and controllable attributions regarding the causes of such behaviour. Thirty formal dementia care-workers viewed two video clips of simulated CB, one under conditions of cognitive ‘busyness’ and another under control conditions of no extra cognitive demands. Self-report measures of attributions were administered after the viewing of each video clip. Findings revealed that competing cognitive demands significantly influenced staff attributions regarding CB, in relation to internality and controllability, and type of CB emerged as a potential moderating factor. No link was found between cognitive busyness and other attributional dimensions. Implications for practice are discussed.
Subject terms:
older people, challenging behaviour, care workers, dementia;