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Supporting staff working with people who challenge services: guidance for employers
- Authors:
- SKILLS FOR CARE, NATIONAL DEVELOPMENT FORUM FOR INCLUSION
- Publisher:
- Skills for Care
- Publication year:
- 2013
- Pagination:
- 52
- Place of publication:
- Leeds
This strategic guidance which has been developed in partnership with people, families, employers and commissioners to help with decision making around workforce development in the context of people who may challenge; is aimed at adult social care employers and commissioners working specifically with adults with a range of support and care needs such as older people with conditions across the dementia spectrum, people with mental health and personality conditions, and those with learning disabilities who have particularly complex needs and/or are labelled as challenging services. The guide will help employers with developing competency and expertise in providing support to people who challenge, across different groups. Following an Introduction outlining its purpose, the guide is arranged as follows: organisational actions; building workforce skills and knowledge; using learning tools and resources and identifying the best training solutions; specialist approaches: additional considerations for working with different people (learning disability, autism, mental health, older people, and multiple conditions); and useful contacts. (Edited publisher abstract)
The presence of behavioural and psychological symptoms and progression to dementia in the cognitively impaired older population
- Authors:
- van der LINDE Rianne M., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 28(7), 2013, pp.700-709.
- Publisher:
- Wiley
This study explores the predictive effect of the presence of behavioural and psychological symptoms (BPS) on the 2-year progression to dementia in a cognitively impaired population without dementia at baseline. Twelve symptoms were measured in 2024 participants from five areas of England and Wales. These included depression, apathy, anxiety, feelings of persecution, hallucination, agitated behaviour, irritability and wandering.The risk of progression to dementia was predicted in those with cognitive impairment for each individual BPS and using a BPS composite score. Wandering and persecution were independently associated with progression to dementia after adjustment for socio-demographic factors, cognitive domains and other BPS. When stratifying by cognitive function, those with low cognition (MMSE 0–18) and 4 or more BPS were more likely to progress to dementia than those without BPS. The predictive effect of BPS in dementia progression has implications for risk stratification of those at high risk of progression to dementia, along with memory impairment, other cognitive impairment and health variables. (Edited publisher abstract)
Dementia
- Authors:
- AMES David, BURNS Alistair, O'BRIEN John
- Publisher:
- Hodder Arnold
- Publication year:
- 2010
- Pagination:
- 828p.
- Place of publication:
- London
- Edition:
- 4th ed.
The new edition of this definitive work on dementia and related disorders has been fully updated and revised to reflect recent advances in this fast-moving field. The editors have brought together a team of the world's leading international experts and key opinion leaders on all aspects of the condition, from history, epidemiology and social aspects to the latest neurobiological research and advanced therapeutic strategies, to provide a broad perspective on this multifaceted problem. The new edition includes: the latest neurobiological research made relevant to everyday practice; a thorough review of all treatment strategies from drug and stem cell therapies through to psychosocial interventions; and a comprehensive review of carer support strategies, community care, long term care facilities, and behavioural management techniques. The book is expected to be of value to a wide audience including; specialists in old age psychiatry, neurology and care of the elderly, and all clinicians working with patients affected by dementia, including psychologists, occupational therapists, social workers and specialist nursing staff. (Winner of the BMA 2011 book awards: psychiatry category.)
Understanding behaviour in dementia that challenges: a guide to assessment and treatment
- Author:
- JAMES Ian Andrew
- Publisher:
- Jessica Kingsley
- Publication year:
- 2011
- Pagination:
- 176p.
- Place of publication:
- London
As people grow older, their physical and psychological needs become more complex. Unmet needs often result in challenging behaviour, particularly if the person suffers from dementia. This behaviour can significantly interfere with the quality of life of a person with dementia, as well as that of those who live with and care for them. The author looks beyond the behaviour itself to the causes. He suggests that challenging behaviours occur at times of distress and reflect an attempt to cope with difficult situations. Drawing on the voices of older people themselves the book works towards understanding the nature of this distress, touching on such issues as pain and lack of stimulation, companionship and autonomy. The author describes the different categories and causes of challenging behaviour in people with dementia, and provides models which will aid identification, assessment and treatment. A thorough evaluation of the use of psychotropic medication is provided, as well as of a wide range of psychological and biopsychosocial interventions. The book contains useful tools and protocols derived from the author's work at a specialist challenging behaviour unit, as well as case studies which demonstrate how the various models may be used in practice.
Affective disorders in older inpatients
- Authors:
- WETTERLING Tilman, JUNGHANNS Klaus
- Journal article citation:
- International Journal of Geriatric Psychiatry, 19(5), May 2004, pp.487-492.
- Publisher:
- Wiley
After dementia the group of depressive disorders is considered to be the second most common psychiatric disorder in the elderly. There is dispute regarding whether depression in the elderly differs from depression in the younger age groups by a longer duration of inpatient treatment, a more frequent occurrence of delusions, more cognitive impairment or by a more frequent co-occurrence of physical disease. This study aimed to compare younger with older inpatients with respect to these aspects. Retrospective chart review of all admissions to the psychiatric department of a General University Hospital (n=9400) and review of the documentation of 15 348 psychiatric consultations in the years 1990-1998. The clinical diagnoses were made according to the ICD-10 criteria. 15.5% of the psychiatric inpatients in this period suffered from depressive episodes (ICD-10 F31.3-31.5,32,33). The proportion of depressive episodes increased with age, making up 5.4% in the age group below 30 years and 37.4% in the age group of 70-79 years. On the basis of the ICD-10 criteria for the severity of depressive episodes no significant differences could be demonstrated between the younger (< 65 years) and the older inpatients ( 65 years). In particular, no higher frequency of psychotic symptoms with increasing age could be found. The length of inpatient treatment did not significantly differ between both age groups. The elder patients showed less suicidal attempts prior to admission and less psychiatric comorbidity, but a significantly higher rate of concurrent physical illness. In 923 inpatients a psychiatrist was consulted by the other medical departments because of a co-occurrence of physical with affective disorders, making up 8.6% of the total seen by the psychiatric consultation service. Here again, the proportion of depressive episodes increased with age. The pattern of the depressive episodes in these patients did not differ from that seen in the psychiatric inpatients. Only clinical diagnoses made by experienced psychiatrists were evaluated. According to these results older depressive inpatients differ from younger ones only with regard to concurrent comorbidity but not with respect to the duration of inpatient treatment or the pattern or severity of depressive symptoms. They more frequently suffered from physical illness but less often showed concurrent psychiatric comorbidity.
Validation of the Algase Wandering Scale (Version 2) in a cross cultural sample
- Authors:
- ALGASE D. L., et al
- Journal article citation:
- Aging and Mental Health, 8(2), March 2004, pp.133-142.
- Publisher:
- Taylor and Francis
This study examined the psychometric properties of an expanded version of the Algase Wandering Scale (Version 2) (AWS-V2) in a cross-cultural sample. A cross-sectional survey design was used. Study subjects were 172 English-speaking persons with dementia (PWD) from long-term care facilities in the USA, Canada, and Australia. Two or more facility staff rated each subject on the AWS-V2. Demographic and cognitive data (MMSE) were also obtained. Staff provided information on their own knowledge of the subject and of dementia. Separate factor analyses on data from two samples of raters each explained greater than 66% of the variance in AWS-V2 scores and validated four (persistent walking, navigational deficit, eloping behavior, and shadowing) of five factors in the original scale. Items added to create the AWS-V2 strengthened the shadowing subscale, failed to improve the routinized walking subscale, and added a factor, attention shifting as compared to the original AWS. Evidence for validity was found in significant correlations and ANOVAs between the AWS-V2 and most subscales with a single item indicator of wandering and with the MMSE. Evidence of reliability was shown by internal consistency of the AWS-V2 (0.87, 0.88) and its subscales (range 0.88 to 0.66), with Kappa for individual items (17 of 27 greater than 0.4), and ANOVAs comparing ratings across rater groups (nurses, nurse aids, and other staff). Analyses support validity and reliability of the AWS-V2 overall and for persistent walking, spatial disorientation, and eloping behavior subscales. The AWS-V2 and its subscales are an appropriate way to measure wandering as conceptualized within the Need-driven Dementia-compromised Behavior Model in studies of English-speaking subjects. Suggestions for further strengthening the scale and for extending its use to clinical applications are described.
Staff perceptions of successful management of severe behavioral problems in dementia special care units
- Authors:
- FOLEY Kristie long, et al
- Journal article citation:
- Dementia: the International Journal of Social Research and Practice, 2(1), February 2003, pp.105-124.
- Publisher:
- Sage
Factors that promote successful management of persons with severe behavioral problems in special care units (SCUs) for dementia were evaluated. Using qualitative data from staff interviews conducted in 36 nursing home SCUs, the study examined the relationships among demographic and behavioral characteristics of 70 residents, management techniques of the staff, and family participation in the management of persons with severe behavioral problems. Problem behaviors were often managed successfully in SCUs, although unpredictable aggression was particularly difficult to control and was a common reason for discharge.
Psychosis, depression and behavioural disturbances in Sydney nursing home residents: prevalence and predictors
- Authors:
- BRODATY Henry, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 16(5), May 2001, pp.504-512.
- Publisher:
- Wiley
Article aims to investigate: the prevalence of behavioural and psychological symptoms of dementia (BPSD) in nursing home residents; the relationships of BPSD with demographic, dementia, diurnal and nursing home variables; and the inter-relationships between different types of BPSD. Found that over 90% of residents exhibited at least one behavioural disturbance. Specifically, there was evidence of psychosis in 60%, depressed mood in 42% and activity disturbances or aggression in 82% of residents. Younger, more functionally impaired residents with a chart diagnosis of psychosis had higher BPSD rates, as did those residing in larger nursing homes. Individual BPSD were significantly intercorrelated. Concludes that BPSD are ubiquitous in nursing home residents. Behavioural disturbances are frequently associated with psychosis and/or depression. The findings suggest the need for psychogeriatric services to nursing homes and smaller facilities.
The effect of challenging behaviour, and staff support, on the psychological wellbeing of staff working with older adults
- Authors:
- COLE R.P., et al
- Journal article citation:
- Aging and Mental Health, 4(4), November 2000, pp.359-365.
- Publisher:
- Taylor and Francis
This study aimed to investigate the relationship between levels of challenging behaviour in older adults living in residential settings, the degree of staff support and the psychological wellbeing of staff. Fifty-one staff working in mental health and 45 staff working in nursing home settings rated residents on the frequency of 25 challenging behaviours, and completed measures of staff support and psychological wellbeing. Staff in the mental health settings had a higher level of perceived staff support than those working in the nursing home settings. Psychological wellbeing in staff was found to be positively correlated to the degree of staff support perceived by staff, and not related to levels of resident challenging behaviour. The implications of these findings, including the need to adopt a more psychological framework to care provision in nursing home settings, are discussed.
Predictors of comprehensive stimulation program efficacy in patients with cognitive impairment. Clinical practice recommendations
- Authors:
- BINETTI Giuliano, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 28(1), 2013, pp.26-33.
- Publisher:
- Wiley
This longitudinal study examined which factors best predict response to a comprehensive stimulation programme offered to patients with dementia and mild cognitive impairment (MCI) and their caregivers. A total of 145 Italian patients (55 with MCI and 90 with dementia), participating to a cognitive motor rehabilitation program, and their 131 caregivers, attending informational/psychoeducational interventions were followed for six months. Three alternative cognitive stimulation interventions were used: Reality Orientation Therapy, Global Reactivation Therapy, and Memory Training. Mini mental state examination, Alzheimer’s Disease Assessment Scale-Cognition, and Clinician’s Interview-Based Impression of Change-plus were the primary outcome measures. Sixty-eight (46.9%) of the 145 subjects were classified as clinical responders. At baseline, responders had a significantly less insight into impairment, greater functional capacity as well as fewer delusions, euphoria, and aberrant motor behaviours than the non-responder. After 6 months, along with an improvement in cognition, responders also showed decreased behavioural disturbances and severity of disturbances. During the analysis the caregiver's burden of distress remained stable; however after 6 months the burden of the caregivers of MCI responders was reduced. The authors conclude that a high level of insight, preserved functional abilities as well as the lack of severe delusions, euphoria, and aberrant motor behaviours are significant predictors of responsiveness to stimulation programmes.