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Observing wandering-related boundary transgression in people with severe dementia
- Authors:
- MacANDREW Margaret, et al
- Journal article citation:
- Aging and Mental Health, 21(11), 2017, pp.1197-1205.
- Publisher:
- Taylor and Francis
Objectives: Wandering-related boundary transgression (BT) in long term care (LTC) frequently manifests as intrusion into another resident's bedroom and is associated with adverse outcomes (loss of privacy, resident-to-resident altercations, and becoming lost). This observational study is the first to empirically describe the characteristics of wandering-related BT in LTC residents with severe dementia. Method: Using real-time observation, seven independently ambulant residents with severe dementia and a positive history of wandering and BT were observed for a minimum of twelve 30 minute periods randomised over two non-consecutive days (n=92 observation periods). Frequency and duration of locomoting/non-locomoting phases and BT (entry into out of bounds/private space), patterns of ambulation (direct, random, pacing, and lapping), and activities observed during BT were measured during observation periods. Results: Across 431 locomoting phases, 58 (13%) resulted in a BT and the bedroom of another resident was most frequently (86%) involved. BT was statistically associated with random ambulation and peak activity periods, and was observed more often in those with more frequent ambulation. Most BT events were unwitnessed by others and occurred when the participant was alone. Conclusions: Describing BT has increased understanding of when, where, and how BT occurs and provides background for future intervention research. (Publisher abstract)
Prevalence, presentation and prognosis of delirium in older people in the population, at home and in long term care: a review
- Authors:
- DE LANGE E., VERHAAK P.F.M., VAN DER MEER K.
- Journal article citation:
- International Journal of Geriatric Psychiatry, 28(2), 2013, pp.127-134.
- Publisher:
- Wiley
Although delirium is relatively common in hospitals, especially in intensive, post-operative and palliative care, its prevalence in the general population is only about 1-2%. The aim of this systematic review was to provide an overview, with the GP in mind, of prevalence, symptoms, risk factors and prognosis of delirium in primary care and institutionalised long-term care. The evidence confirms that the prevalence of delirium among the elderly aged 65+ years is 1–2%. It rises with age, reaching about 10% among a “general” population aged 85+ years. In populations with higher proportions of demented elders prevalence can be 22%. In long-term care, it ranges between 1.4% and 70%, depending on diagnostic criteria and on the prevalence of dementia. Age and cognitive decline are significant risk factors for delirium in all groups. In terms of prognosis, most studies agree that older people who previously experienced delirium have a higher risk of dementia and a higher mortality rate. Population and long-term care studies confirm this tendency. The authors conclude that although delirium in a non-selected population aged over 65 years is uncommon, prevalence rises quickly in selected older groups. They emphasise the need for primary care doctors to be aware of a relatively high risk of delirium among the elderly in long-term care, those over 85 years and those with dementia.
Aggression exhibited by older dementia clients toward staff in Japanese long-term care
- Authors:
- KO Ayako, et al
- Journal article citation:
- Journal of Elder Abuse and Neglect, 24(1), January 2012, pp.1-16.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
Aggression as a symptom of dementia is often directed at the caregivers of dementia clients. This study investigated the experiences of staff members from seven Japanese hospitals who had been treated aggressively by older dementia clients. Altogether, 170 questionnaires were analysed. Findings revealed that, over the course of one year, 75% of staff members had experienced physical aggression and 64% verbal aggression. Working numerous night shifts, working shifts other than 3-shifts, and being allotted assignments with clients who had a lower average level of physical capacity were the factors associated with recurrent client aggression. Those staff members who spent adequate time caring for their clients, who gained client consent before providing care, and who tried to build a trusting relationship with their clients were found to have experienced less aggression. Stress, which was likely to enhance the risk of the staff mistreatment and neglect of older clients, was found to be higher among those who experienced aggression. Implications for practice are discussed.
Bathing people with dementia: the bathroom and beyond
- Author:
- JENKINS Deirdre A.L.
- Publisher:
- University of Stirling. Dementia Services Development Centre
- Publication year:
- 1998
- Pagination:
- 40p.
- Place of publication:
- Stirling
This publication, written for front line staff in long term care settings, provides a insight about the issues which arise in helping people with dementia bathe. Easy to read, with humour, it can help caregivers to make bathing a positive experience for patients with dementia.
Quality of life in dementia patients in long term care
- Authors:
- GONZALEZ-SALVADOR Teresa, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 15(2), February 2000, pp.181-189.
- Publisher:
- Wiley
This project evaluates variables associated with the quality of life (QOL) in dementia residents in a long term care facility using a recently standardised and validated dementia-specific QOL scale (ADRQL). Results found that residents exhibited better QOL than expected. Suggests that future longitudinal studies address: reorientation, activity therapy, treatment of depression, and avoidance of benzodiazepines might improve QOL in this population. Interventions that might improve orientation and physical abilities, such as cholinomimetic therapies, psychosocial intervention or behavioural strategies, should also be studied in future research on QOL.
Severe dementia: the provision of longstay care
- Author:
- NORMAN Alison
- Publisher:
- Centre for Policy on Ageing
- Publication year:
- 1987
- Pagination:
- 271p.
- Place of publication:
- London
Supportive care for older people with dementia: socio-organisational implications
- Authors:
- MIELE Francesco, et al
- Journal article citation:
- Ageing and Society, 42(2), 2022, pp.376-408.
- Publisher:
- Cambridge University Press
For many years, dementia care has been dominated by the standard medical approach, in which dementia is treated mainly with drugs, such as anti-anxiety, antidepressant and anti-psychotic medications. With the aim of seeking effective treatments for patients with dementia, over the last years, several contributions have criticised the pervasive use of drugs for the management of behavioural and physiological symptoms related to dementia, proposing personalised interventions aimed at supporting patients and their relatives from diagnosis until death. With particular reference to long-term settings, this work is aimed at understanding the organisational implications of three types of interventions (labelled supportive care interventions - SCIs) that have characterised this shift in dementia care: person-centred, palliative and multi-disciplinary care. Conducted by following the integrative review method, this review underlines how SCIs have controversial consequences on the quality of care, the care-givers’ quality of life and cultural backgrounds. After an in-depth analysis of selected papers, this paper offers some considerations about the implications of SCIs for long-term care organisations and future research directions. (Edited publisher abstract)
Factors associated with SARS-CoV-2 infection and outbreaks in long-term care facilities in England: a national cross-sectional survey
- Authors:
- SHALLCROSS Laura, et al
- Journal article citation:
- Lancet Healthy Longevity, early cite 11 February 2021,
- Publisher:
- Elsevier
Background: Outbreaks of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have occurred in long-term care facilities (LTCFs) worldwide, but the reasons why some facilities are particularly vulnerable to outbreaks are poorly understood. This study aimed to identify factors associated with SARS-CoV-2 infection and outbreaks among staff and residents in LTCFs. Methods: This study did a national cross-sectional survey of all LTCFs providing dementia care or care to adults aged 65 years or older in England between May 26 and June 19, 2020. The survey collected data from managers of eligible LTCFs on LTCF characteristics, staffing factors, the use of disease control measures, and the number of confirmed cases of infection among staff and residents in each LTCF. Survey responses were linked to individual-level SARS-CoV-2 RT-PCR test results obtained through the national testing programme in England between April 30 and June 13, 2020. The primary outcome was the weighted period prevalence of confirmed SARS-CoV-2 infections in residents and staff reported via the survey. Multivariable logistic regression models were fitted to identify factors associated with infection in staff and residents, an outbreak (defined as at least one case of SARS-CoV-2 infection in a resident or staff member), and a large outbreak (defined as LTCFs with more than a third of the total number of residents and staff combined testing positive, or with >20 residents and staff combined testing positive) using data from the survey and from the linked survey–test dataset. Findings: 9081 eligible wLTCFs were identified, of which 5126 (56·4%) participated in the survey, providing data on 160 033 residents and 248 594 staff members. The weighted period prevalence of infection was 10·5% (95% CI 9·9–11·1) in residents and 3·8% (3·4–4·2) in staff members. 2724 (53·1%) LTCFs reported outbreaks, and 469 (9·1%) LTCFs reported large outbreaks. The odds of SARS-CoV-2 infection in residents (adjusted odds ratio [aOR] 0·80 [95% CI 0·75–0·86], p<0·0001) and staff (0·70 [0·65–0·77], p<0·0001), and of large outbreaks (0·59 [0·38–0·93], p=0·024) were significantly lower in LTCFs that paid staff statutory sick pay compared with those that did not. Each one unit increase in the staff-to-bed ratio was associated with a reduced odds of infection in residents (0·82 [0·78–0·87], p<0·0001) and staff (0·63 [0·59–0·68], p<0·0001. The odds of infection in residents (1·30 [1·23–1·37], p<0·0001) and staff (1·20 [1·13–1·29], p<0·0001), and of outbreaks (2·56 [1·94–3·49], p<0·0001) were significantly higher in LTCFs in which staff often or always cared for both infected or uninfected residents compared with those that cohorted staff with either infected or uninfected residents. Significantly increased odds of infection in residents (1·01 [1·01–1·01], p<0·0001) and staff (1·00 [1·00–1·01], p=0·0005), and of outbreaks (1·08 [1·05–1·10], p<0·0001) were associated with each one unit increase in the number of new admissions to the LTCF relative to baseline (March 1, 2020). The odds of infection in residents (1·19 [1·12–1·26], p<0·0001) and staff (1·19 [1·10–1·29], p<0·0001), and of large outbreaks (1·65 [1·07–2·54], p=0·024) were significantly higher in LTCFs that were for profit versus those that were not for profit. Frequent employment of agency nurses or carers was associated with a significantly increased odds of infection in residents (aOR 1·65 [1·56–1·74], p<0·0001) and staff (1·85 [1·72–1·98], p<0·0001), and of outbreaks (2·33 [1·72–3·16], p<0·0001) and large outbreaks (2·42 [1·67–3·51], p<0·0001) compared with no employment of agency nurses or carers. Compared with LTCFs that did not report difficulties in isolating residents, those that did had significantly higher odds of infection in residents (1·33 [1·28–1·38], p<0·0001) and staff (1·48 [1·41–1·56], p<0·0001), and of outbreaks (1·84 [1·48–2·30], p<0·0001) and large outbreaks (1·62 [1·24–2·11], p=0·0004). Interpretation: Half of LTCFs had no cases of SARS-CoV-2 infection in the first wave of the pandemic. Reduced transmission from staff is associated with adequate sick pay, minimal use of agency staff, an increased staff-to-bed ratio, and staff cohorting with either infected or uninfected residents. Increased transmission from residents is associated with an increased number of new admissions to the facility and poor compliance with isolation procedures. (Edited publisher abstract)
Risk factors related to the admission of people with dementia into a long-term care institution in Spain: an explorative study
- Authors:
- RISCO Ester, et al
- Journal article citation:
- Ageing and Society, 38(1), 2018, pp.192-211.
- Publisher:
- Cambridge University Press
Risk factors associated with admission of people with dementia to long-term care institutions need to be identified to support health-care professionals in dementia care at home. An explorative study, combining quantitative and qualitative data collection methods, was performed in people with dementia in Spain. The sample, consisting of people with dementia receiving formal care from health-care professionals but at risk of institutionalisation, and their informal care-givers; and people with dementia recently admitted to a long-term care institution, and their informal care-givers, was interviewed between November 2010 and April 2012. Perceived reasons for admission were determined through an open-ended question put to both groups. Presumed risk factors were collected with validated questionnaires and analysed using bivariate analysis. A total of 287 people with dementia and informal care-givers were studied. Reasons given by the institutionalised group were mostly related to the level of dependency of the person with dementia. People recently admitted to a long-term care institution had more cognitive impairment, a greater degree of dependency and poorer quality of life than those still living at home. Home-care services in Spain need to develop or improve interventions based on the risk factors identified in this study: informal care-giver profile, high cognitive impairment, high level of dependency and the poor quality of life of the person with dementia. (Publisher abstract)
From wandering to wayfaring: reconsidering movement in people with dementia in long-term care
- Author:
- GRAHAM Megan E.
- Journal article citation:
- Dementia: the International Journal of Social Research and Practice, 16(6), 2017, pp.732-749.
- Publisher:
- Sage
The movement of people with dementia in long-term care continues to be an issue of concern among clinicians, caregivers and families. This article will examine the social construction “wandering” and its association with pathology, risk discourse and surveillance technologies. Further, the article will explore the recent shift from the term “wanderer” to the phrase “people who like to walk” in person-centred dementia care. Engaging with Ingold’s concept of movement as wayfaring, an alternative becoming-centred understanding of movement and its significance for people with dementia will be presented and illustrated through a case study. The paper concludes that depathologizing movement opens the possibility to see movement in people with dementia as an intention to be alive and to grow, rather than as a product of disease and deterioration. Suggestions for future research and implications for care interventions are discussed. (Publisher abstract)