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Minimising the use of restraint in care homes for older people: creative approaches
- Author:
- SOCIAL CARE INSTITUTE FOR EXCELLENCE
- Publisher:
- Social Care Institute for Excellence
- Publication year:
- 2010
- Place of publication:
- London
Exploring the case of an unsettled new care home resident, this video shows how finding out more about a person’s life story provides clues to new approaches to care. There is an interview with the care home manager who describes what happened in this particular case and how, by providing relevant activities for the resident, it was possible to take him off antipsychotic drug treatment. The National Director of the National Association of Providers of Activities for Older People (NAPA) also encourages care home managers to support their staff in examining routine care practices. Staff can be empowered to look at what is going on and to make creative changes to the care they provide. Other interviews include the Director of Dementia Care for BUPA and the new Clinical Director for Older People.
Bathing in residential care: understanding the experiences of residents and their care providers
- Authors:
- HOLROYD Ann, HOLROYD Heather
- Journal article citation:
- Quality in Ageing and Older Adults, 16(2), 2015, pp.106-117.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to understand how changes in an older adult’s physical capacity alter their bathing preferences, how the care environment incorporates residents’ values and beliefs around bathing to fulfil these changing care needs, and how institutional factors, such as staff scheduling and communication processes, influence Resident Care Aides’ (RCAs) bathing practices. Design/methodology/approach: A multiple methods approach involving surveys and interviews with residents and RCAs in a Canadian residential care facility. This paper draws mostly from the semi-structured, qualitative interviews with older adult residents (n=9; Mini Mental Status Exam (MMSE) scores > 15) and RCAs (n=10) on two nursing units offering different bathing options. Findings: Decreasing energy levels and physical decline were commonly cited reasons for residents’ changing bathing preferences. Residents were overall very appreciative of the bathing care they received in residential care, and identified the weekly tub bath as an anticipated encounter where they experienced a valued social interaction with their assigned RCA. While identifying bathing as an occasionally stressful aspect of their work, RCAs also described the bathing experience as an intimate bonding activity. The study identified bathing as an important activity in residential care. Originality/value: Previous studies have focused on moderate to severely cognitively impaired older adults’ and their demonstration of agitated behaviours during bathing. Most participants in this study had only minor cognitive impairment, as measured by MMSE scores (average score=20.6); therefore, this study provides insight into the experiences and needs of older adults whose perspective is not generally reflected in the literature. (Publisher abstract)
Managing agitated behaviour in people with Alzheimer's disease: the role of live music
- Authors:
- COX Elissa, NOWAK Madeleine, BUETTNER Petra
- Journal article citation:
- British Journal of Occupational Therapy, 74(11), November 2011, pp.517-524.
- Publisher:
- Sage
Agitation due to Alzheimer's disease (AD) presents a challenge to occupational therapists working in the older people's care sector. The therapeutic value of music is not new but background music and music therapy are emerging as promising tools in the management of agitation in AD. This exploratory study investigated whether individually focused live music could reduce agitated behaviour in this group. This quasi-experimental one-group design investigated the effect of a live, one-to-one, musical violin intervention (evidence suggests the most effective intervention is not heavily percussive) on agitated behaviour in people with moderate-severe AD in a residential care setting in North Queensland. A relevant repertoire was developed with the help of older people without dementia. All seven participants received the musical intervention on three occasions. They were videoed before, during and after each session and behaviour was assessed by the investigator and a blinded assessor, using a modified Cohen-Mansfield Agitation Inventory. Thirty agitated behaviours were examined. Overall agitated behaviour was reduced. Significant reductions were observed in pacing/aimless wandering, performing repetitious mannerisms and general restlessness. The total number of agitated behaviours decreased significantly (median 5 behaviours before the intervention to 1 during and 1 after). The authors conclude that live music may be an effective strategy for reducing short-term agitated behaviour among people with AD.
Optimising treatment and care for people with behavioural and psychological symptoms of dementia: a best practice guide for health and social care professionals
- Author:
- ALZHEIMER'S SOCIETY
- Publisher:
- Alzheimer's Society
- Publication year:
- 2011
- Pagination:
- 26p.
- Place of publication:
- London
More than 90% of people with dementia will experience behavioural and psychological symptoms of dementia (BPSD) as part of their illness. These symptoms include agitation, aggression, hallucinations and delusions. This guide has been designed to support health and social care professionals to determine the best treatment and care for people experiencing BPSD. It has been designed to be a practical, informative tool, with an emphasis on alternatives to drug treatment. Good practice recommendations, such as the NICE dementia guidelines, recommend psychosocial interventions as the first line approach and emphasise the importance of assessing medical conditions and pain, which often underpin the development of these symptoms. The value of not rushing into treatment is also important, as many people with BPSD will experience significant improvement or resolution of symptoms over a 4-6 week period. The toolkit provides 2 simple flow diagrams to be used depending on whether the person with dementia is already prescribed antipsychotics or not. The flow diagrams should be used to determine the best care and treatment for each person with dementia. The guidance, charts and care plans are colour-coded according to a traffic light system representing: prevention; watchful waiting; and specific interventions and antipsychotic prescription.
Concept mapping: a process to promote staff learning and problem-solving in residential dementia care
- Authors:
- ABERDEEN Suzanne M., LEGAT Sandra G., BARRACLOUGH Simon
- Journal article citation:
- Dementia: the International Journal of Social Research and Practice, 9(1), February 2010, pp.129-151.
- Publisher:
- Sage
A person-centred assessment and problem-solving approach is widely recommended as the preferred method for managing the behavioural and psychological symptoms of care home residents with dementia (BPSD). However the authors suggest that this is not well implemented in residential dementia care and Australia is not alone in this. The paper argues for the use of concept mapping to aid problem solving BPSD and to facilitate team learning about dementia. The process, which includes an element of brain storming (although the ideas must be evidence based) is said to have the potential to improve the quality of care by providing an efficient framework for problem-solving. It facilitates data analysis; suggested to be a missing link in problem-solving BPSD. It may also reduce the burden on individual staff, improve the skills and knowledge of all levels of staff and foster learning organisations. Potential challenges to the implementation and success of the process, which include staff shortages, the need for effective leadership and organisational support, are considered.
Strategies that helped Betty feel busy and useful again
- Authors:
- WOOD-MITCHELL Amy, MILBURN Margaret
- Journal article citation:
- Journal of Dementia Care, 16(3), May 2008, pp.24-27.
- Publisher:
- Hawker
The Newcastle Challenging Behaviour Service model is an evidence-based approach used to guide a person-centred therapy for people with challenging behaviour. The authors explain how the team worked with staff to better understand the needs of a woman routinely trying to be 'let out' of a care home.
Ethical and effective: approaches to residential care for people with dementia
- Author:
- O'SULLIVAN Grace
- Journal article citation:
- Dementia: the International Journal of Social Research and Practice, 12(1), 2013, pp.111-121.
- Publisher:
- Sage
Person-centred care is considered essential for people with dementia living in a residential care home and purpose-built facilities and environmental design are reported to enhance safety and to have a positive effect on behaviour. Research findings have highlighted the inappropriate use of antipsychotic drugs and there is debate about their value in ‘managing’ symptoms. This paper outlines the approaches and methods used to make a difference to the provision of care for people living with dementia in a long-term residential care facility in New Zealand. A combination of approaches was used to enable residents of two secure dementia units to live life within their ability. Essential to the success of the change process was staff education, knowledge of the person, a varied leisure activity programme and a supportive environment. The most significant outcome of the change process, which evolved over a four-year period, was the elimination of antipsychotic drugs. Statistics also showed a decline in falls and behavioural issues, and feedback from family members was positive. In light of this evidence, the authors suggest that it is ethically wrong to give people with dementia antipsychotic medications because their behaviour is deemed to be unacceptable, when there are other viable options.
The aims, role and impact of an intermediate care service for people with dementia: reflections on a conference workshop
- Authors:
- WILKIE David, et al
- Journal article citation:
- Quality in Ageing and Older Adults, 12(2), 2011, pp.109-118.
- Publisher:
- Emerald
The aims, role and impact of a specialist intermediate care service for people with dementia in Kent, entitled the Home Treatment Service (HTS) is described. The authors reflect on two workshops about the service, delivered as part of the "Dementia Care: A Positive Future" conference held in May 2010. The 45 workshop participants included service providers, professionals and family carers. The aims and nature of the service were outlined by members of the clinical team as: adopting a multi-professional approach, emphasising the value of a shared assessment process and having a commitment to flexible and intensive working within a person centred framework. Focusing on the HTS's work with care homes, presenters offered case illustrations to highlight its collaborative approach to working with service users, staff, managers and families to improve the quality of life for users presenting with challenging behaviour and preventing placement breakdown. Discussion with participants explored the obstacles and opportunities in working productively with care homes. The HTS's potential to reduce reliance on anti-psychotic medication was specifically highlighted. In addition to improving user and carer quality of life, outcomes of HTS intervention include a reduction in and quicker discharge from, mental health hospitals and maintaining the person in their existing setting.
Reducing the use of antipsychotic drugs: a guide to the treatment and care of behavioural and psychological symptoms of dementia
- Author:
- ALZHEIMER'S SOCIETY
- Publisher:
- Alzheimer's Society
- Publication year:
- 2011
- Pagination:
- 26p.
- Place of publication:
- London
It is very common for people with dementia to experience behavioural and psychological symptoms such as aggression and agitation. This leaflet is aimed at people with dementia and their carers who want to know more about behavioural and psychological symptoms of dementia and how they can be prevented and treated. It emphasises that people with dementia and their carers have the right to be involved in decisions about treatment. The leaflet describes a number of simple treatment and therapy options based on the principles of person-centred care that can dramatically improve these symptoms without the need for medication. For many people the symptoms will improve over 4 weeks without the need for medication. If these treatments do not work, the doctor may prescribe antipsychotic drugs. The leaflet provides information about these drugs and their risks and side effects. Suggested questions that can be asked to the doctor are provided.
Effect of enhanced psychosocial care and antipsychotic use in nursing home residents with severe dementia: a cluster randomised trial
- Authors:
- FOSSEY Jane, et al
- Journal article citation:
- British Medical Journal, 1.04.06, 2006, pp.756-758.
- Publisher:
- British Medical Association
This study aims to evaluate the effectiveness of a training and support intervention for nursing home staff in reducing the proportion of residents with dementia who are prescribed neuroleptics. The research was carried out in 12 specialist nursing homes for people with dementia in London, Newcastle, and Oxford. Training and support interventions were delivered to nursing home staff over 10 months, focusing on alternatives to drugs for the management of agitated behaviour in dementia. The main outcome measures were the proportion of residents in each home who were prescribed neuroleptics and mean levels of agitated and disruptive behaviour (Cohen-Mansfield agitation inventory) in each home at 12 months. At 12 months the proportion of residents taking neuroleptics in the intervention homes (23.0%) was significantly lower than that in the control homes (42.1%): average reduction in neuroleptic use 19.1% (95% confidence interval 0.5% to 37.7%). No significant differences were found in the levels of agitated or disruptive behaviour between intervention and control homes. The authors conclude that the promotion of person centred care and good practice in the management of patients with dementia with behavioural symptoms provides an effective alternative to neuroleptics.