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Trajectories of at-homeness and health in usual care and small house nursing homes
- Authors:
- MOLONY Sheila, et al
- Journal article citation:
- Gerontologist, 51(4), August 2011, pp.504-515.
- Publisher:
- Oxford University Press
Long-term care providers across the United States are building new residential environments that weave humanistic person-centred philosophies into clinical care, organisational policies, and built environments. The small house model (SmH) relocates the resident from institutional care to a place that is believed to better emulate home. The aim of this study was to compare and contrast trajectories of at-homeness and health over time between residents remaining in a usual care nursing home and residents moving from that home to a SmH. The setting for the study was a 100-bed nursing home in a continuing care retirement community in the Midwest. Five new SmHs were built as part of this retirement community. Interviews were conducted with residents before the move to the SmHs and 1, 3, and 6 months after the move. The findings showed that prior to the move individuals who decided to relocate to the SmH had more depressive symptoms and lower levels of at-homeness. Their levels of at-homeness increased after the move, and, in addition, their levels of functional dependence decreased. Most participants who chose to stay in the nursing home reported high baseline levels of at-homeness and maintained this over the next 6 months. Qualitative findings highlight the variables that contributed to at-homeness in both groups. The study demonstrates that a ‘one size fits all’ approach may not be best because at-homeness is an individualised construct.
Counselling older people with alcohol problems
- Authors:
- FOX Mike, BLANCHARD Martin
- Publisher:
- Jessica Kingsley
- Publication year:
- 2011
- Pagination:
- 208p.
- Place of publication:
- London
Providing effective counselling services to the growing number of over-55s who misuse alcohol requires a specialised approach. They are often patronised, their ability to recover not acknowledged, and expected to fit into generic treatment systems. This practical guide explores the factors that differentiate older drinkers, and introduces a person-centred model designed to help counsellors and other healthcare professionals provide this group of clients with the help and support they need. Older people with alcohol problems often have complex personal histories, and are particularly vulnerable to long-term dependency, social isolation and self-medication. The authors explore the influences, patterns and triggers that affect the development and progression of alcohol dependency in this age group, and provide a detailed description of a theoretical model and therapeutic process that has proved successful in practice. Illustrative case studies are included and guidance is also given for working with clients with dementia or mental health problems. The book is aimed at counsellors and other healthcare professionals who encounter alcohol problems in their clinical practice, including clinical psychologists, social workers, occupational therapists and community psychiatric nurses.
Guidelines for care: person-centred care of people with dementia living in care homes: framework
- Author:
- ALZHEIMER'S SOCIETY
- Publisher:
- Alzheimer Society of Canada
- Publication year:
- 2011
- Pagination:
- 67p., bibliog.
- Place of publication:
- Toronto
These guidelines for care present a framework aimed at improving the quality of care of people with dementia in care homes through a person-centred philosophy. The Alzheimer Society suggests that people with dementia have the right to enjoy the highest possible quality of life and quality of care by being engaged in meaningful relationships which are based on equality, understanding, sharing, participation, collaboration, dignity, trust and respect. The framework is an evidence based foundation for the development of knowledge translation tools to enhance quality care. A Rapid Evidence Assessment (REA) was completed to systematically examine practice guidelines published in peer-reviewed journals regarding the care of people in advanced stages of Alzheimer's disease living in care homes. The guidelines consist of the following sections: what does a person-centred philosophy mean; what does person-centred care look like in a care home; ensuring family inclusiveness; extending a person-centred philosophy through end of life.
Patient-centered approach to building problem solving skills among older primary care patients: problems identified and resolved
- Authors:
- ENGUIDANOS Susan, et al
- Journal article citation:
- Journal of Gerontological Social Work, 54(3), April 2011, pp.276-291.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
Problem Solving Therapy (PST) teaches patients to address their life difficulties by reducing problems into smaller sections and identifying specific steps towards making positive change. This article describes the problems identified by older primary care patients enrolled in PST, and explores factors associated with successful problem resolution. The participants were 107 patients aged 65 years and more with 2 or more chronic conditions and at least one emergency room visit or hospital admission over the last 6 months. The intervention was conducted at the primary care clinic or at the patient’s home, and aimed to include between 4 and 8 45-min sessions with a social worker. The patients identified problems in their lives and directed the focus of subsequent sessions as consistent with the steps of PST. A total of 568 problems were identified, 59% of which were resolved. The most commonly identified problems included health related issues such as need for exercise or weight loss activities, medical care and medical equipment needs, home and garden maintenance, and gathering information on their medical condition. Problems identified by patients were 2.2 times more likely to be solved than those identified by a health care professional. The article concludes that using PST in primary care may facilitate patients in addressing key health and wellness issues.
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.
Personalised befriending support for older people
- Author:
- MULVIHILL Joe
- Journal article citation:
- Quality in Ageing and Older Adults, 12(3), October 2011, pp.180-183.
- Publisher:
- Emerald
The author’s purpose is to raise awareness of the many benefits associated with older people accessing befriending services and to increase the number that are set up and commissioned. The paper contains a literature review and focuses on the results of two pilot projects. Befriending services can be used to support older people in a variety of ways: as a personalised form of care for those who may be isolated or lonely; to prevent the onset of dementia; to encourage more active lives; and to increase quality of life. Befriending services can also lead to cost saving benefits for the NHS through the early intervention and prevention of complicated health issues and through reducing dependency on its resources too. The positive results from the pilot projects suggest that befriending services should be available as an option of choice for all older people; particularly those with personal budgets.
Re-igniting the Spark of Life: a philosophy and whole systems approach
- Authors:
- VERITY Jane, LEE Hilary
- Journal article citation:
- Journal of Dementia Care, 19(5), September 2011, pp.24-27.
- Publisher:
- Hawker
This article presents an introduction to Spark of Life Philosophy and how it is being implemented and evaluated in a range of dementia care settings around the world. The spark represents the wellbeing of the human spirit, and ensuring a strong and healthy spirit is a cornerstone of the Spark of Life Philosophy. The key to reigniting the spark in dementia patients is through the quality of interaction that takes place between people. In dementia care, the Spark of Life Philosophy is implemented as a whole systems approach, with a club programme for people with dementia, a torchbearer’s programme for selected staff members, and an education programme for everyone connected with an organisation. This article details these three aspects of the Spark of Life Philosophy, and presents evidence of the efficacy of the approach. Overall, the Spark of Life Philosophy redefines what it means to have dementia, and the possibilities for those that do when supported with compassion.
Using pre therapy to release long silent voices
- Author:
- SMITH Paul
- Journal article citation:
- Journal of Dementia Care, 19(5), September 2011, pp.20-22.
- Publisher:
- Hawker
This article describes pre therapy, a potentially significant form of person-centred approach to dementia care. The concept of pre therapy is an important evolution in person-centred psychotherapy based on the psychological contact between the therapist and client, and necessary for the therapeutic experience. Pre therapy explores three central construct - contact function, contact behaviours, and contact reflections – each of which are described. The core principles behind this technique are that it focuses on the client and what they are experiencing, the client’s experience of the world is central, the therapist does not use questions or words to direct the client, and it is used with people who are ‘pre-expressive’ (when people seem to be locked into their own worlds). Although not a common form of therapy, pre therapy is now being recognised as a powerful tool in reaching those that are traditionally difficult to reach.
Safeguarding adults in care homes
- Author:
- SOCIAL CARE INSTITUTE FOR EXCELLENCE
- Publisher:
- Social Care Institute for Excellence
- Publication year:
- 2011
- Place of publication:
- London
This film looks at aspects of good safeguarding practice in a care home for older people that specialises in dementia. Staff work in a person centred way, spending time with residents and getting to know them well so that they can recognise any changes in behaviour that could suggest abuse. Residents also feel comfortable about sharing any worries that they might have. The care home has an open management culture where staff feel confident about raising safeguarding concerns, either directly with managers or during supervision sessions. Where necessary, an external professional, such as a GP, will be consulted. Managers are also in regular contact with relatives so that they can discuss all aspects of a person's care, including potential safeguarding issues.
Person-centred support: choices for end of life care
- Authors:
- FLEMING Jennie, et al
- Publisher:
- Shaping Our Lives
- Publication year:
- 2011
- Pagination:
- 67p.
- Place of publication:
- London
This report is one of a series emanating from the Shaping our Lives User Network ‘s Standards We Expect Project. The purpose of this project was to develop person-centred support in social care and other services, in line with the standards of service that users want. This project collected the views of people living in residential and nursing homes, their relatives and carers, practitioners, and home managers. The aim was to discover what participants thought were the barriers to support being person-centred at the end of life and how these barriers might be overcome. Five homes took part; 33 people were interviewed and a focus group conducted with a further seven carers and relatives. Most residents were content with their care. Many had not thought about or discussed end of life care, other than their funeral. Often relatives made important decisions for their loved one but some residents were happy for this to happen. None of the residents interviewed had an advanced directive. Practitioners described a reluctance to talk about end of life choices with residents; feeling that it was inappropriate before a relationship had been established. The report recommends that whenever they have capacity residents should make choices for themselves and that there should be more openness about the subject of death. A number of more specific recommendations were also made.