Current experiences and educational preferences of general practitioners and staff caring for people with dementia living in residential facilities

Christopher Beer,Osvaldo P Almeida,Barbara Horner,Samuel Scherer,Penelope Flett,Leon Flicker,Nick Bretland,Frank Schaper,Nicola T Lautenschlager

doi:10.1186/1471-2318-9-36

Abstract

BackgroundResidential care is important for older adults, particularly for those with advanced dementia and their families. Education interventions that achieve sustainable improvement in the care of older adults are critical to quality care. There are few systematic data available regarding the educational needs of Residential Care Facility (RCF) staff and General Practitioners (GPs) relating to dementia, or the sustainability of educational interventions. We sought to determine participation in dementia education, perceived levels of current knowledge regarding dementia, perceived unmet educational needs, current barriers, facilitators and preferences for dementia education.MethodsA mixed methods study design was utilised. A survey was distributed to a convenience sample of general practitioners, and staff in 223 consecutive residential care facilities in Perth, Western Australia. Responses were received from 102 RCF staff working in 10 facilities (out of 33 facilities who agreed to distribute the survey) and 202 GPs (19% of metropolitan GPs). Quantitative survey data were summarised descriptively and chi squared statistics were used to analyse the distribution of categorical variables. Qualitative data were collected from general practitioners, staff in residential care facilities and family carers of people with dementia utilizing individual interviews, surveys and focus groups. Qualitative data were analysed thematically.ResultsAmong RCF staff and GPs attending RCF, participation in dementia education was high, and knowledge levels generally perceived as good. The individual experiences and needs of people with dementia and their families were emphasised. Participants identified the need for a person centred philosophy to underpin educational interventions. Limited time was a frequently mentioned barrier, especially in relation to attending dementia care education. Perceived educational needs relating to behaviours of concern, communication, knowledge regarding dementia, aspects of person centred care, system factors and the multidisciplinary team were consistently and frequently cited. Small group education which is flexible, individualized, practical and case based was sought.ConclusionThe effectiveness and sustainability of an educational intervention based on these findings needs to be tested. In addition, future interventions should focus on supporting cultural change to facilitate sustainable improvements in care.

Highlights

Residential care is important for older adults, for those with advanced dementia and their families
[2] a large proportion of Residential Care Facility (RCF) residents have dementia (48%), and this is the commonest medical problem affecting older people in residential care. [2,4] Ninety-six per cent of people with dementia living in care accommodation in Australia have moderate or severe dementia, compared to only 7% of people with dementia living in households
To be eligible for Continuing Professional Development (CPD) credit, activities must be prospectively approved, providing evidence of need, proposed objectives and evaluation, In this study, we aimed to collect data to inform development of a sustainable educational intervention for RCF staff and General Practitioners (GPs) based on the perceived needs and preferences of learners

Summary

Introduction

Residential care is important for older adults, for those with advanced dementia and their families. There are few systematic data available regarding the educational needs of Residential Care Facility (RCF) staff and General Practitioners (GPs) relating to dementia, or the sustainability of educational interventions. [2] a large proportion of RCF residents have dementia (48%), and this is the commonest medical problem affecting older people in residential care. [5] Informed residential care is important for older adults with dementia, for those with advanced dementia, and their families. Dementia is the most common problem managed by GPs at RCF consultations. [6] The ability of RCF staff and GPs to identify and respond to dementia is of critical importance. Therapeutic nihilism, desire to avoid risk, resourcing and competence have been identified as barriers to GPs participating in shared care models in the UK, and may be relevant in Australia. [10]

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