HOW DO CARE HOME STAFF EXPERIENCE, UNDERSTAND AND MANAGE AGITATION IN RESIDENTS WITH DEMENTIA? A QUALITATIVE STUDY

Abstract

Agitation in dementia is common, persistent, distressing and related to care home admission and increased costs. There is limited evidence for sustained effects of any intervention targeting agitation in care home residents and little is known about how front-line care home staff understand and manage agitated residents. To inform the development of sustainable and practical psychosocial interventions for agitation we conducted the first qualitative study of care home staff experiences of caring for agitated residents. We conducted 25 in-depth interviews with staff from six care homes. We used purposive sampling to include staff of either sex, differing ages, ethnicities, nationalities and with different roles. We transcribed interviews and entered them into NVivo 11 software and conducted thematic analysis. Care staff experienced agitation as diverse, unpredictable and of varying severity. They reported feeling frightened, powerless and overwhelmed when residents were agitated, especially when attempted solutions did not work, or if they felt unsupported by colleagues and managers or unable to meet the competing demands of their role. Staff understood agitation as expression of unmet social, emotional, physical or environmental need, which the person with dementia can no longer resolve. Despite experiencing a range of barriers to managing agitation at individual, interpersonal, organizational and socio-political levels, staff responses to agitation were flexible and adaptive, applying a process of ‘trial and error’ based upon prior experience. Strategies ranged from ‘hands on’ de-escalation techniques, to team based approaches, however it was acknowledged that sometimes ‘nothing worked’. Medication was described as a last resort, with side-effects and limited effectiveness. Using skilled communication, getting to know residents and maximising pleasant interaction was seen as integral to preventing agitation from happening. Future RCTs of psychosocial interventions to reduce agitation in care homes should support staff to respond to resident unmet needs and incorporate how staff can minimise the impact of agitation upon themselves. To ensure sustainability, interventions should build upon approaches and strategies already being used by care home staff whilst addressing barriers to staff putting potentially beneficial strategies into practice.