Dementia In Long-term Care Research Articles

Prevalence, causes, and consequences of moral distress in healthcare providers caring for people living with dementia in long-term care during a pandemic.

Healthcare providers caring for people living with dementia may experience moral distress when faced with ethically challenging situations, such as the inability to provide care that is consistent with their values. The COVID-19 pandemic produced conditions in long-term care homes (hereafter referred to as ‘care homes’) that could potentially contribute to moral distress. We conducted an online survey to examine changes in moral distress during the pandemic, its contributing factors and correlates, and its impact on the well-being of care home staff. Survey participants (n = 227) working in care homes across Ontario, Canada were recruited through provincial care home organizations. Using a Bayesian approach, we examined the association between moral distress and staff demographics and roles, and characteristics of the long-term care home. We performed a qualitative analysis of the survey’s free-text responses. More than 80% of care home healthcare providers working with people with dementia reported an increase in moral distress since the start of the pandemic. There was no difference in the severity of distress by age, sex, role, or years of experience. The most common factors associated with moral distress were lack of activities and family visits, insufficient staffing and high turnover, and having to follow policies and procedures that were perceived to harm residents with dementia. At least two-thirds of respondents reported feelings of physical exhaustion, sadness/anxiety, frustration, powerlessness, and guilt due to the moral distress experienced during the pandemic. Respondents working in not-for-profit or municipal homes reported less sadness/anxiety and feelings of not wanting to go to work than those in for-profit homes. Front-line staff were more likely to report not wanting to work than those in management or administrative positions. Overall, we found that increases in moral distress during the pandemic negatively affected the well-being of healthcare providers in care homes, with preliminary evidence suggesting that individual and systemic factors may intensify the negative effect.

‘Going through the Eye of the Storm’: The Impact of Covid-19 on the Long-Term Dementia Care Workforce

Context: Official guidance on Covid-19 failed to take account of the prevalence of dementia among people living in care homes or its implications for implementing infection control measures.Objective: To gain insight into the experience of those charged with implementing Covid-19 restrictions in long-term dementia care environments.Methods: Twenty members of the long-term dementia care workforce shared their experiences, using interviews, online discussion groups, or written personal accounts.Findings: Thematic analysis identified four key aspects of the participants’ experience: 1) Confusion and stress arising from the implementation of new policies, which changed very frequently; 2) The negative impact of measures such as social isolation, PPE, and coronavirus testing on people living with dementia and their families; 3) The impact on their own mental health and well-being over time; 4) Creative problem-solving and collaboration in the face of these challenges. Analysis suggests that the social care dementia workforce faced many of the same challenges identified for acute healthcare workers, with the addition of a sense of personal bereavement and responsibility when residents died.Limitations: The study is United Kingdom (UK)-dominated. Data were collected retrospectively and relate predominantly to the first wave of the pandemic. Most participants were studying on a MSc programme on which the first and third authors teach.Implications: Future guidance to care homes must take account of the high numbers of people with cognitive difficulties living in such environments. Co-designed strategies are needed to address the longer-term implications of Covid-19 for the social care dementia workforce.

The impact of a training intervention on nursing care for people with dementia in long-term care: A quasi-experimental study

Various dementia training interventions have been developed for nursing staff, but there is inconclusive evidence on their effectiveness and which elements are key to positive outcomes. The aim of this study was to evaluate how nurses assess the prevalence of challenging behavior of people with dementia, nursing staff members’ responses to challenging behavior, and nurses’ competence, before the training and three and 12 months after the training. The main content of the training intervention was advancing person-centered care and its development. Data were collected through a survey of nursing staff ( n = 127) at two Finnish nursing homes across three distinct time points. The TREND statement was used to enhance the quality and transparency of the research. The prevalence of challenging behavior in the experimental group significantly decreased one year after training, while no change was observed in the control group. No change in nursing staff members’ responses to challenging behavior was observed in either group over the study period. Nurses in the experimental group demonstrated significant improvements in self-assessed competence both three months and one year after the training intervention. Hence, regular nursing staff training can decrease the prevalence of challenging behavior among older people with dementia and enhance nurses’ competence in nursing. The support of supervisors plays a significant role in these changes.

Feasibility of Routine Quality of Life Measurement for People Living With Dementia in Long-Term Care.

Maximizing quality of life (QoL) is the ultimate goal of long-term dementia care. However, routine QoL measurement is rare in nursing home (NH) and assisted living (AL) facilities. Routine QoL measurement might lead to improvements in resident QoL. Our objective was to assess the feasibility of using DEMQOL-CH, completed by long-term care staff in video calls with researchers, to assess health-related quality of life (HrQoL) of NH and AL residents with dementia or other cognitive impairment. Cross-sectional study. We included a convenience sample of 5 NHs and 5 AL facilities in the Canadian province of Alberta. Forty-two care staff who had worked in the facility for ≥3months completed DEMQOL-CH assessments of 183 residents who had lived in the facility for 3months or more and were aged ≥65years. Sixteen residents were assessed independently by 2 care staff to assess inter-rater reliability. We assessed HrQoL in people with dementia or other cognitive impairment using DEMQOL-CH, and assessed time to complete, inter-rater reliability, internal consistency reliability, and care staff ratings of feasibility of completing the DEMQOL-CH. Average time to complete DEMQOL-CH was <5minutes. Staff characteristics were not associated with time to complete or DEMQOL-CH scores. Inter-rater reliability [0.735, 95% confidence interval (CI): 0.712-0.780] and internal consistency reliability (0.834, 95% CI: 0.779-0.864) were high. The DEMQOL-CH score varied across residents (mean= 84.8, standard deviation= 11.20, 95% CI: 83.2-86.4). Care aides and managers rated use of the DEMQOL-CH as highly feasible, acceptable, and valuable. This study provides a proof of concept that DEMQOL-CH can be used to assess HrQoL in NH and AL residents and provides initial indications of feasibility and resources required. DEMQOL-CH may be used to support actions to improve the QoL of residents.

‘’We usually choose safety over freedom’’: results from focus groups with professional caregivers in long-term dementia care

BackgroundPeople with dementia living in nursing homes are mostly sedentary, which is a consequence of various personal, environmental and organizational factors. Until now, studies on physical activity and safety in dementia have focused on residents and caregivers from the viewpoint of (individual) care provision and health benefits. There has been little to no focus on the possible influence of group dynamics between care providers with regard to physical activity and safety. The aim of this study is to gain more insight into the viewpoints and intentions of groups of professional caregivers towards safety and physical activity and the potential influence of the group-oriented setting in long-term care on physical activity of individual residents.MethodsA qualitative study comprising three focus group discussions including professional caregivers (n = 15) was conducted within two long-term care organizations in the Netherlands. Focus group discussions were structured using an interview guide derived from a preliminary framework, based on existing literature and complemented with clinical expertise.ResultsSeven themes could be derived from the focus group discussions that influence physical activity and safety: 1) Individual health and abilities; 2) Balancing physical activity and safety; 3) Physical restraints; 4) Group interests versus the individual interests; 5) Organization of care and physical environment; 6) Perceived responsibilities and tasks of professional caregivers and 7) Change is challenging.ConclusionsDue to multiple influencing factors, the balance for care providers in long-term care generally tends towards safety over physical activity. Furthermore, in order to stimulate physical activity various limitations are experienced, including the organization of care, the general health of the residents and difficulty to achieve changes in daily care. Most importantly, the group interests of both the professional caregivers and the residents have a substantial influence on the incorporation of physical activity in daily care.

Staff perceptions of the consequences of COVID-19 on quality of dementia care for residents in Ontario long-term care homes.

ObjectivesThe first wave of the COVID‐19 pandemic necessitated extensive infection control measures in long‐term care (LTC) and had a significant impact on staffing and services. Anecdotal reports indicate that this negatively affected LTC residents' quality of care and wellbeing, but there is scarce evidence on the effects of COVID‐19 on quality of dementia care in LTC.MethodsFrom December 2020 to March 2021, we conducted a cross‐sectional online survey among staff who worked in LTC homes in Ontario, Canada. Survey questions examined staffs' perceptions of the impact of COVID‐19 on dementia quality of care during the initial wave of the COVID‐19 pandemic (beginning 1 March 2020).ResultsThere were a total of 227 survey respondents; more than half reported both worsened overall quality of care (51.3%) and worsening of a majority of specific quality of care measures (55.5%). Measures of cognitive functioning, mobility and behavioural symptoms were most frequently described as worsened. Medical and allied/support staff had the highest odds of reporting overall worsened quality of care, while specialized behavioural care staff and those with more experience in LTC were less likely to. LTC home factors including rural location and smaller size, staffing challenges, higher number of outbreaks and less COVID‐19 preparedness were associated with increased odds of perceived worsening of quality of dementia care outcomes.ConclusionsThese findings suggest that COVID‐19 pandemic restrictions and related effects such as inadequate staffing may have contributed to poor quality of care and outcomes for those with dementia in LTC.

Expanding the conversation: A Person-centred Communication Enhancement Model.

The intricacy and impact of human communication has long captured the attention of philosophers, scholars and practitioners. Within the realm of care and service provision, efforts to maximize outcomes through optimal person-provider communication have drawn research and clinical focus to this area for several decades. With the dawning of the person-centred care movement within healthcare, and in particular long-term care home and dementia care settings, improvement in care providers’ use of person-centred communication strategies and enhancement of relationships between residents, their families and care providers are desired outcomes. Thus, several person-centred care and communication theoretical perspectives have been employed to ground study in this field. However, a comprehensive theoretical position to underpin person-centred communication in dementia and older adult research does not exist to our knowledge. To offer expansion to the theoretical work in this emerging field, a Person-Centred Communication Enhancement Model for long-term care and dementia care is proposed, as well as rationale for its development. This discussion will also provide an overview and critique of the extant philosophies, theories, frameworks and models that have been utilized in the study of person-centred communication within the context of long-term care and dementia care.

Content and comprehensiveness in the nursing documentation for residents in long-term dementia care: a retrospective chart review

BackgroundInsight into and understanding of content and comprehensiveness in nursing documentation is important to secure continuity and high-quality care planning in long-term dementia care. The accuracy of nursing documentation is vital in areas where residents have difficulties in communicating needs and preferences. This study described the content and comprehensiveness of nursing documentation for residents living with dementia in nursing homes.MethodsWe used a retrospective chart review to describe content and comprehensiveness in the nursing documentation. Person-centered content related to identity, comfort, inclusion, attachment, and occupation was identified, using an extraction tool derived from person-centered care literature. The five-point Comprehensiveness in the Nursing Documentation scale was used to describe the comprehensiveness of the nursing documentation in relation to the nursing process.ResultsThe residents’ life stories were identified in 16% of the reviewed records. There were variations in the identified nursing diagnoses related to person-centered information, across all the five categories. There were variations in comprehensiveness within all five categories, and inclusion and occupation had the least comprehensive information.ConclusionFindings from this study highlights challenges in documenting person-centered information in a comprehensive way. To improve nursing documentation of residents living with dementia in nursing homes, nurses need to include residents’ perspectives and experiences in their planning and evaluation of care.

The Rationale and Design of Behavioral Interventions for Management of Agitation in Dementia in a Multi-Site Clinical Trial.

Agitation and aggression are common in patients with Alzheimer's disease and related dementias and pose a significant burden on patients, caregivers, and the healthcare systems. Guidelines recommend personalized behavioral interventions as the first-line treatment; however, these interventions are often underutilized. The Standardizing Care for Neuropsychiatric Symptoms and Quality of Life in Dementia (StaN) study (ClinicalTrials.gov Identifier # NCT0367220) is a multisite randomized controlled trial comparing an Integrated Care Pathway, that includes a sequential pharmacological algorithm and structured behavioral interventions, with treatment-as-usual to treat agitation in dementia in long-term care and inpatient settings. To describe the rationale and design of structured behavioral interventions in the StaN study. Structured behavioral interventions are designed and implemented based on the following considerations: 1) personalization, 2) evidence base, 3) dose and duration, 4) measurement-based care, and 5) environmental factors and feasibility. The process to design behavioral interventions for each individual starts with a comprehensive assessment, followed by personalized, evidence-based interventions delivered in a standardized manner with ongoing monitoring of global clinical status. Measurement-based care is used to tailor the interventions and integrate them with pharmacotherapy. Individualized behavioral interventions in patients with dementia may be challenging to design and implement. Here we describe a process to design and implement individualized and structured behavioral interventions in the context of a multisite trial in long-term care and inpatient settings. This process can inform the design of behavioral interventions in future trials and in clinical settings for the treatment of agitation in dementia.

Moral distress - a threat to dementia care? A qualitative study of nursing staff members\u2019 experiences in long-term care facilities

BackgroundDementia is a public health priority worldwide due to its rapidly increasing prevalence and poses challenges with regard to providing proper care, including end-of-life care. This study is part of a research project about nursing staff members’ experiences with providing palliative care for people with severe dementia in long-term care facilities. In an earlier study, we found that structural barriers that complicated the provision of palliative care led to moral distress among nursing staff. In this study, we performed a secondary analysis of the same data set to gain a deeper understanding of nursing staff members experiences of moral distress while providing palliative care for residents with severe dementia in long-term care facilities.MethodsA qualitative, descriptive design was used. Data were collected during in-depth interviews with 20 nursing staff members from four Norwegian long-term care facilities. Content previously identified as moral distress was reanalysed by thematic text analysis, as described by Braun and Clarke, to gain a deeper understanding of the phenomenon.ResultsThe nursing staff members’ experiences of moral distress were generally of two types: those in which nursing staff members felt pressured to provide futile end-of-life treatment and those in which they felt that they had been prevented from providing necessary care and treatment.ConclusionThe findings indicate that nursing staff members’ experiences of moral distress were related to institutional constraints such as time limitations and challenging prioritizations, but they were more often related to value conflicts. Nursing staff members experienced moral distress when they felt obligated to provide care and treatment to residents with severe dementia that conflicted with their own values and knowledge about good palliative care. Both education interventions focused on improving nursing staff members’ skills regarding communication, ethical judgement and coping strategies; in addition, supportive and responsive leadership may have significant value with regard to reducing moral distress. Our findings indicate a need for further research on interventions that can support nursing staff members dealing with ethical conflicts in providing palliative care to residents with dementia.

Nurses' Experiences of Caring for Long-Term Care Residents With Dementia During the COVID-19 Pandemic.

The COVID-19 pandemic has had a negative impact on older persons who reside in long-term care settings, especially residents living with dementia. The physical and psychological burden of the current pandemic has also been felt by frontline caring staff including nurses caring for persons living with dementia. The aim of the study was to explore the experiences of nurses while caring for residents with dementia who resided in long-term dementia care units during the COVID-19 pandemic. Nine Maltese nurses working in dementia care units were interviewed during the month of February 2021. Following analysis of the transcripts, three themes were identified; ‘living the challenges of the pandemic’, ‘passing through a roller coaster of emotions’ and ‘building on personal and organisational resilience’. The participants lived through several challenges which in turn generated both positive and negative emotions. Moving forward through this period mostly relied on their coping strategies, how they negotiated infection control measures with the residents’ quality of life and how their organisation was able to provide quality dementia care pre-COVID-19. The study indicated how personal and organisational resilience could have influenced the participants’ experience of the pandemic and helped nursing staff in developing new ways of working.

Implementation of eHealth to Support Assessment and Decision-making for Residents With Dementia in Long-term Care: Systematic Review.

BackgroundAs dementia progresses, symptoms and concerns increase, causing considerable distress for the person and their caregiver. The integration of care between care homes and health care services is vital to meet increasing care needs and maintain quality of life. However, care home access to high-quality health care is inequitable. eHealth can facilitate this by supporting remote specialist input on care processes, such as clinical assessment and decision-making, and streamlining care on site. How to best implement eHealth in the care home setting is unclear.ObjectiveThe aim of this review was to identify the key factors that influence the implementation of eHealth for people living with dementia in long-term care.MethodsA systematic search of Embase, PsycINFO, MEDLINE, and CINAHL was conducted to identify studies published between 2000 and 2020. Studies were eligible if they focused on eHealth interventions to improve treatment and care assessment or decision-making for residents with dementia in care homes. Data were thematically analyzed and deductively mapped onto the 6 constructs of the adapted Consolidated Framework for Implementation Research (CFIR). The results are presented as a narrative synthesis.ResultsA total of 29 studies were included, focusing on a variety of eHealth interventions, including remote video consultations and clinical decision support tools. Key factors that influenced eHealth implementation were identified across all 6 constructs of the CFIR. Most concerned the inner setting construct on requirements for implementation in the care home, such as providing a conducive learning climate, engaged leadership, and sufficient training and resources. A total of 4 novel subconstructs were identified to inform the implementation requirements to meet resident needs and engage end users.ConclusionsImplementing eHealth in care homes for people with dementia is multifactorial and complex, involving interaction between residents, staff, and organizations. It requires an emphasis on the needs of residents and the engagement of end users in the implementation process. A novel conceptual model of the key factors was developed and translated into 18 practical recommendations on the implementation of eHealth in long-term care to guide implementers or innovators in care homes. Successful implementation of eHealth is required to maximize uptake and drive improvements in integrated health and social care.

Registered nurses' reasoning process during care planning and documentation in the electronic health records: A concurrent think-aloud study.

To explore the clinical reasoning process of experienced registered nurses during care planning and documentation of nursing in the electronic health records of residents in long-term dementia care. Clinical reasoning is an essential element in nursing practice. Registered nurses' clinical reasoning process during the documentation of nursing care in electronic health records has received little attention in nursing literature. Further research is needed to understand registered nurses' clinical reasoning, especially for care planning and documentation of dementia care due to its complexity and a large amount of information collected. A qualitative explorative design was used with a concurrent think-aloud technique. The transcribed verbalisations were analysed using protocol analysis with referring phrase, assertional and script analyses. Data were collected over ten months in 2019-2020 from 12 registered nurses in three nursing homes offering special dementia care. The COREQ checklist for qualitative studies was used. The nurses primarily focused on assessments and interventions during documentation. Most registered nurses used their experience and heuristics when reasoning about the residents' current health and well-being. They also used logical thinking or followed local practice rules when reasoning about planned or implemented interventions. The registered nurses moved back and forth among all the elements in the nursing process. They used a variety of clinical reasoning attributes during care planning and nursing documentation. The most used clinical reasoning attributes were information processing, cognition and inference. The most focused information was planned and implemented interventions. Knowledge of the clinical reasoning process of registered nurses during care planning and documentation should be used in developing electronic health record systems that support the workflow of registered nurses and enhance their ability to disseminate relevant information.

Barriers and Facilitators of Pain Management in Persons With Dementia in Long-Term Care: A Scoping Review

Approximately 50% of individuals with dementia regularly experience moderate to severe pain, which is largely undermanaged. Several studies have explored the barriers and facilitators of pain management for persons with dementia; yet the evidence has not been systematically reviewed. This review aimed to synthesize current evidence on the barriers and facilitators of pain management in persons with dementia in long-term care. A PRISMA guided literature search was conducted in PubMed, CINAHL, and PsycINFO. Titles, abstracts, and full texts were screened. Included articles were original research examining the barriers or facilitators of pain assessment and treatment in individuals with dementia in long-term care. Quality assessment was conducted using the Risk of Bias tool and Johns Hopkins Level of Evidence. Ten studies were identified, including four quantitative studies, five qualitative studies, and one with both quantitative and qualitative research. Barriers of pain management identified include residents’ ability to self-report pain, pain medication side effects, need discrepancy among residents and their families, reluctance in administering analgesics, lack of pain assessment tools, lack of guidance in providing nonpharmacological interventions, and lack of clinical guidelines. Facilitators of pain management include clinicians with caring and enthusiastic characteristics, clinicians’ knowledge of residents, positive relationships among clinicians, good communication skills, using validated pain assessment tools, understanding pain indicators, clinical experience, and need-driven continuing education. These results can guide clinical practice in long-term care. Interventions should be developed to target these barriers and facilitators and improve pain management in persons with dementia.

Caring for a Relative With Dementia in Long-Term Care During COVID-19.

ObjectivesThe COVID-19 pandemic created unique stressors for caregivers of persons with dementia living in long-term care (LTC) facilities. The purpose of this qualitative study was to identify the challenges associated with caring for a relative with dementia in LTC during the pandemic, as well as resources, strategies, and practices caregivers found helpful in coping with COVID-19.DesignThis study was conducted within the context of an ongoing randomized controlled trial of a psychosocial intervention to support caregivers. Open-ended survey responses (n = 125) and semistructured interviews with a subset of the sample (n = 20) collected between June 2020 and June 2021 explored caregivers' experiences during COVID-19.Setting and ParticipantsParticipants included 125 family caregivers of persons with dementia living in residential LTC.MethodsThematic analysis was used to identify themes capturing caregivers' experiences.ResultsIn addition to concerns about COVID-19 infection, participants reported key challenges such as the difficulty of maintaining contact with relatives because of visiting restrictions, lack of information about relatives' health and well-being, worries about overburdened LTC staff, impossibility of returning relatives home from the LTC facility, and fears about relatives dying alone. Participants also identified resources, strategies, and practices that they perceived as helpful, including effective infection prevention within the LTC facility, good communication with LTC staff, and creative strategies for connecting with their relatives.Conclusions and ImplicationsThis qualitative analysis informs recommendations for practice within LTC facilities, as well as supports that may help caregivers manage stressful situations in the context of COVID-19. Vaccination and testing protocols should be implemented to maximize family caregivers' opportunities for in-person contact with relatives in LTC, as alternative visiting modalities were often unsatisfactory or unfeasible. Informing caregivers regularly about individual residents' needs and status is crucial. Supports for bereaved caregivers should address complicated grief and feelings of loss.

Frailty and dementia in long‐term care: An analysis of the InterRAI data over the past decade

Older adults in long-term care are typically frail with multiple health problems and functional impairments; many have dementias of Alzheimer's disease (AD) or other types. Frailty and dementia have a complex relationship; deterioration in one can make people more susceptible to the other. The association between frailty and dementia in long-term care is not well understood. We conducted this study to investigate 1) how frailty differed by AD and dementia diagnoses in long-term care residents, and 2) whether the relationship between frailty and dementia changes over time. Data were retrieved from the InterRAI Residential Care assessments conducted in Fraser Health, Canada. Participants aged 65 years and over at the time of admission to one of the 83 long-term care facilities between 2010 and 2019 (number of participants n=25,744; mean age=84.7±7.7 (85-111) years; 63.2% females) were included in the study. Diagnosis of AD (n=4,055) and other dementias (n=11,882) were recorded during the assessment. A frailty index (FI) was calculated for each participant using 36 variables from their first full MDS2.0 assessment. Deficits included diseases, symptoms, functions, nutrition and other health conditions. The FI was presented as the ratio of deficits present over the total number of deficits considered (i.e., 36 here; higher FI indicating more deficits). Group mean differences of the FI were examined using ANOVA. Relations of the FI with AD and dementia diagnoses were examined using multivariate regressions, adjusted for year of assessment and demographics. The FI of the individuals increased exponentially with age (r=0.127, p<0.001) and differed significantly among diagnoses (no dementia=0.369±0.137, AD=0.394±0.144, other dementias=0.422±0.144, F=370.15, p<0.001). The 99% limits of the FI ranged 0.686 - 0.736, depending on assessment year. Frailty increased dementia risks: a 1% increase of the FI was associated with 2.7% (95% confidence interval CI=2.4-2.9) higher risk for other dementias and 1.4% (1.1-1.6) for AD, independent of the effects of age, sex, and the year of admission. Data demonstrate the robust characteristics of the frailty index. The consistent association between frailty and dementia in long-term care over the decade has implications for integrated management strategies to delay frailty and dementia trajectories among at-risk residents.

Eating Difficulties among Older Adults with Dementia in South Korean Long-Term Care Facilities: A Scoping Review

Purpose: This study synthesized the literature on eating difficulties among older adults with dementia in long-term care facilities.Methods: A scoping review, using the framework proposed by Arksey &amp; O'Malley (2005) and supplemented by Levac et al. (2010), was conducted. Literature was searched from RISS, KISS, DBpia, PubMed, and CINAHL. Two reviewers independently selected studies and extracted their characteristics, using pre-tested forms to determine final inclusion. In total, 1283 articles were identified, and 13 articles were used for the final analysis.Results: The Eating Behavior Scale and the Edinburgh Feeding Evaluation in Dementia scale were the most widely utilized measurement tools. The most common factors related to eating behavior in older adults with dementia were cognitive and physical functions in the individual domain, the caregiver's attitude toward eating in the inter-individual domain, and meal type in the environmental domain.Conclusion: Measurement tools reflecting the eating behavior of older adults with dementia must be developed to obtain a comprehensive understanding of this issue and create effective interventions for the specific context of long-term care facilities in Korea. The results of this study are intended to serve as a basis to develop meal support programs for older adults with dementia.

Working at Green Care Farms and Other Innovative Small-Scale Long-Term Dementia Care Facilities Requires Different Competencies of Care Staff.

The culture change movement within long-term care in which radical changes in the physical, social and organizational care environments are being implemented provides opportunities for the development of innovative long-term care facilities. The aim of this study was to investigate which competencies care staff working at green care farms and other innovative types of small-scale long-term dementia care facilities require, according to care staff themselves and managers, and how these competencies were different from those of care staff working in more traditional large-scale long-term dementia care facilities. A qualitative descriptive research design was used. Interviews were conducted with care staff (n = 19) and managers (n = 23) across a diverse range of long-term facilities. Thematic content analysis was used. Two competencies were mainly mentioned by participants working in green care farms: (1) being able to integrate activities for residents into daily practice, and (2) being able to undertake multiple responsibilities. Two other competencies for working in long-term dementia care in general were identified: (3) having good communication skills, and (4) being able to provide medical and direct care activities. This study found unique competencies at green care farms, showing that providing care in innovative long-term care facilities requires looking further than the physical environment and the design of a care facility; it is crucial to look at the role of care staff and the competencies they require.

Event-Specific Emotional Expression of Persons Living With Dementia in Long-term Care: A 6 Months Follow-up Study.

This longitudinal study aimed to explore the event-specific emotional expressions of persons living with dementia in long-term care during a 6-month period with repeated observations. Emotional expressions at three specific events (mealtime, personal care, and social activity) were videotaped at the beginning, month 3, and month 6. Thirty participants were enrolled, and nine observations were made for each participant. Mixed-effect models were used for statistical analysis. The type of care events, the person who provides care, and the facility type were associated with emotional expressions. Specifically, personal care, interaction with non-nursing providers, and facility type were associated with positive emotional expressions. Negative emotional expressions were related to personal care, interaction with family or volunteer, and facility type. This study provides a better understanding of event-specific emotional expressions and knowledge to support the development of emotion-oriented intervention programs to improve the psychological well-being of persons living with dementia.

Dementia care education interventions on healthcare providers' outcomes in the nursing home setting: A systematic review.

Given the increasing prevalence of people with dementia in long-term care, various educational interventions have been developed to enhance the dementia care competence of healthcare providers. The study aim was to appraise the evidence of the effects of dementia care educational programs on improving the preparedness of nursing home staff. Articles on dementia care education interventions for nursing home staff were searched from eight databases. The primary outcomes were staff knowledge, attitude, competence, and sense of competence or self-efficacy related to dementia. The secondary outcomes were psychological outcomes, including burnout, caregiving stress, well-being, and job satisfaction. The quality of evidence was appraised using the Joanna Briggs Institute Critical Appraisal tool. Out of the 3269 articles identified, 19 randomized controlled trials comprising 3947 participants from eight countries were included. The methodological quality of included studies was fair. A significant improvement in staff knowledge regarding dementia was reported. The intervention effects on attitudes and competence were insignificant, and the effects on the sense of competence or self-efficacy related to dementia care were inconsistent. The effects on psychological outcomes seem limited because few significant changes were found. Multiple teaching methods, peer support, qualified trainers, and post-training support were effective components in designing the educational interventions. However, given the variations in content and dose and the methodological limitations of the included studies, the effects of educational programs were inconclusive. The findings highlight the necessity of high-quality studies on dementia-care educational interventions, especially in other cultures than Western countries, such as in Asia.