Dementia In Residential Aged Care Research Articles

"It's Opened My Eyes to a Whole New World": Positive Behaviour Support Training for Staff and Family Members Supporting Residents With Dementia in Aged Care Settings.

This study examined the acceptability and usefulness of Positive Behaviour Support (PBS) training in enhancing the capabilities of support staff and family members providing behaviour support to residents with dementia in residential aged care (RAC). A mixed-methods pilot study was conducted across 3 RAC organisations, involving pre- and post-training questionnaire assessments for clinical leaders (n = 8), support staff (n = 37) and family members (n = 18). Findings indicated increased confidence among support staff and family members in providing behaviour support, with 96% indicating it would support their practices across settings. Key training benefits included identifying and addressing underlying causes of challenging behaviours. A majority (89%) expressed the need for further behaviour support training. Recommendations focus on developing systems to enable effective and collaborative behaviour support practices. Further research is needed to examine application of PBS principles and planning for residents living with dementia.

Reparations for people living with dementia: Recognition, accountability, change, now!

There is a significant and longstanding problem of harm to people living with dementia in long term care institutions ('LTC institutions', referred to by others as 'care homes', 'nursing homes', 'long term care', 'residential aged care facilities'), along with a failure to redress the harm or hold people accountable for this harm. This article reports on an Australian project that found reparations must be a response to harm to people living with dementia in residential aged care. Using a disability human rights methodology, focus groups were conducted with people living with dementia, care partners and family members, advocates and lawyers to explore perspectives on why and how to redress harm to people living with dementia in Australian LTC institutions. Researchers found four key themes provide the basis for the necessity and design of a reparative approach to redress - recognition, accountability, change, now. The article calls for further attention to reparations in dementia scholarship, with a particular focus on the role that can be played in the delivery of reparations by the LTC industry, dementia practitioners, and dementia scholars. Ultimately, this article provides a new understanding of responses to violence, abuse, neglect and other harms experienced by people living with dementia in LTC institutions, which centres justice, rights, and transformative change.

Chemical restraint as behavioural euthanasia: case studies from the Royal Commission into Aged Care Quality and Safety

BackgroundThe prescription of psychotropic medication to older people living with dementia in residential aged care has become an increasing concern. The use of prescription medication is often prefaced as a way of preventing harm to self and others. However, the use of such medications has been considered a way of managing some of the behavioural and psychological symptoms of dementia. Using a large secondary data set, this study aimed to identify the precursors and mediating factors that influence the use of chemical restraint of older people in residential aged care.MethodsPublicly available documents from the Australian Royal Commission into Aged Care Quality and Safety were used as the data corpus for this study. Keywords were used to search over 7000 documents to extract a set of topic-related content. We identified the cases of seven people in respite or permanent residential aged care who had been prescribed or administered psychotropic medication under circumstances that appeared to demonstrate chemical restraint. All documents relating to the cases were collated for our data set. A descriptive case study approach to analysis was taken.ResultsFour key descriptive patterns were identified: labelling and limits to tolerance, pushing prescription as a solution, coverups and avoiding consent, and family’s fight for liberty. Triangulation across the data and academic literature supports the findings.ConclusionOur findings provide some insight into how chemical restrain happens. Featuring throughout the cases were reports of a lack of workforce capacity to care for and support residents exhibiting dementia behaviours. Prescription of psychotropic medications featured as a “first resort” care solution. Family and friends found such approaches to care unacceptable and frequently challenged the practice. Where consent for prescription was explicitly denied, more covert approaches are demonstrated. Family awareness, presence, and advocacy were key to challenging the practice of chemical restraint. Shortfalls in the capacity of the current workforce come into play here. However, workforce shortcomings can no longer mask this ubiquitous practice. Just as importantly the spotlight needs to be turned on the prescribers and the providers.

Exercise interveNtion outdoor proJect in the cOmmunitY – results from the ENJOY program for independence in dementia: a feasibility pilot randomised controlled trial

The Seniors Exercise Park program is an evidence-based outdoor physical and social activity program designed originally for older people with no cognitive impairment. This study aimed to pilot this program for people living with dementia in residential aged care. We examined the feasibility of delivering the program, evaluating its structure, safety, and supervision needs. In addition, physical, social, health and cognitive benefits of participation were examined.MethodThis was a feasibility pilot randomised controlled design. Adults aged ≥ 60 years with symptoms of dementia and/or diagnoses of dementia were recruited from an aged care facility in Australia. Participants allocated to the intervention underwent a 12-week structured supervised physical activity program using the outdoor Seniors Exercise Park equipment followed by a 12-week maintenance phase, while the controls received usual care programs. Assessments occurred at baseline, 12 and 24-weeks. Feasibility evaluation included recruitment rate, retention, attendance, overall adherence, dropout rate, adverse events, program delivery modifications and supervision requirements. A suite of cognitive and health-related questionnaires and physical function measures were also collected.ResultsSixteen participants were recruited (recruitment rate: 58.6%), eight for the intervention (83.3 ± 7.5 years, 87.5% women) and eight for the control (age 87.5 ± 3.0 years, 87.5% women). Eighty-eight percent completed the 12-week structured program, with 75% retention at 24-weeks. Across the 24-week period, 84.3% participation adherence was reported. No falls or adverse events occurred. Modifications of the program mainly related to method of communication, cueing and adjustments to suit individual personality and characteristics. A ratio of one trainer to two participants was practical and safe. There were no significant changes over time between groups in any of the secondary outcomes. High level of engagement, enjoyment and mood was reported throughout the exercise program.ConclusionThe Seniors Exercise Park physical activity program was safe and feasible for people living with dementia in residential care, with high levels of enjoyment, positive attitude, and engagement reported in the intervention group. Individualised communication during program delivery was needed to facilitate motivation and participation. Further research is needed to assess the program effectiveness on physical and cognitive function on a larger scale.Trial registrationThis trial is registered with the Australian New Zealand Clinical Trials Registry—Registry Number ACTRN12620000733976. Registered on the 13/07/2020.

The impact of montessori-based programmes on individuals with dementia living in residential aged care: A systematic review.

This systematic review examined the effectiveness of Montessori-based programmes for individuals with dementia living in residential aged care. Nine databases were searched between January 2010 to October 2021, including Scopus, CINAHL, MEDLINE, Web of Science, SocINDEX with Full Text, PubMed, PsycINFO, Cochrane library and Cochrane Registry. Publications were included if they used Montessori-based programmes as interventions for individuals with dementia living in residential aged care and were qualitative, quantitative, mixed-method, or pilot studies. The quality of eligible studies was assessed using Joanna Briggs Institute critical appraisal instruments and the Mixed Method Critical Appraisal Tool. The findings were tabulated and narratively synthesised. Fifteen studies were included in this review. The quality scores of the 15 studies ranged from 62 to 100 out of 100. Four key categories of outcomes were observed: (1) significantly improved engagement; (2) significantly improved mental health outcomes, including affect, depression, agitation, excessive eating and psychotropic medication prescriptions; (3) significantly improved feeding difficulty but mixed results regarding nutritional status; and (4) no significant changes in the activities of daily living and quality of life of individuals with dementia. Cognitive capacity, personal preferences, individual care needs and the design of Montessori-based activities are pivotal to tailoring personalised Montessori-based activities for individuals with dementia in residential aged care and to maximise intervention outcomes. The synergistic effect of integrating Spaced Retrieval with Montessori-based activities in improving the eating ability and nutritional status of individuals with dementia was also noticed. The study summarised evidence about the effectiveness of Montessori-based programmes for individuals with dementia and informed healthcare professionals about how to implement individualised Montessori-based programmes.

The Delivery of Person-Centered Care for People Living With Dementia in Residential Aged Care: A Systematic Review and Meta-Analysis.

Person-centered care is the gold standard of care for people living with dementia, yet few systematic reviews have detailed how it is delivered in practice. This mixed-methods review aimed to examine the delivery of person-centered care, and its effectiveness, for people living with dementia in residential aged care. A systematic review and meta-analysis. Eligible studies were identified across 4 databases. Quantitative and qualitative studies containing data on person-centered care delivered to people with dementia living in residential aged care were included. Meta-analysis using a random-effects model was conducted where more than 3 studies measured the same outcome. A narrative meta-synthesis approach was undertaken to categorize verbatim participant quotes into representative themes. Risk of bias was undertaken using quality appraisal tools from the Joanna Briggs Institute. 41 studies were identified for inclusion. There were 34 person-centered care initiatives delivered, targeting 14 person-centered care outcomes. 3 outcomes could be pooled. Meta-analyses demonstrated no reduction in agitation (standardized mean difference -0.27, 95% confidence interval [CI], -0.58, 0.03), improvement in quality of life (standardized mean difference -0.63, 95% CI: -1.95, 0.70), or reduced neuropsychiatric symptoms (mean difference -1.06, 95% CI: -2.16, 0.05). Narrative meta-synthesis revealed barriers (e.g., time constraints) and enablers (e.g., staff collaboration) to providing person-centered care from a staff perspective. The effectiveness of person-centered care initiatives delivered to people with dementia in residential aged care is conflicting. Further high-quality research over an extended time is required to identify how person-centered care can be best implemented to improve resident outcomes.

The Dementia Engagement Modelling Program (DEMP): a novel Australian model of care for aged care residents affected by COVID‐19

Like other countries, aged care homes in Australia have been significantly affected by the COVID-19 pandemic. To ensure the safety of residents and staff, lockdown, and social restrictions (e.g., limited or no visits from family) have been introduced across Australia. These measures caused tremendous emotional, psychological, and physical burdens on residents, particularly those living with dementia. In response to the pandemic, the Australian Government has funded the Aged Care COVID-19 Grief and Trauma support package for older people receiving aged care, their families, and aged care staff. Part of this package is the Dementia Engagement Modelling Program (DEMP), a free national support program developed by Dementia Support Australia, HammondCare to help staff support residents whose wellbeing have been affected by COVID-19 with tailored engagement strategies. The program represents a first line multimodal support for people living with dementia in residential aged care who may have experienced withdrawal, frustration, or fear and at a greater risk of developing behaviors and psychological symptoms of dementia (BPSD), such as apathy, anxiety, and depression. Through a multidisciplinary team of dedicated consultants, the program delivers best practice, person-centered engagement strategies to support staff, providing meaningful engagement, comfort, and reassurance to residents living with dementia. DEMP consultants work collaboratively and closely with lifestyle and care staff to develop tailored activities and provide appropriate resources (e.g., brokerage items such as music therapy) for engagement. DEMP will also provide support and coaching to staff for the individual or small groups to ensure that both staff and residents gain the full benefit from the program. The eligibility criteria for DEMP support include aged care homes that: 1) experienced an outbreak of COVID-19 or those subject to a precautionary lockdown, and/or 2) sought engagement plans and strategies for residents living with dementia, or those at risk of developing BPSD due to COVID-19 restrictions. This descriptive study will discuss the DEMP's model of care, eligibility criteria, activities, and outcomes and provide case examples that can guide meaningful engagement for other aged care residents living in other countries during COVID-19.

Australian National Aged Care Classification behaviour assessment and people living with dementia in residential aged care: Inclusive language for reform?

To examine the language of the behaviour assessment in the new Australian National Aged Care Classification (AN-ACC) funding instrument. We explored whether the (BRUA) will support an inclusive and progressive approach for people living with dementia in residential aged care. Databases were searched to identify publicly available literature relating to the development of the AN-ACC and BRUA, and hand searches of reference lists and selected websites were completed to identify additional grey literature, dementia language and best practice guidelines. Criteria for language use were extracted and compared with the BRUA in the light of the current national aged care reform agenda, as well as research with and perspectives of people with lived experience of dementia. The language within the BRUA did not align with international dementia language guidelines, and the content presented was disrespectful to those with lived experience. The assessment appears inconsistent with international best practices and is potentially discriminatory within the aged care cohort. The BRUA is intended as a funding instrument and not as a care planning tool, yet the negative representation of the lived experience of people with dementia embedded within a mandated assessment is likely to influence industry practice by condoning unsuitable language and attitudes amongst assessors, providers and staff. For better alignment with the current positive agenda for aged care reform in Australia, we recommend continued review and updating of this tool to avoid unintended consequences.

Estimating the cost of an individualised music intervention for aged care residents with dementia.

Individualised music listening has been shown to reduce agitation and improve mood in people with dementia. However, there is a paucity of research describing the cost of implementing such interventions in residential care settings for older people. To determine the cost of implementing an individualised music intervention for older people with dementia in residential aged care in Australia. A simple cost analysis was undertaken to determine the cost of delivering the individualised music intervention to 32 older people with dementia at two residential aged care facilities in New South Wales. The analysis took into consideration the operating, training and delivery costs, as well as the costs of purchasing the music equipment and downloads. The cost of delivering the individualised music intervention was found to be AU$6,623.76 per year - or AU$3.98 per resident per week, at 2017 values. At 2022 values, this equates to an annual cost of AU$7,130.07 (£4,031.85) for 32 residents and a weekly cost of AU$4.28 (£2.42) per resident per week. The cost of implementing the individualised music intervention was relatively low compared with the overall cost of residential aged care for older people with dementia.

Exercise interveNtion outdoor proJect in the cOmmunitY\u2014ENJOY program for independence in dementia: a feasibility pilot randomised controlled trial study protocol

BackgroundWhile the underlying neuropathology of dementia is not curable, interventions and treatment, such as physical activity, can offer physical and functional gains leading to better mobility, independence and quality of life. The Seniors Exercise Park program is an evidence-based physical and social activity program using an innovative design in outdoor exercise equipment specifically designed for older people. This unique program has never been tested with older people living with dementia. This study will evaluate the feasibility of delivering the Seniors Exercise Park program for people living with mild to moderate dementia in residential aged-care. This study will identify the optimal physical activity program, evaluate the safety of equipment usage and determine optimal supervision needs. The potential physical, social, quality of life and cognitive benefits of participation in the Seniors Exercise Park program will also be examined.MethodsThis is a feasibility pilot randomised controlled design with pre-post evaluation. Adults aged ≥ 60 years who have symptoms of dementia and/or who have been diagnosed with dementia will be recruited from an aged-care facility in Melbourne. Participants allocated to the intervention group will undergo a 12-week structured supervised physical activity program using the outdoor Seniors Exercise Park equipment followed by a 12-week maintenance phase (unstructured physical activity). Participants will be assessed at baseline, 3 and 6 months. Participants allocated to the control group will attend activities provided by the aged-care facility. A sample of 12 participants per group is the targeted sample size. Feasibility will be evaluated in terms of recruitment rate, retention, attendance, overall adherence, dropout rate, adverse events, modifications to the exercise program delivery and supervision needs. A comprehensive suite of cognitive and health-related questionnaires and physical function measures will also be collected.DiscussionThe ENJOY program for independence in dementia will determine the suitability of the Seniors Exercise Park program for people diagnosed with mild to moderate dementia. Outcomes could inform future design of dementia-friendly built environments to increase physical activity participation for residential aged-care facilities.Trial registrationThis trial is registered with the Australian New Zealand Clinical Trials Registry—Registry Number ACTRN12620000733976. Registered on the 13th of July 2020.

Ending confinement and segregation: barriers to realising human rights in the everyday lives of people living with dementia in residential aged care

ABSTRACT Human rights are increasingly being considered in Australian law reform and policy discussions on how to improve the circumstances of people living with dementia in care homes. This article enriches understanding of the views on human rights held by people living with dementia and those who support, advocate and care for them, in order to ensure that law and policy reforms that promote human rights can be meaningfully enjoyed in practice. Drawing on data from focus groups and interviews with people living with dementia, care partners, aged care workers, and lawyers and advocates, this article argues that there is general support among stakeholders for human rights. However, this support was qualified by their acknowledgement of entrenched economic, cultural and sociolegal barriers to the recognition of human rights in the everyday lives of people living with dementia. The article concludes that urgent action is required to transform the cultural, economic and social drivers of ambivalence and resistance to dementia and human rights within aged care and the broader community.

Staff perceptions of caring for people exhibiting behavioural and psychological symptoms of dementia in residential aged care: A cross-sectional survey.

ObjectivesTo explore the attitudes of direct care staff in residential aged care when interacting with, and responding to, residents exhibiting behavioural and psychological symptoms of dementia (BPSD).MethodsCross‐sectional survey (n = 70).ResultsParticipants favoured a person‐centred approach to their management of residents with BPSD and were aware of the causes of BPSD. There were significant differences between personal care workers’ (PCWs) and enrolled nurses’ (ENs) perceptions of the impact of interpersonal relationships and the physical environment on aggressive behaviours, and between registered nurses and both PCWs and ENs regarding the use of medications for aggressive behaviour and a medical approach to care.ConclusionsThe attitudes of participants reflected an awareness of BPSD and its causes. Participants recognised the benefits of a person‐centred paradigm, but more education directed towards ENs and PCWs regarding appropriate administration and potential risks of psychotropic medication for BPSD may be beneficial.

The use of technology to promote meaningful engagement for adults with dementia in residential aged care: a scoping review.

A considerable number of adults with dementia live in residential aged care facilities, where loneliness and boredom are common. Computer-based and electronic technologies have advanced significantly and there is potential for such technologies to improve engagement of residents with dementia. However, the nature and extent of the evidence supporting the use of these technologies is unclear. The aim of this study was to investigate the use of computer-based and electronic technologies for enhancing meaningful engagement of adults with dementia living in residential aged care. A scoping review was conducted. Nine databases were searched from 2008-2018. Included studies were summarized, compared and synthesized according to technology type. Twenty studies were included. Most studies were conducted in Australia (n = 7) and Europe (n = 8). Study designs were quantitative (n = 12), mixed methods (n = 5), descriptive (n = 2) or qualitative (n = 1). Studies aimed to investigate interaction, engagement, behaviors or quality of life (n = 14), to examine the feasibility of technologies (n = 3), or had both aims (n = 3). Technology type fell into two categories: robotics (n = 14) and multi-media computer programs (n = 6). Across both technology types, there were conflicting results in relation to positive impact on meaningful engagement. Studies only investigated the doing, belonging and connecting aspects of meaningful engagement. Additionally, there was a lack of consistency across studies in how activity, interaction and engagement were measured. The role and potential of new technologies to enhance meaningful engagement for those with dementia should focus on creating human-to-human interactions while taking individual preference and person-centered principles into account.

Promoting mealtime function in people with dementia: A systematic review of studies undertaken in residential aged care

BackgroundDementia is one of the most prevalent conditions in older adults in residential aged care. Dementia has a significant impact on a person’s ability to eat, drink and participate in mealtime activities. Dementia impacts memory, appetite, gross and fine motor skills, communication skills, mood and social behaviours, all of which can decrease the person’s ability to engage in a meal. ObjectivesThe objective was to review the literature on strategies to promote mealtime function in people with dementia living in residential aged care and assess their effectiveness. The review considered studies reporting outcome measures that related to nutritional status, communication, behaviour and eating skills and ability. DesignSystematic review using the Joanna Briggs Institute review methods. Data sourcesSeven databases (MEDLINE, CINAHL, Cochrane Database of Systematic Reviews, EMBASE, Current Contents, PsycINFO and Allied and Complementary Medicine Database) were searched for research published 2000–2017 in English. Eligible studies included quantitative studies reporting a mealtime intervention delivered to people with dementia in residential aged care compared with standard care reporting nutritional, behavioural or functional outcomes, including observation studies with no comparator. Review methodsStudies were screened and independently appraised by two reviewers using Joanna Briggs Institute (JBI) critical appraisal tools based on study design. Data was extracted from eligible studies using JBI extraction tables that assess study design, population characteristics, intervention and comparator, outcome measures and findings. Results related to mealtime function were tabulated and reported in narrative format. Results136 studies were identified, of which 20 were eligible for inclusion. Studies reported strategies related to: food presentation; meal styles; environment adaptations; skills training; music therapy and animal-assisted therapy. Outcomes included measures of nutritional status, communication and behavioural and psychological symptoms of dementia. Low quality evidence suggested that playing music and introducing fish to the dining room may improve the food intake of people with dementia by a small amount. Montessori and spaced retrieval programs also demonstrated some positive impact on eating skills and nutritional intake. Animal-assisted therapy also demonstrated small statistically significant improvements in weight and body mass index. ConclusionThere is insufficient evidence to highly recommend any specific intervention to improve mealtime functional ability in people with dementia. Further research is required through robust study designs using valid and reliable outcome measures to demonstrate clinically significant effects for mealtime interventions.

Time for Australia to revisit antipsychotic use in dementia in residential aged care

Time for Australia to revisit antipsychotic use in dementia in residential aged care

Supporting the spiritual needs of people with dementia in residential aged care

ABSTRACTObjective: To describe how an Australian age care provider, BaptistCare NSW & ACT, has embraced the National Guidelines for Spiritual Care in Aged Care for people with dementia.Method: A 12-month study was conducted in 19 Baptistcare residential homes, including 14 dementia units. Data were obtained from selected items of the Person-Centred Environment and Care Assessment Tool using interviews, observation, and document review.Results: The person-centred approach was instituted in adhering to the Guidelines for people with dementia. Conclusion: The person-centred approach assists in actioning the Guidelines for people with dementia.

Direct health and residential care costs of people living with dementia in Australian residential aged care.

ObjectivesThis analysis estimates the whole‐of‐system direct costs for people living with dementia in residential care by using a broad health and social care provision perspective and compares it to people without dementia living in residential care.MethodsData were collected from 541 individuals living permanently in 17 care facilities across Australia. The annual cost of health and residential care was determined by using individual resource use data and reported by the dementia status of the individuals.ResultsThe average annual whole‐of‐system cost for people living with dementia in residential care was approximately AU$88 000 (US$ 67 100) per person in 2016. The cost of residential care constituted 93% of the total costs. The direct health care costs were comprised mainly of hospital admissions (48%), pharmaceuticals (31%) and out‐of‐hospital attendances (15%). While total costs were not significantly different between those with and without dementia, the cost of residential care was significantly higher and the cost of health care was significantly lower for people living with dementia.ConclusionThis study provides the first estimate of the whole‐of‐system costs of providing health and residential care for people living with dementia in residential aged care in Australia using individual level health and social care data. This predominantly bottom‐up cost estimate indicates the high cost associated with caring for people with dementia living permanently in residential care, which is underestimated when limited cost perspectives or top‐down, population costing approaches are taken.

Tales from the ACFI: Dementia in residential aged care.

Provide an overview of how care needs in permanent residential aged care differ by dementia status. On entry into permanent residential aged care, people's care needs are assessed on the Aged Care Funding Instrument (ACFI). ACFI also captures health conditions that are considered to affect the cost of people's care, such as dementia. Data were compared between 2009 and 2015. Assessed care needs have increased regardless of dementia status. However, compared with people without dementia, people with dementia were more likely to be rated 'high' in each of the three care need domains. In addition, people with dementia were more likely to require some assistance in specific areas that underlie these broad domains, such as nutrition, continence and cognition. Dementia is associated with increased complexity in assessed care needs in permanent residential aged care.

Experiences of family-staff relationships in the care of people with dementia in residential aged care: a qualitative systematic review protocol.

The objective of this systematic review is to identify, critically appraise and synthesize the best available literature regarding experiences and perceptions of family-staff relationships in the care of people with dementia living in residential aged care facilities.More specifically, the objectives are to identify family caregiver and healthcare staff experiences and perceptions of their own and each other's roles and responsibilities and the characteristics that facilitate or hinder a constructive family-staff relationship.

Effectiveness of interventions to improve family-staff relationships in the care of people with dementia in residential aged care: a systematic review protocol.

REVIEW QUESTION / OBJECTIVE The objective of this review is to identify and appraise existing evidence regarding the effectiveness of interventions designed to enhance staff-family relationships for people with dementia living in residential aged care facilities. More specifically, the objectives are to identify the effectiveness of constructive communication, cooperation programs, and practices or strategies to enhance family-staff relationships. The effectiveness of these interventions will be measured by comparing the intervention to no intervention, comparing one intervention with another, or comparing pre- and post-interventions. Specifically the review question is: What are the most effective interventions for improving communication and cooperation to enhance family-staff relationships in residential aged care facilities? INCLUSION CRITERIA Types of participants This review will consider studies that include: Family caregivers of people with dementia who are living in residential aged care facilities People with dementia who are living in residential aged care facilities Health care staff working in residential aged care facilities who are caring for people with dementia. All other settings will be excluded. Types of interventions This review will consider studies that evaluate interventions (e.g. programs, practices and strategies) designed to enhance family-staff relationships when compared to usual care (i.e. no intervention), when compared to another intervention, or compared to pre- and post-intervention. Family members include anyone involved in the caregiving process of the person with dementia, e.g. a husband or daughter. There is no limit to the age, diagnosis or severity of dementia of the person with dementia. TRUNCATED AT 250 WORDS