Dementia In Residential Care Facilities Research Articles

The Impact of Dual-Tasks and Disease Severity on Posture, Gait, and Functional Mobility among People Living with Dementia in Residential Care Facilities: A Pilot Study.

Gait speed and timed-up-and-go (TUG) predict cognitive decline, falls, and mortality. Dual-tasks may be useful in cognitive screening among people living with dementia (PWD), but more evidence is needed. This cross-sectional study aimed to compare single- and dual-task performance and determine the influence of dementia severity on dual-task performance and interference. Thirty PWD in two residential care facilities (Age: 81.3 ± 7.1 years; Montreal Cognitive Assessment: 10.4 ± 6.0 points) completed two trials of single- (feet apart) and dual-task posture (feet apart while counting backward), single- (walk 4 m) and dual-task gait (walk 4m while naming words), and single- (timed-up-and-go (TUG)), and dual-task functional mobility (TUG while completing a category task) with APDM inertial sensors. Dual-tasks resulted in greater sway frequency, jerk, and sway area; slower gait speed; greater double limb support; shorter stride length; reduced mid-swing elevation; longer TUG duration; reduced turn angle; and slower turn velocity than single-tasks (ps < 0.05). Dual-task performance was impacted (reduced double limb support, greater mid-swing elevation), and dual-task interference (greater jerk, faster gait speed) was related to moderate-to-severe compared to mild PWD. Moderate-to-severe PWD had poorer dynamic stability and a reduced ability to appropriately select a cautious gait during dual-tasks than those with mild PWD, indicating the usefulness of dual-tasks for cognitive screening.

Exploring the Association Between Physical Activity and Cognitive Function Among People Living with Dementia.

Physical activity preserves cognitive function in people without dementia, but the relationship between physical activity and cognitive domains among people living with dementia is unclear. The objective of this study was to explore the association between physical activity and cognition domains among people living with dementia. Participants living with dementia in residential care facilities (complete case analysis: n = 24/42) completed a battery of cognitive tests (global cognition: Montreal Cognitive Assessment; executive function: Trail-Making Test, Digit Span Forward Test; perception and orientation: Benton Judgement of Line Orientation Test; language: Boston Naming Test; learning and memory: Rey Auditory Verbal Learning Test; complex attention: Digit Symbol Substitution Test). Participants wore an actigraphy monitor on their non-dominant wrist over seven days. We conducted a linear regression for total physical activity (independent variable) with race (white/black), fall risk (Morse Fall Scale), and the number of comorbidities (Functional Comorbidities Index) as covariates, and cognitive tests as variables of interest. Participants were primarily male (75%), white (87.5%), and 50%had unspecified dementia (Alzheimer's disease: 33%). Greater physical activity was associated with poorer global cognition, better executive function, and better learning and memory (ps < 0.05). Physical activity was not related to visuospatial perception, language, or complex attention. Physical activity may preserve executive function and learning and memory among people living with dementia. Wandering is more common in later stages of dementia, which may explain greater physical activity observed with lower global cognition. Regularly assessing physical activity may be useful in screening and monitoring cognitive changes.

INVESTIGATING THE RELATIONSHIP BETWEEN HABITUAL ACTIVITY AND COGNITIVE DOMAINS AMONG PEOPLE LIVING WITH DEMENTIA

Abstract Habitual activity preserves cognitive function in people without dementia, but the relationship between habitual activity and cognitive domains among people living with dementia is unclear. The purpose of this study was to explore the association between habitual activity and cognition domains among people living with dementia. Participants living with dementia in residential care facilities (complete case analysis: n=24/42) completed a battery of cognitive tests (global cognition: Montreal Cognitive Assessment; executive function: Trail-Making Test, Digit Span Forward Test; perception and orientation: Benton Judgement of Line Orientation Test; language: Boston Naming Test; learning and memory: Rey Auditory Verbal Learning Test; complex attention: Digit Symbol Substitution Test). Participants wore an actigraphy monitor on their non-dominant wrist over seven days. We conducted a linear regression for total habitual activity (independent variable) with race (white/black), fall risk (Morse Fall Scale), and the number of comorbidities (Functional Comorbidities Index) as covariates, and cognitive tests as variables of interest. Participants were primarily male (75%), white (87.5%), and 50% had unspecified dementia (Alzheimer’s disease: 33%). Greater habitual activity was associated with poorer global cognition, better executive function, and better learning and memory (ps&amp;lt; 0.05). Habitual activity was not related to visuospatial perception, language, or complex attention. Habitual activity may preserve executive function and learning and memory among people living with dementia. Wandering is more common in later stages of dementia, which may explain greater habitual activity observed with lower global cognition. Regularly assessing habitual activity may be useful in screening and monitoring cognitive changes.

PALLIATIVE CARE IN RESIDENTIAL CARE HOMES: IMPLEMENTATION CHALLENGES AND EARLY FINDINGS IN THREE CLINICAL TRIALS

Abstract This symposium will describe, compare and contrast three active clinical trials implementing palliative care models for people with dementia in residential care facilities and nursing homes. SPA-LTC is a pragmatic clinical trial in three Canadian provinces, providing training to palliative care teams and a process for triggered palliative care conferences. EMBED-Care, based in the United Kingdom, is testing a digital clinical support tool to improve integrated palliative care for people with dementia using holistic assessment and promoting shared decision-making. UPLIFT-AD is a multi-state U.S. based clinical trial, providing training for in-facility Palliative Care Leads and facilitating specialty palliative care clinician consults for people with moderate to advanced dementia. This symposium provides an opportunity to compare methodologic choices in study design, including intervention design, use of internal (care facility) based resources vs. external supports, and outcome assessment. Presenters will describe implications of these design choices for the implementation of the trial and for longer term sustainability. Implementation experience, including barriers and facilitators to palliative care programs for people with dementia, will be described.

Experiences of healthcare staff in managing responsive behaviour of people with dementia in residential care facilities: a qualitative literature review

Background/Aims Dementia is a collective term for all conditions that cause damage to the brain. Responsive behaviour is one of the symptoms of dementia trajectory and more than 90% of people with dementia present with responsive behaviour. These behaviours, including aggression and agitation, can adversely affect residents and staff in residential care services. There is a lack of understanding of how staff experience and manage responsive behaviours in residential settings. The aim of this qualitative literature review was to explore the experiences and perceptions of healthcare staff in managing responsive behaviour of residents with dementia in older persons’ residential care services. Methods A systematic search across six databases was performed using the Setting, Perspective, Phenomenon of interest, Comparison, Evaluation framework. Synthesis was guided by ‘best fit’ framework using the Valuing, Individualised, Perspective, Social and psychological environment framework. Results A total of nine articles were included in the review. From the Valuing, Individualised, Perspective, Social and psychological environment framework, the following sub-themes were found: valuing residents and staff; knowing residents through life history; unmet needs; the perspective of institutionalised care practices; emotional distance; the importance of meaningful activities; and a supportive environment. Conclusions The findings identified that access to dementia-specific education and a supportive management structure can help staff manage responsive behaviours of residents with dementia.

245 A PILOT STUDY EVALUATING USE AND ACCEPTABILITY OF A NATIONAL AUDIT TOOL AND MANUAL FOR PSYCHOTROPIC MEDICATIONS IN RESIDENTIAL CARE

Abstract Background Psychotropic medications are frequently prescribed for long-term care residents, even though the risks frequently outweigh the benefits. A draft tool was developed for self-audit of the appropriateness of psychotropic medications prescribed for non-cognitive symptoms for people with dementia in Residential-Care Facilities (RCF). Prior to national use, the audit tool, audit manual and training required piloting. Methods The case notes of ten residents with dementia were selected at random within a single RCF. A set of notes were audited by professional staff after online (pre-recorded) audit training, with subsequent feedback by the auditors on the process via focus groups/individual interviews. A second set of notes were then audited, with feedback via a brief survey. Results All auditors (7 nurses, 4 doctors, and 4 therapists) gave feedback via a focus group(n=4) or 1:1 interviews; 7 also completed the second-round survey. The pre-audit online training was welcomed but some auditors required additional support during the audit, especially if inexperienced or if there was a gap between training and audit performance. Improvement suggestions for the audit manual included shortening it; adding a glossary of terms, and additional information for decisions on the appropriateness of “as needed” (PRN) medications. Auditors reported difficulties with reading handwriting, locating information in the chart, and determining if a medication was newly or previously prescribed on occasion (due to inconsistencies with prescribing documentation). Conclusion Overall, the feedback was positive; all reported that the audit was relevant to their practice, and the manual and online training were useful. Future audits could be facilitated by electronic prescriptions, protected time to complete audits, and site audit leads (senior nursing or medical staff who are familiar with the residents, the audit topic, and with performing the audit). Inexperienced auditors should have, in addition to a training session, a supported auditing session.

Developing an effective strategy to implement non‐pharmaceutical interventions amongst residents with dementia in residential care facilities: Caregivers’ perspectives

AbstractBackgroundNon‐pharmaceutical interventions based on unfulfilled needs amongst residents with dementia reduce symptoms of agitation, aggression and depression. However, to implement these interventions in daily practice in residential care facilities, caregivers need to (a) analyse resident’s behaviour, (b) recognize unfulfilled needs and (c) apply an individualized non‐pharmaceutical intervention.ObjectivesTo develop an effective strategy for the implementation of such complex approach, insights in caregivers’ perception of barriers and facilitating factors are needed.MethodsA total of thirteen focus group interviews with fifty‐six caregivers from twelve residential care facilities was conducted between October 2019 and February 2020.ResultsDespite a person‐centred vision and culture in residential care facilities, caregivers recognize that dealing with altered behaviour amongst residents with dementia is challenging and that non‐pharmaceutical interventions are seldom used. However caregivers are willing to invest in a team‐based person‐centred approach, different perspectives on priorities in care processes seem to influence the implementation. Participants refer to the importance of an open team culture where safety is guaranteed. An open culture stimulates an attitude of reflection, which is necessary to attune person‐centred care to different perspectives. Therefore the presence of clinical and facilitating leadership is crucial to ensure motivation, a sense of competency, communication, problem‐solving competences, practical organization of non‐pharmaceutical interventions and continuity in care processes. Ward managers and clinical leaders prefer to be supported by an implementation coach who provides education and training to the team members and who facilitates from a neutral perspective moments of intervision on a regular base.ConclusionsCaregivers recognize the presence of a person‐centred vision and culture, team willingness and different perspectives on priorities in care processes as influencing factors for the implementation of non‐pharmaceutical interventions. Strong clinical and facilitating leadership and the availability of an implementation coach may support caregivers in dealing with different perspectives on priorities in care. Implications for clinical practice: An educational package, intervision sessions and a leadership trajectory are recommended elements of strategy to implement non‐pharmaceutical interventions based on unfulfilled needs amongst residents with dementia.

Next of kin's experiences with and attitudes towards digital monitoring technology for ageing people with dementia in residential care facilities. A qualitative study based on the voices of next of kin and care providers.

To explore next of kin's experiences and attitudes regarding information surrounding the introduction and use of technology to monitor residential home residents with dementia. As our population ages, conditions increase health care and societal challenges. Digitalisation and welfare technology are important for developing health services for the ageing population; adapting information-sharing and communication about these pics with those involved, such as next of kin, will become increasingly important for developing appropriate services. This qualitative study has an exploratory and interpretative approach, using in-depth interviews based on a hermeneutical-phenomenological perspective. During the process of implementing a variety of residential care monitoring technologies, data were collected primarily via semi-structured, in-depth interviews with care providers and next of kin. In addition to the individual interviews, one focus group interview was carried out with care providers. Next of kin are a heterogeneous group who need differing types of information - and different styles of communication - to convey information about their relatives in residential care. General attitudes among the next of kin towards welfare technology were positive. Three analytic themes that illustrate the next of kin concerns emerged: (1) concern for safety, autonomy and ethics; (2) resistance and optimism towards technology; (3) information about the use of monitoring technology. Digital monitoring technology is increasingly being implemented in residential care. Next of kin are salient in this context. Accordingly, best practices for informing and communicating in a collaborative process must be developed. While some next of kin have resources and are able to be highly engaged, others are unable or unwilling to be active participants in their family members' lives. It is critical that care providers are aware that next of kin are a heterogeneous group. Our proposed profiles may prove helpful for giving the right information and attention to next of kin, and this may improve residential care services. These findings may aid in the tailoring of information and communication systems to individual next of kin's needs and in improving residential care services.

Nursing Staff’s Knowledge and Attitudes towards Dementia in an Indian Nursing Home: A Qualitative Interview Study

Background: Despite the increased prevalence of dementia in India, there is reported to be little awareness of the disease. This could lead to a late diagnosis, a reduced number of choices regarding future care, and misinterpretation of the symptoms or neglect. Taking into consideration that most nurses caring for older people in the future will work with people with dementia, there is concern that they may not be able to meet the needs of this group of patients unless they have the necessary knowledge and a positive attitude. Aim: To explore the knowledge about and attitude towards dementia among nursing staff working in residential care facilities for older people in India. Method: An explorative and descriptive qualitative design was used. Two semi-structured focus group interviews were conducted with nursing staff working in 6 nursing homes in India. Qualitative content analysis was used. Ethical approval was granted by the Norwegian Social Science Data Services. Findings: The participants highlighted the following 3 dimensions in relation to their knowledge of and attitudes toward dementia in residential care facilities in India: (1) people with dementia – a walking mystery; (2) we need to go along with them, but it is challenging; and (3) if we know, we can care for them in a better way. Conclusion: The findings revealed a wide range of differences in attitude towards and inadequate knowledge of dementia among nursing staff. However, their overall attitudes toward people with dementia was positive.

Delirium: A suggestive sign of COVID-19 in dementia.

Approximately 40% - 60% of people with dementia in residential care facilities experience behavioral and psychological symptoms (BPSD), such as agitation, psychosis, or apathy [1]. During the COVID-19, older adults with dementia were likely to develop behavioral changes [2]. Among multiple factors contributing to the behavioral disturbances in unprecedented times, delirium was not well recognized in dementia, especially among those without respiratory failure [3,4]. In the EClinicalMedicine, Tino Emanuele Poloni and colleagues report a retrospective study of delirium superimposed on dementia during the COVID-19 outbreak peak in a dementia facility in Italy [5].

The influence of organizational factors on the attitudes of residential care staff toward the sexuality of residents with dementia

BackgroundThe attitudes of care staff toward the sexuality of residents with dementia they care for is assumed to influence the residents’ expression of their sexuality in the way they want. This paper examines the effect of organizational factors, person-centered care, and the culture of the organization on the attitudes of care staff toward the sexuality of residents with dementia in residential care facilities (RCF) .MethodsCare staff in different functions at six RCF organizations (N = 187) participated. Using a survey, we gathered information on demographics and care-staff careers, attitudes toward resident sexuality, the culture of the organization, person-centered care, and knowledge of resident sexuality. Ordinary least square (OLS) hierarchical analyses were performed to analyze results.ResultsCare staff attitudes were found to be positively affected by person-centered care, and marginally positively affected by a supportive culture in the organization, Moreover, knowledge of resident sexuality positively affected care staff ‘attitudes toward resident sexuality, and the presence of policy regarding resident sexuality affected them negatively .ConclusionsDespite different study limitations, these results give a first insight in a broad perspective on care staff attitudes toward resident sexuality. In addition to improving knowledge of the care staff, enhancing person-centered care and a supportive culture in the organization will improve care-staff attitudes toward resident sexuality.

Reciprocal design: inclusive design approaches for people with late stage dementia

ABSTRACTMore people, than ever before, are living into advanced old age. As a result, incidences of age-related, non-communicable disease such as dementia will increase. Dementia is an umbrella term for a range of conditions that impact cognitive and physical functioning. It is terminal. Scientific communities continue to search for a cure. Meanwhile, attention is increasingly being refocused, exploring what it means to have a good quality of life and how to live well with dementia, regardless of the stage of the disease. Design has an important role to play in supporting quality of life of people living with dementia. However, designers need to take into account the many varied contexts in which people live, the different manifestations of the disease, and individual wants, needs and preferences. Co-creative approaches can enable people living with dementia and stakeholders in their care, to engage in the design process and impact products and services made for them, provide opportunities for social engagement, interaction and pleasure, and give designers insights into the embodied experience of living with dementia and the social and cultural impact. This paper discusses a participatory design research project with people living with advanced dementia in residential care facilities in Australia.

Dementia care in Ontario, Canada: evidence of more timely diagnosis among persons with dementia receiving care at home compared with residential facilities

ObjectiveHome care (HC) has been promoted as an efficient alternative to residential care (RC). However, little is known about the individuals who receive HC. This study compared the cognitive and functional statuses of persons with dementia receiving HC or RC at the time of diagnosis with dementia. It was hypothesized that persons with dementia receiving RC would have declined further, both cognitively and functionally. Study designPopulation-based secondary data analysis. MethodsData from the Canadian Institute for Health Information's Continuing Care Reporting System and the Home Care Reporting System, 2009–2011, were used. Respective populations of 39,604 and 21,153 persons with dementia who received either RC or HC were included. Cognitive and functional statuses were measured using a cognitive performance scale (CPS) and an activities of daily living (ADL) scale, respectively. ResultsThe mean CPS score was higher for the RC group (3.2 vs 2.5). The proportion of individuals diagnosed when impairment was moderate to very severe (CPS ≥ 4) was higher in the RC group (32.0% vs 13.3%). The mean ADL score was also higher for the RC group (3.5 vs 1.6). The proportion of individuals diagnosed when they required extensive assistance or were totally dependent (ADL ≥ 3) was markedly higher in the RC group (72.3% vs 27.3%). All findings were statistically significant (P < 0.0001). Multivariable analysis suggested that RC clients were nearly four times more likely than HC clients to be diagnosed at a later stage (odds ratio = 3.74, 95% confidence interval 3.54–3.95). ConclusionsPersons with dementia in RC facilities in Ontario are diagnosed when their cognitive and functional statuses have declined more than those of their HC counterparts.

Effects of high-intensity functional exercise on depressive symptoms among people with dementia in residential care facilities: a randomised controlled trial

Effects of high-intensity functional exercise on depressive symptoms among people with dementia in residential care facilities: a randomised controlled trial

Person‐centredness and its association with resident well‐being in dementia care units

To report a study of the relationship between person-centred care and ability to perform activities of daily living, quality of life, levels of pain, depressive symptoms, and agitated behaviours among residents with dementia in residential care facilities. Standardized measurements of person-centred care have not previously been used to investigate the relationship between person-centred care and well-being for residents with dementia in residential aged care units. This study had a cross-sectional design. Staff and resident surveys were used in a sample of 1261 residents with dementia and 1169 staff from 151 residential care units throughout Sweden. Valid and reliable scales were used to measure person-centredness and ability to perform activities of daily living, quality of life, levels of pain, depressive symptoms, and agitated behaviours in residents. All data were collected in May 2010. Person-centred care was correlated with residents' ability to perform activities of daily living. Furthermore, residents in units with higher levels of person-centred care were rated as having higher quality of life and better ability to perform activities of daily living compared with residents in units with lower levels of person-centred care. There seems to be a relationship between person-centredness, residents' ability to perform activities of daily living, and residents' quality of life. Further studies are needed to explain the variation of person-centredness between units and the extent and ways this might impact on the quality of life and well-being of frail older residents with cognitive impairments in clinical practice.

The effects of seal-like assistive robots for interaction skills and activity participation of older adults with dementia in residential care facilities

Sung, H C1; Hu, H F2; Wang, C H3; Hung, H C4; Lai, Z Y3; Chang, S H5 Author Information

Evaluating the Quality of Life of People with Dementia in Residential Care Facilities

Aims: Our purpose was to compare recipient and caregiver perception of the quality of life (QoL) of people with dementia in residential care facilities and to identify the factors associated with their perception of QoL. Methods: Residents’ QoL was evaluated by both the patient and the caregiver, using the Quality of Life in Alzheimer’s Disease and several other indices. Results: The correlation between the self-rated QoL score and the staff-rated QoL score was low. Conclusions: The staff tended to underestimate QoL. The main determinants of QoL were the functional status and depression. Improving physical function and mood may be beneficial in providing a better QoL.

Oral hygiene care for residents with dementia: a literature review

This paper presents a literature review of oral hygiene care for adults with dementia in residential aged care facilities, including evidence for: (1) prevalence, incidence, experiences and increments of oral diseases; (2) use of assessment tools to evaluate residents' oral health; (3) preventive oral hygiene care strategies; and (4) provision of dental treatment. The impact of dementia on residential care is ever-increasing and regular oral hygiene care provision is challenging for cognitively impaired residents. Although an abundance of oral hygiene care recommendations for older people have been published, the supporting evidence has not been clearly delineated. A review was conducted of English language publications (1980-2002), using a two-step approach (keyword electronic database search, supplemented with secondary search of cited references). All 306 selected articles were critically reviewed and systematically categorized. Evidence confirmed clinicians' observations of poor oral health in older residents with dementia. Possible risk factors identified were: salivary dysfunction, polypharmacy, medical conditions, swallowing and dietary problems, functional dependence, oral hygiene care assistance and poor use of dental care. One comprehensive, reliable and validated oral assessment screening tool for residents with dementia had been published. Expert opinion indicated that oral assessment screening by staff and a dentist would be ideal at admission and regularly thereafter. Clinicians and researchers suggested that oral hygiene care strategies were effective in preventing oral diseases and appropriate for residents with dementia. These literature review findings supported the use of oral assessment screening tools by staff and efficacious preventive oral hygiene care strategies/products for adults with dementia in residential care facilities. Further research with this population is needed to develop and validate oral assessment tools and staff education programmes, trial preventive oral hygiene care strategies/products and trial dementia-focused behaviour management and communication strategies.

A Systematic Review of Oral Health Assessment by Nurses and Carers for Residents with Dementia in Residential Care Facilities

This paper presents systematic review findings to best summarize the assessment of oral health and the use of oral assessment tools by nurses and carers for adults with dementia living in residential aged care facilities. The systematic review searched electronic databases for articles in English (1980 to 2002) and supplemented these with a secondary search of references cited in articles meeting the review inclusion criteria. Delineation is needed between a comprehensive dental examination conducted by a qualified dentist and a dental assessment screening by a carer, nurse, allied health professional or medical practitioner. Dental examinations should be supplemented with oral health assessments and screenings by trained nurses and carers to monitor residents' oral health, evaluate oral hygiene care interventions, act as a trigger to call in a dentist when required, assist with residents' individualized oral hygiene care planning and assist with triaging and prioritization of residents' dental needs. To date, the most comprehensive, validated and reliable assessment screening tool for use by nurses and carers with cognitively impaired institutionalized residents is the Brief Oral Health Status Examination. Other less comprehensive oral assessment tools that are useful for nurses and carers of institutionalized dementia populations include the Index of Activities of Daily Oral Hygiene and the Mucosal Plaque Score. These review findings presented evidence to support the use of oral assessment screening tools by nurses and carers for cognitively impaired residents living in residential aged care facilities. Few validated and reliable tools have been published for use by carers in the cognitively impaired residential care population, and continued evolution of oral assessment screening tools needs to embrace the complete spectrum of residents' levels of cognitive impairment.