Dementia In Residential Care Settings Research Articles

Dementia and dignity of identity: A qualitative evidence synthesis.

In the late stages of dementia, individuals rely on others for their wellbeing and this creates an ethical imperative for responsive dementia care. Through a qualitative evidence synthesis of literature on what constitutes responsive dementia care, we identified dignity of identity as a central theme. Dignity of identity is the status each of us holds in relation to others and reflects our past experiences and our aspirations for the future. We did a qualitative evidence synthesis of 10 qualitative studies conducted with a total of 149 research participants, 95 of whom had dementia, and 54 of whom were paid and family member caregivers to people with dementia. Using “new materialism disability studies” as our theoretical framework, we illustrate how environments, both material and discursive, shape the abilities of people with dementia in residential care settings (RSCs) to live well and we use our findings to point to ways forward in dignity of identity-enhancing dementia care practice. Echoing the literature, we observe that people with dementia have the virtual capacity to live with dignity of identity and illustrate how material conditions and discourse influence the transition of dignity of identity in people with dementia from a virtual capacity to an actual capacity and how demonstrated capacity in turn influences material conditions and discourse surrounding care for people with dementia in RSCs. We call for a greater acknowledgement within literature on dignity and dementia of structural barriers to dignity of identity-enhancing care. The COVID-19 pandemic has shown us the fatal consequences of insufficient material conditions in RCSs and we hope that on a societal level there is improvement to both the material conditions in RCSs as well as an improvement in discourse about those who live and work in RCSs.

A review of factors that contribute to sub‐optimal medication management for older adult with dementia in residential care settings: Nurses’ perspectives

AbstractBackgroundMedication use can play an important role in the health and well‐being of people with dementia in the long‐term care facilities. However, nurses often find the process of managing medicines for this population to be complex and challenging. As a result, various strategies are being employed to facilitate the medication management process including altering or modifying medications, hiding medication in food or drink of residents, and deviation from the ‘rights’ of medication administration (Barnes et al., 2006; Mc Gillicuddy et al., 2017; Mercovich et al., 2014; Qian et al. 2018; Serrano Santos et al., 2016; Thomson et al., 2009; Verrue et al., 2011; Wright, 2002). These practices are associated with increased risk of medication errors (Kartunen et al., 2019). Despite this, factors contributing to these practices are not well understood.MethodA comprehensive search of CINAHL, Medline, SOCIndex, PubMed, and PsychINFO databases was conducted between November and December 2019. ProQuest Dissertations and Theses and Google Scholar were used to search for gray literature. No date limitation was applied. A modified form of standardized critical appraisal tool known as mixed method appraisal tool (MMAT) was used to assess the quality of the papers (Hong, Gonzalez‐Reyes, & Pluye, 2018). Nvivo was used to extract findings. Data synthesis was done using convergent synthesis approach, more specifically, thematic analysis (Hong et al. 2017).ResultThe search resulted in 806 unique titles for screening. A total of 96 abstracts were screened, after which a full‐text review conducted for 59 articles. After the full‐text review, 12 articles were eligible to be included in the final report. The findings highlighted 2 major factors: individual and system factorsConclusionThere is need for both individual and system interventions to facilitate safe medication management for residents with dementia.

Persoonsgerichte zorg voor personen met dementie in Vlaamse woonzorgcentra

Background Providing person centered care for elderly persons with dementia in residential care settings is challenging. Furthermore, little insight exists into how employees apply person centered care.Goal Map the provision of person centered care for elderly persons with dementia by employees in nursing homes in the Dutch speaking part of Belgium.Methods Eight interviews and two focus groups were conducted with 25 employees of six residential care settings. A descriptive research approach was applied in four phases.Results Three themes emerged from the data concerning employee experiences with person centered care: (1) organizational support; (2) team support and (3) employee mindset. As person centered actions within the current practice, two themes were identified: (4) care at the pace of the resident and (5) contact adapted to the residents' needs.Conclusion Five themes regarding person centered care were found. However, specific examples of how this care was provided in practice could not be provided or were mostly examples of basic care. Employees are often obstructed by task oriented care. Setting the wishes and needs of the residents as reference point, providing organizational support, and investing in training might facilitate person centered care in residential care settings.

Mitigating Moral Distress in Dementia Care: Implications for Leaders in the Residential Care Sector.

In 2012, the World Health Organization estimated that the number of people living with dementia worldwide was approximately 35.6 million; they projected a doubling of this number by 2030, and tripling by 2050. Although the majority of people living with a dementia live in the community, residential facility care by nursing providers is a common part of the dementia journey in most countries. Previously published research confirms that caring for people living with dementia in such facilities often creates moral distress for nursing care providers. In this paper, the authors share additional findings from a two-year, two-phase, mixed methods study of moral distress as experienced by nursing caregivers of residents with dementia in residential care settings in a Western Canadian province. The findings relate to strategies to reduce moral distress in this caregiving group, with a particular focus on the role of supportive and responsive leadership. Important implications for practice and for leadership in the residential care sector are presented.

Mitigating Moral Distress in Dementia Care: Implications for Leaders in the Residential Care Sector.

In 2012, the World Health Organization estimated that the number of people living with dementia worldwide was approximately 35.6 million; they projected a doubling of this number by 2030, and tripling by 2050. Although the majority of people living with a dementia live in the community, residential facility care by nursing providers is a common part of the dementia journey in most countries. Previously published research confirms that caring for people living with dementia in such facilities often creates moral distress for nursing care providers. In this paper, the authors share additional findings from a two-year, two-phase, mixed methods study of moral distress as experienced by nursing caregivers of residents with dementia in residential care settings in a Western Canadian province. The findings relate to strategies to reduce moral distress in this caregiving group, with a particular focus on the role of supportive and responsive leadership. Important implications for practice and for leadership in the residential care sector are presented.

The role of objects in supporting older adults with dementia to tell stories about their lives

Abstract The article discusses the role objects can play in creative projects that aim to support older adults living with dementia in residential care settings to tell stories about their lives. The role of objects in the telling of these stories is explored through a discussion of projects by Stanislaw Przybylski, an animator based in Sweden, and by Age Exchange Theatre Trust, an arts and reminiscence charity based in London. The article draws on Jennifer Gonzalez’s concept of autotopographies to propose that collections of personal artefacts can be a significant form of self-representation. The role of objects in object-based storytelling practices is questioned through Bill Brown’s ‘Thing theory’ that proposes a difference between encountering recognizable objects and engaging with the materiality or thingliness of them. These theories are applied to the projects to question the role and significance of objects to the participants’ life stories and sense of self. The article proposes that the narratives of the stories relating to participants’ lives and the art-making process itself become fragmented and deconstructed when working with people with dementia and that arts facilitators with object-based practices may be particularly well equipped to respond to this.

Quality of care for people with dementia in residential care settings and the “Vážka” Quality Certification System of the Czech Alzheimer Society

IntroductionPeople with dementia are one of the most vulnerable groups of residents of long-term care institutions. The Czech Alzheimer Society (CALS) aims to improve the situation of people with dementia and their families using various methods, including the improvement of quality of care. ObjectiveTo present the development of the “Vážka” Quality Certification System developed by CALS through first-hand experience. MethodsCALS organised workshops and focus groups to discuss the main issues in dementia care quality, worked to define criteria and their classification, and developed the “Vážka” Certification System. CALS also evaluated these criteria in practice through a pilot evaluation project and established standards that were achievable within the system of dementia care in the Czech Republic. The main characteristics of the process of assessment and certification are: partnership and mutual discussion, evaluation of relational care, respect for the dignity of people with dementia and those who care for them, and the level of collaboration with families. ResultsThirty-two facilities have been successfully certified. Among these feature 25 residential services, 5 day care centres, 1 weekday centre and 1 healthcare department. ConclusionThe criteria within “Vážka” are meaningful and valid. They change slightly with any increasing quality of care but they need not be radically changed or updated. After its first years of experience, it is possible to say that the system is able to confirm good practice in care for people with dementia in actual conditions and distinguish it from care which is not acceptable.

Bathing People with Dementia: When Education Is Not Enough

This qualitative study describes health care assistants' (HCA) perceptions and experiences related to bathing people with dementia in residential care settings. Data were collected from three focus groups with 18 HCA participants from 12 different residential care facilities. HCAs constructed two definitions of a successful bath, which informed their choice of bathing strategies. Three themes emerged from the data analysis in regard to their bathing strategies: I Know You, I Am All Alone, and I Am Not Prepared. These data informed the development of a framework to guide gerontological nurses in creating and supporting the opportunity for successful bathing.

S2‐03‐04: Behavioral alternatives to anti‐psychotic prescribing for people with dementia in residential care settings

S2‐03‐04: Behavioral alternatives to anti‐psychotic prescribing for people with dementia in residential care settings

Description of the behaviour of wandering in people with dementia living in nursing homes - a review of the literature

The aim of the international literature review is the clarification of wandering as a behaviour of people with dementia in nursing homes. The term wandering often stigmatizes those affected. A clear definition and description of a phenomenon is an important basis for its operationalization. Three electronic databases were used. The keywords 'wandering', 'challenging behaviour', 'dementia', 'assessment' and 'long term care' including all associated terms, both singly and in combination, were used to identify articles published in English and German up to 2007. Abstracts of all papers found were screened and included if they focused on wandering and dementia in residential care settings. The content regarding definition and description of wandering from the 164 papers identified was summarized. As the aim of the study was to show the knowledge about the definition of wandering, a formal quality assessment of the studies was not conducted. The literature shows a great number of definitions, descriptions and taxonomies for the term wandering, many of them based on older studies. The term is diffuse and is difficult to differentiate from other forms of behaviour such as agitation. Most of the more recent scientific publications come from the USA and support theoretically and empirically based suggestions for a scientific definition of wandering. The debate about the behaviour of wandering shows clearly the importance of discussing intensively each type of behaviour associated with dementia. Challenging behaviour as such does not exist; it is a collective term for very different types of behaviour with various meanings. The same applies to wandering. At the moment there is no conclusive definition of wandering, there are no obvious causes for it and therefore no clear intervention recommendations; however, research has contributed towards defining and understanding this phenomenon.

The Experience of Living With Dementia in Residential Care: An Interpretative Phenomenological Analysis

The subjective psychological experience of people with moderate to severe dementia living in residential care is insufficiently understood. In the present study we aimed to explore the subjective experience of life with dementia in residential care from the perspective of the person with dementia, and to understand the psychological impact of being in this situation. This was an exploratory qualitative study. Eighty individuals with dementia who were living in residential care homes engaged in unstructured conversations with a researcher. We subjected the transcripts of the resultant 304 conversations to interpretative phenomenological analysis in order to develop a thematic account. The experience of living with dementia in residential care was fundamentally one of experiencing difficult and distressing emotions relating to loss, isolation, uncertainty, fear, and a sense of worthlessness. Participants generally tried to cope by accepting and making the best of things and affirming their past sense of self and identity, but some also expressed frustration and anger. Participants were able to describe aspects of their situation and their emotional response to it, grounded in a strong retained sense of self and identity. The participants' experience emphasizes the importance of improving the living situation of elders with dementia in residential care settings.

Associations between the working characteristics of nursing staff and the prevalence of behavioral symptoms in people with dementia in residential care

Clinical experience suggests that the work characteristics of staff in residential care may influence the well-being of residents with dementia. However, few studies have explored those anecdotal experiences. The aim of this study was to investigate associations between work characteristics of nursing staff and prevalence of behavioral symptoms among people with dementia in residential care settings. The self-report job strain assessment scale was used to measure staff perceptions of their working environment, and the Multi Dimensional Dementia Assessment Scale to measure the occurrence of behavioral symptoms among residents in 40 residential care units for people with dementia. The findings show that in settings where staff reported high job strain, the prevalence of behavioral symptoms was significantly higher compared to settings where staff reported low job strain. Furthermore, settings characterized by staff having a more positive caring climate had significantly less prevalence of escape, restless and wandering behaviors compared to settings having a less positive caring climate. There was no statistically significant association between staff members' self-reported knowledge in caring for people with dementia and prevalence of behavioral symptoms. This study provides evidence for the oft-cited clinical experience that the well-being of nursing staff is associated with the well-being of people with dementia in residential care settings.

Aggressive behaviour by people with dementia in residential care settings: a review

This paper considers the phenomenon of aggressive behaviour perpetrated by people with dementia in residential care settings. Aggressive behaviour is defined in the context of people with dementia, and the problem of ascertaining the incidence of aggression among people with dementia is discussed. The emotional impact of assaults on nurses and other professionals is highlighted, and differing perspectives on the causation of aggressive behaviour are considered. Management strategies derived from the physical/pharmacological; environment management; behaviour modification and person-centred approaches are reviewed. Our conclusion is that while certain strategies appear to reflect good and common sense practice, in particular those deriving from the person-centred approach, there is no clear research evidence for the general effectiveness of any one management approach, and each has drawbacks of a practical or ethical nature. There is also little empirical information about how professional carers actually manage aggressive behaviour in practice.

Influence of cognitive impairment, functional impairment and care setting on dementia care mapping results

Quality of life (QOL) for people with dementia has become a major focus over the past decade. Dementia care mapping (DCM) is an observational measure of quality of care given by staff in formal care settings, as well as a measure of QOL that has been used in many studies of people with dementia in residential care settings. However, the method itself has not been rigorously studied in a scientific manner. For this report, mapping data were collected for 166 persons with dementia in three types of care settings: special care facilities that are licensed nursing homes, assisted living facilities, and adult day centers. The relationships between DCM and several independent variables including cognitive status, functional status, care setting, depression, length of stay, and co-morbid illnesses were assessed. Both cognitive status and functional status were found to be associated with DCM scores. Moreover, DCM was sensitive in differentiating among persons with four levels of cognitive impairment. Implications for practice are discussed.