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P30. Care services: Nursing home care

Detailed programme and abstracts

P30.1. Evaluation of Sociotherapeutic Living Environments for individuals with dementia living in a nursing home

NOORDAM Hanneke1, GERRITSEN Debby1, LEONTJEVAS Roeslan2, NIJSTEN Hanneke3, KOOPMANS Raymond1, GERRITSEN Debby1

1Radboudumc Alzheimer Center the Netherlands, Nijmegen, Netherlands, 2Open University, Heerlen, Netherlands, 3Archipel Zorggroep, Eindhoven, Netherlands,

Background and objective: In a sociotherapeutic living environment (SLE), the supply of care, therapeutic guidance, daily activities and housing, are methodically coordinated, in order to achieve the best possible quality of life. Within one care-organization different living groups can be organized, based on residents’ social, psychological and physicalcareneeds. Over the last decade, several Dutch nursing homes introduced SLE’s. The objective of the ‘LIVE-study’ is the evaluation and scientific underpinning of SLE’s for individuals with dementia living in a nursing home.

Methods:  A literature study, a process evaluation and a feasibility study were carried out using an action research approach. Residents, relatives and professionals contributed actively to each phase. The literature search focused on scientific papers and practice documents. For the process evaluation of existing SLE’s, we conducted observations, in-depth interviews and focus groups. Using qualitative content analysis, SLE components and relevant implementation issues were identified. The feasibility study (not reported here), will further explore relevant process and outcome measures.

Results: Literature study identified different components of SLE’s and their interactions: individual care needs define therapeutic goals, which are consequently translated into needs for the physical and social environment and relevant organizational characteristics. In the process evaluation, stakeholders reported several advantages of clustering on care needs, e.g. more continuity in care, less agitation of residents. Further, potential improvements were suggested regarding activity range, family participation, placement issues, communication, expertise.

Conclusion: The study revealed positive aspects and potential improvements in existing SLEs. Moreover, after combining the SLE literature with quality-of-life literature, we concluded that when matching living groups based oncareneeds of persons with dementia, as is the case in current STLs, the resident’s need for individuality and social inclusion might be overlooked. First results of the study suggest a more explicit focus on these needs in studied SLE’s.

P30.2. Optimising hearing-related communication for care home residents with dementia (ORCHARD): A realist synthesis

CROSBIE Brian1, FERGUSON Melanie2, WONG Geoff3, WALKER Dawn-Marie4, VANHEGAN Stevie5, DENING Tom1

1University of Nottingham, Nottingham, United Kingdom, 2NIHR Nottingham Hearing Biomedical Research Centre, Nottingham, United Kingdom, 3University of Oxford, London, United Kingdom, 4University of Southampton, Southampton, United Kingdom, 5patient and Public Involvement Lead, Nottingham, United Kingdom,

Background and Aims: Hearing impairment and dementia are common in care homes, as the communication needs of residents with dementia and hearing loss are often poorly met. This may result in withdrawal, isolation and depression. Research shows that hearing aids and other assistive hearing technologies can improve communication for residents. However, the care home context can impinge on the effectiveness of hearing devices. Individuals with dementia often don’t tolerate them, with resulting damage or loss. In addition, there is little dementia focused communication training provided for care staff, nor hearing aid maintenance training. Moreover, hearing loss is often perceived as the inevitable result of ageing, with low priority towards maintaining individuals’ hearing. The aim of the ORCHARD study was to understand the issues that stand in the way of optimising hearing communication and offer solutions by informing care home practice guidelines.

Methods: To address hearing communication, we conducted a realist review of available literature. We also used experts' understanding of this complex health situation and developed a theory of how care homes could manage hearing communication better. We then searched the literature looking for data to help confirm, refute or refine our understanding of how hearing communication could be improved.

Results: Our findings present five areas of care delivery which enhance hearing communication for residents with dementia and hearing loss. They include: leadership towards positive regard for residents; communication training for staff; knowing the person & responsive awareness; monitoring hearing devices and communication; managing noise in the care home environment.

Conclusions: With positive leadership providing appropriate training and resources, care staff can feel confident and able to meet the communication needs of residents with dementia and hearing loss. Our results will be used to inform guidelines in hearing-related communication and identify research priorities with a focus on practical interventions.

P30.3. A model of integrated care for people with dementia: The experience of a temporary special dementia care unit (t-SDCU) in Modena District

PELLITTA ANTONELLA1, MANNI Barbara2, BERGAMINI Lucia2, FEDERZONI Lucia3, FABBO Andrea1, SPANÒ Andrea4

1UOC Dementia and Cognitive Disorders, AUSL Modena, Italy, 2AUSL Modena, Modena, Italy, 3Division of Geriatric Medicine, Dept of Medicine, Endocrinology, Metabolism and Geriatrics, University of Modena and Reggio Emilia., Modena, Italy, 4Modena Health District, Modena Local Health Authority and Services (AUSL), Modena, Italy

Background: Behavioural and psychological symptoms of dementia (BPSD) are known predictors of institutionalization, lower quality of life, and caregiver distress. Leading to ALCOVE recommendations (2013), a network of services dementia dedicated must be organised to assess and manage BPSD with psycho-social interventions, which were found to be effective in preventing BPSD and delaying institutionalization, as first line strategy.

Objective: our aim is to develop an integrated model of care for a temporary special dementia care unit (t-SDCU) in nursing home settings, strictly connected with Modena psychogeriatric network, to assess the efficacy in terms of BPSD improvement and reduction of institutionalization, antipsychotic drug and restraints.

Methods: we retrospectively collected data from three t-SDCU in Modena district in 2017. Each t-SDCU was provided with a multi professional team with specialized knowledge to deliver a higher quality of dementia care.

All patients met the admission criteria of having dementia-related major BPSD (NPI score > 24/144 or at least in one domain a score of 12) and high caregiver burden. Before the admission and at the discharge a multi-professional team, composed by a geriatrician, the local social services and a nurse, must assess the situation to evaluate the most appropriate care plan.

Results: 126 cases were analysed (73:53=F:M), aged 82,8 years old (SD 7,86). Most of them came from home (69%), had moderate-severe cognitive impairment (MMSE 10,1; SD 7,99) with severe BPSD (NPI 43,69; SD 14,24). After a short period of stay in t-SDCU (average length of stay130 days) the 45,2% of them return to home obtaining a significant behavioural improvement in terms of NPI reduction despite a decreased prescription of typical antipsychotic drugs.

Conclusion: A model of care which provides different levels of assistance in specialized settings (t-SDCU) could improve BPSD also through a unified management of network services by a specialized team.

P30.4. The aching backbone of long term residential care: The narrative of the nurses’ aide

BOOI Laura1, SIXSMITH Andrew2, CHAUDHURY Habib2, SIXSMITH Judith4, O'CONNOR Deborah2

1Global Brain Health Initiative, Montreal, Canada, 2Professor, Vancouver, Canada, 4Professor, Dundee, United Kingdom

Background:  There continues to be a dearth of research focused on the perceptions of assistant personal, or nurse’s aides in long-term residential care (LTRC). Nurses aides provide upwards of 90% of the direct care for residents in LTRC and thus hold great potential in improving residents’ quality of life. This doctoral dissertation examines the perceptions held by nurse’s aides towards their role as carers to residents in LTRC, especially persons living with dementia, across the contexts of personal, interpersonal, and organizational levels, while considering the broader social-political-economic context of LTRC.

Methods: Data sources for this qualitative, multi-method study include 70 hours of semi-structured interviews with 36 nurse’s aides working in one LTRC setting in British Columbia, Canada. Group workshops, participant observations and interviews with the management team were additional sources of data.

Results: The information generated from this study has identified ways in which nurse’s aides in LTRC conceptualize their role as dementia carers, the barriers and facilitators they perceive pertaining to their delivery of care and the prevention of abuse within these settings. Nearly all nurse’s aides reported having witnessed multiple incidences of abuse as well as deciding against reporting, most for fear of detrimental outcomes to themselves or other members of the healthcare team. Reported staff morale among nurse’s aides is low, with feelings of disempowerment and disenfranchisement within their care team and the greater society.

Conclusion: Nurses aides are often overlooked by educational interventions but if empowered, they have the potential to vastly improve the culture of care within LTRC environments. Attempts to empower nurse’s aides within LTRC should focus on creating organizational cultures that promote high morale and collaboration of all members of the care staff including nurse’s aides themselves.

P30.5. Results of an extended dementia care model of intervention to an entire nursing home

REINTJENS Christophe, CHARRAS Kevin

Fondation Médéric Alzheimer, Paris, France

Introduction: Congruency between social and physi­cal environment is essential to promote well-being and adapted behaviors for People with dementia (PwD) and also their caregivers. Eval’zheimer® is a psychosocial model of intervention intended to fit caring practices and environmental design to institutionalized people with dementia, especially in special care unit. According to previous research on this model of intervention can help reduce behavioral symptoms and improve communication skills, autonomy, social abilities, and quality of life of PwD.

In France, as in Europe, retirement homes are experiencing an increase of people with dementia related cognitive impairments that can be representative of 60 to 70% of residents in some facilities. To address this issue the Fondation Médéric Alzheimer has experimented the feasibility of extending the Evalzheimer model of intervention to an entire retirement home.

Methods: This experimental study was carried out using a cluster randomized control trial on 4 retirement homes in Franceduring a year. It aimed at evaluating if an extension of the Eval’zheimer® model of intervention to an entire nursing care home could produce similar results. Outcome measures for residents addressed cognitive, behavioural and quality of life assessments and outcome measures for professional caregivers’ address job content and burnout assessments.

Results: Burnout indicators decreased for the caregiver of the experimental group compared to the caregivers of the control group after the intervention.  A tendency to maintain resident’s cognitive status was also observed in the experimental group in comparison to the control group.

Discussion:General results of this intervention, and perspectives on environmental management of dementia, will be described in terms of specificity of dementia friendly environments, dementia related psychosocial interventions and generalizability potential to other institutionalised elderly people, as well as organisational and professional outcomes.

P30.6. The course of neuropsychiatric symptoms in nursing home residents from admission to 30-month follow-up

BERGH Sverre2, HELVIK Anne-Sofie1, ŠALTYTĖ BENTH Jūratė3, SELBÆK Geir4

2Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway,1Norwegian University of Science and Technology, Trondheim, Norway, 3Akershus University Hospital, Lørenskog, Norway, 4Norwegian National Advisory Unit on Aging and Health, Oslo, Norway

Aim: The aim was to describe the prevalence and persistence of clinically significant neuropsychiatric symptoms (NPS) in nursing home residents with dementia, and to study the association between the severity of dementia and specific neuropsychiatric sub-syndromes over time. 

Methods: In total, 583 residents with dementia were included at admission to a nursing home and followed with biannual assessments until death, or to 30 months’ follow-up. In total, 221 residents were still in the study at the 30 months’ follow-up, 305 had died and 57 residents had left the study for other reasons. Data on demographics, cognition, level of dementia, NPS, personal activities of daily living (P-ADL), physical health, medication and type of nursing home unit were collected. NPS was assessed using the Neuropsychiatric Inventory Nursing Home version (NPI-NH).

Results: The prevalence and persistence at two consecutive time points of clinically significant NPS was high during the study period. The NPI agitation sub-syndrome score increased during the study period, while the affective and psychosis sub-syndrome scores remained unchanged. More severe dementia was associated with higher NPI agitation, psychosis and affective sub-syndrome score.

More severe P-ADL, use of antipsychotics and sedatives, lower age and staying in special care unit (SCU) were associated with higher agitation sub-syndrome score. Poor physical health, more severe P-ADL, female gender, and use of antipsychotics, antidepressants and sedatives were associated with higher affective sub-syndrome score. Being married, use of antipsychotics and sedatives, and being a resident in SCU were associated with higher psychosis sub-syndrome score.

Conclusion: NPS are among the most distressing dementia symptoms, both for the patients and the caregivers. Our findings regarding the relationship between the major NPS syndromes and dementia severity, as well as other key patient characteristics, are crucial for approaches aiming at preventing and treating NPS in nursing home patients with dementia.

 

 
 

Last Updated: Friday 24 August 2018

 

 
  • Acknowledgements

    The 28th AE Conference in Barcelona received funding under an operating grant from the European Union’s Health Programme (2014-2020). Alzheimer Europe, CEAFA and Fundación Alzheimer España gratefully acknowledge the support of all conference sponsors.
  • European Union
  • Roche
 
 

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