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P10: Acute and residential care

Detailed programme, abstracts and presentations

P10: Acute and residential care

P10.1. Enhancing the caring environment

COWAP Victoria, KNIGHT Karen

People living with dementia are likely to stay in an acute hospital three times longer than other people following admission and the longer people living with dementia are in hospital the greater the risk of an adverse event, e.g. dehydration, increased confusion and decreased functional independence. Consequently, in order to improve the experience for older people with dementia and to reduce unnecessary costs to the health and social care system, discharge from hospital must be as effective and timely as possible.

The St Nicholas House step down unit was developed in a NorseCare Residential Care Home in Dereham Norfolk and has enabled an early discharge from hospital for older people with a cognitive impairment, but unable to return directly home or to longer term care.

Quality of life improvements to residents are delivered through the:

•               provision of a ‘home from home’ environment with a simple to understand building layout to support easy way-finding together with colour schemes that follow best practice guidelines. 

•               use of assistive technology to support and maximise independence which allow residents to rehabilitate further on their journey back to independent living. 

•               provision of communal spaces designed to a domestic scale with a ‘working’ kitchen and lounge/dining area in order to support residents to regain and maintain as many life skills as possible. 

•               availability of a visitors’ room to facilitate greater involvement of families and carers in the process

The project has enabled staff to fully appreciate and understand best practice in dementia care and facilitated engagement with specialist community providers delivering a more ‘joined up’ approach to dementia care.

This project was made possible by the funding available through the Department of Health Dementia Capital Programme: Improving the environment of care for people with dementia..

P10.2. Getting it right for dementia – real solutions for improving hospital care

MCNAMARA George, TERRY Gavin, KANE Martina

Alzheimer’s Society’s annual report, Dementia 2015, published in July of this year, reports on how people are living with dementia, presenting the findings from our annual survey of people with dementia and their carers. This year’s report also has a special focus on people with dementia and their experiences of transition into, care within and discharge from hospital, in England.

The issues around hospital care for people with dementia are well known, and include low levels of awareness amongst hospital staff of the specific needs of people with dementia, extended length of stay compared to admission for people without dementia who go in for the same procedure, delayed discharge and increased numbers of people with dementia being discharged to care homes.

The Care Quality Commission1 published Cracks in the Pathway in 2014, identifying widespread evidence of people with dementia being admitted to hospital when they do not need to be, and not being discharged quickly enough, with widespread variability in the levels of care that people with dementia received when transitioning from care homes into hospital and at time of discharge. 

The work of the Dementia Action Alliance2 to produce the Right Care Hospital Charter aims to address the need to make hospitals and their workforces consistently dementia aware and dementia friendly. The recently launched John’s Campaign3 highlights the need for better involvement and recognition of carers whilst their loved ones are in hospital.

Unnecessary admissions and delayed discharge are both costly to the exchequer and have a negative effect on the quality of life of people with dementia. With the input of key experts in the field of hospital care for people with dementia, Alzheimer’s Society will develop solutions to these issues and how they should be implemented, integrating across health and social care provision.

We will look specifically at examples of best practice around transition into, care within and discharge from hospital and how they can be developed into wider practical guidance, capturing the essential elements that make them work, and identifying how and by whom they will need to be implemented to ensure that all aspects of hospital care for people with dementia and their carers improves.

P10.3. Impact of extended dementia care and dementia friendly environments to entire retirement homes.

CHARRAS Kevin, REINTJENS Christophe

Introduction: Special Care Units (SCU) in retirement homes can only handle a limited number of people with dementia and/or related cognitive impairments, thus setting aside many people in need of those units and without specific care. 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.

Since 2007, the Fondation Médéric Alzheimer has implemented a psychosocial intervention (Eval’zheimer) that combines an environmental intervention with a training program for professional caregivers in over 40 SCUs in France. A general experience feedback reported by 30 of these SCUs, is that the intervention also addresses needs of residents that do not have cognitive impairments and should target other areas of retirement homes in order to support resident that would need so.

Method: In order to address this need, the Fondation Médéric Alzheimer is leading an exploratory action-research consisting in extending the Eval’zheimer model of intervention in four entire retirement homes in France. The experimental design adopted for this experiment is a simple blind cluster randomized control trial assessed by independent psychologists. Two retirement homes (N=174 residents) will have benefited of the intervention while the two others, (N=210 residents), will serve as controls. Outcome measures for residents address cognitive, behavioural and quality of life assessments and outcome measures for professional caregivers address job content and burnout assessments.

Results: The general hypothesis of this experiment is that the intervention should satisfy needs of most residents with and without dementia related cognitive impairments that do not live in SCUs, enhance quality of life and decrease possible cognitive and behavioural symptoms. Professional caregivers should experience more job satisfaction and less burnout.

Discussion: Results of this study will be discussed 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.

P10.4. An evidence-based physical activity protocol for people living with a dementia in residential accommodation

BRETT Lindsey, TRAYNOR Victoria, STAPLEY Paul, MEEDYA Shahla

Background: Physical activity has many benefits for older people but there is limited evidence evaluating the specific benefit for people with a dementia, in particular for those living in residential accommodation.  This makes it difficult to determine the optimum parameters of physical activity for this population.

Aim: To present a protocol of a physical activity study which tested the effects of an intervention on health outcomes and the well-being of people living with a dementia in residential accommodation. The protocol was generated from a systematic review of physical activity interventions with people living with a dementia.

Method: The systematic review was used to develop an evidence based protocol for a physical activity intervention undertaken with people living with a dementia in residential accommodation by a physiotherapy doctoral candidate in South Australia.

Findings: The physical activity protocol consisted of a range of physical mobility activities (strength, balance, endurance and flexibility) for two groups of participants: (i) physically active individuals and (ii) individuals participating in sitting activities.  This ensured most people with a dementia were eligible to participate in the study.  The effectiveness of the protocol was tested through a randomised controlled trial.  The health outcome measures were a range of mobility measures and well-being was measured using the Cohen-Mansfield Agitation Inventory.

Conclusion: An evidence-based physical activity protocol for people living with a dementia in residential accommodation was implemented and tested using a randomised controlled trial.  The findings identified the strength, balance, endurance and flexibility physical activities which are specifically effective for: (i) physically activity individuals and (ii) individuals participating in sitting activities. The findings are being implemented by the doctoral candidate as she continues her work as a physiotherapist with people living with a dementia in residential accommodation.

P10.5. Social stimulation and dementia: does it have an impact on social interactions of people with dementia living in nursing homes?

MABIRE Jean-Bernard, GAY Marie-Claire, VRIGNAUD Pierre, GARITTE Catherine, VERNOOIJ-DASSEN Myrra

Introduction: people with dementia living in nursing home do interact with others. Very few studies focused on the impact of psychosocial interventions on social interactions. The objective of this study is to assess the direct impact of one social stimulation session on social interactions of people with dementia.

Methods: 60 volunteers with moderate dementia living in a French nursing home were paired in groups of six residents. 36 residents were assigned to participate at one social stimulation session and 24 residents to a control group. Social stimulation consists in one 40-minutes session including participants’ presentation, reminder of elements of temporo-spatial orientation and 4 exercises about the four seasons. Social behaviours were videotaped and analysed with a validated grid of observation, the Social Behaviours Residents Index (SOBRI) (Mabire et al, submitted) according two components: social interactions between residents and with caregivers. Participants in the control group sat together at a table with newspapers on the table without direct stimulation. Comparisons before-after the session between the groups were analysed in a statistic way.

Results: the observation tool has good stability of measure: each component is correlated before and after (<.005). Social interactions with caregivers increased significantly in the social stimulation group after the session (<.05). There is no significant difference in terms of social interactions between residents but trends show that 23 residents (63.9%) in social stimulation group increase social interactions between residents against 11 (45.8%) for the control group.

Conclusion: social stimulation seems to promote social interactions with caregivers and between residents. These results are encouraging. Further studies are needed to confirm these trends in a largest sample and in a long-term social stimulation.

 

 
 

Last Updated: Tuesday 29 September 2015

 

 
  • Acknowledgements

    The 25th AE Conference in Ljubljana received funding under an operating grant from the European Union’s Health Programme (2014-2020). Alzheimer Europe and Spominčica gratefully acknowledge the support of all conference sponsors.
  • European Union
  • Roche
  • SCA Global Hygiene
 
 

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