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P15. Residential care

Detailed programme and abstracts

P15. Residential care (Wednesday 2 Nov., 8.30 - 10.00)

P15.1. Addressing ethical dilemmas faced by professional carers of people with dementia in care homes and hospital settings

GOVE Dianne

Caring for people with dementia in an ethical manner is not an option but a fundamental component of good care. However, achieving ethical care and learning how to deal with such situations takes place in a particular working environment, which is affected by a range of factors such as staffing levels, skills and training, collaboration with colleagues, the hierarchical structure, budgets, laws and organisational procedures. All too often ethical dilemmas and ethically challenging situations arise. Professionals want to do the right thing but sometimes are unsure what the right thing is and then there is the question “right for whom”?

In this presentation, I will present a guide produced by the ethics working group, set up by Alzheimer Europe, on addressing ethical dilemmas faced by health and social care professionals providing dementia care in care homes and residential settings.

The guidance and related training materials were designed to enable health and social care professionals to reflect on a range of ethically challenging situations, empower them to tackle any they might encounter, enable them to reflect on the approach they adopt and (if they feel the need) enable them to justify the approach they adopt to themselves and anyone who might ask. 

Health and social care professionals must also be able to count on the support of their organisation. Ethical care must be a priority for those responsible for running the care homes and hospitals in which they provide care for people with dementia.  I will therefore also present suggestions developed by the working group for organisations on how to build an ethical infrastructure.

P15.2. Shared spaces in residential care facilities supporting thriving, participation and a sense of home

ROSENBERG Lena, JOHANSSON Karin, HJALMARSSON Jenny, BORELL Lena

Objectives: Shared spaces in residential care facilities (i.e. dining/living rooms, corridors and outdoor areas) are places where activities and social interactions often take place. Careful design of these spaces is therefore of crucial importance in order to support possibilities for participation, a sense of home and thriving for persons with dementia living in residential care facilities.

The aim was to identify design aspects that support participation, thriving and a sense of home in residential care facilities for persons with dementia.

Method: In order to learn from good examples, eight residential care facilities in Sweden that had been acknowledged as good examples of design of the physical environment were included in the study. They were identified through professional networks and organisations for people with dementia. Ethnographic methods allowing persons with dementia to be involved were used. Data consisted of field notes from participant observations, photos and short interviews. Data were analysed using a grounded theory approach.

Preliminary findings: Three themes describing driving forces of central importance in order to support thriving, participation and a sense of home were identified; the pulsing heart, magnetic places and flexibility in place. The pulsing heart is symbolized by a specific place where the explicit or implicit ideology of the residential care facility is generated and manifested through artifacts and actions. Magnetic places were places where residents went spontaneously and that held an inherent potential for participation and a sense of home. Flexibility in place refers to the importance of dynamic ways to use the shared spaces at the nursing home without losing their reconcilability. These findings are relevant for health professionals, architects, designers and care planners involved in restoring or re-designing existing nursing homes as well as planning and building new nursing homes.

P15.3. Make-believe matters. The moral role of material innovations in dementia care

KAMPHOF Ike, HENDRIKS Ruud

In an ageing society, dementia care is expected to benefit from innovative material support. Currently many new high- and low-tech interventions are being developed or already being used to improve the quality and efficiency of care and to support the well-being of people with dementia. Electronic doors provide increased freedom, while securing safety. Sociable robots offer companionship and stimulation. Personalized photoprints on doors and other dementia friendly design solutions support orientation, and VR installations are expected to ensure meaningful and enriched experiences.

However, many of these artefacts contain elements of make-believe that are potentially deceptive. People with dementia are increasingly dependent on their social and material environment for care, orientation and retaining a sense of self. At the same time their disease makes them particularly susceptible to deception and a loss of trust in their social and material surroundings. The question what dementia friendly design actually entails is still unanswered. And what is the proper place of material innovations in daily care practice, specifically when it comes to make-believe?

This paper addresses these questions from the perspective of person-centered care that demands that care sustains the personhood of people with dementia. We focus on the following question: Under which conditions can practices with artefacts that involve make-believe be seen as supportive of personhood and when do they count as deceptive or manipulative and as undermining personhood?

We will discuss this question in reference to two case studies: the humanoid robot ZORA as used in motivating vulnerable elderly people to be involved in physical exercise and social activity; and innovations for interior design that provide high- and low-tech “nudges” to support the orientation of people with dementia and quietly direct their behavior.

P15.4. Managing Faecal Incontinence in people with advanced dementia resident in Care Homes, a realist synthesis of the evidence (FINCH study)

RUSSELL Bridget, GOODMAN Claire, NORTON Christine, BUSWELL Marina, HARARI Danielle, HARWOOD Rowan, ROE Brenda, RYCROFT MALONE Jo, DRENNAN Vari M., FADER Mandy, MADEN Michelle, CUMMINGS Karen, BUNN Frances

Background: Eighty per cent of UK care home (CH) residents are living with dementia. Faecal incontinence (FI) is more likely in older people in CHs than those who live at home. Incontinence pads are the most common management approach. This does little to protect residents’ dignity, skin health, disguise odour or make life much easier for staff.

Objectives: To investigate FI care for people living with dementia in CHs, identifying what works, for whom and in what circumstances.

Methods: Using a theory driven approach to evidence review (realist synthesis) we interviewed stakeholders (resident representatives, clinicians, care workers, CH providers and managers) and interrogated 62 documents (research, policy, guidelines and training materials) on continence care. This suggested six possible explanations or programme theories for what was likely to improve FI management in care homes

The programme theories guided further searches, identification of literature, data extraction and analysis of different configurations of contexts, mechanisms and outcomes within the evidence to explain what works, when and in what circumstances.

Results: Searches produced 1500 papers, 27 were included and six possible approaches to the management of FI for people affected by dementia were identified, drawing on bio-medical, psychosocial and systems based theories of what supports effective care.

Further iterative searches added 35 papers. We found little evidence of how dementia affects a person’s ability to benefit from different approaches to continence care. Interventions with potential to improve outcomes are those that align education and training with personal care routines, the dementia specific skills needed for continence care and value unqualified  staff’s expertise.

Conclusions: Organisational and clinical knowledge about FI and dementia are important contextual factors but to achieve good resident outcomes care staff need authority to act on knowledge and training, and interventions must fit into the workflow and setting.

P15.5. Improving wellbeing for people with dementia living in a purpose built care environment by introducing self-chosen activities 

BUSHELL Sophie, INNES Anthea

This paper will report on a three-year research study conducted in a long term residential care home in the South of England. The study examined how to improve the day-to-day lived experience of individuals with dementia by introducing activities chosen by the participants themselves and which by their very nature correspond to the individuals’ unique skills, interests and preferences. Drawing on an action research approach, fourteen people living with dementia were interviewed about the activities they used to enjoy before moving to the care home and asked which activities they felt they would like to continue or try. Dementia Care Mapping was used to chart the progress of introducing individualized self-chosen activities over the duration of the study, and any impact for each individual living with dementia.

This paper will discuss the key finding that it is possible to introduce meaningful activities self-chosen by individuals and will that this is possible to achieve in simple and cost effective ways. This highlights the potential for care homes to make person-centered care a reality through careful consideration and application of individuals’ unique life experiences, preferences and abilities. Person centred care can therefore become reality rather than rhetoric if appropriate action is taken.

P15.6. Social interactions between people with dementia living in nursing home

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

Introduction: in contrast to the image of people with dementia living in nursing home being not responsive to other persons, they do interact. High psychosocial stimulation had a positive impact on social interactions between people with dementia in comparison to low stimulation. In order to learn more about their communication capacities, this study aims to assess the direct impact of psychosocial stimulation on length and themes of interaction.

Methods: 36 residents with moderate dementia living in nursing home were paired in nine groups of four-six residents. Residents received during five week an environmental psychosocial intervention consisting of 40-minutes workshops. Topics were cognitive stimulation, reminiscence, newspapers and active discussion stimulation. Workshops were videotaped. The length of interaction between the residents and with care staff during the eight minutes before and after each workshop has been assessed and a content analysis was conducted to specify the interaction themes.

Results: 63 workshops were conducted. The mean time of interaction after the stimulation presented a significantly increase of 67% between residents (p=.027) and of 151% with care staff (p=.022). There is no impact according to the topic of the workshop. Content interaction analysis highlighted 18 categories of conversation topics among residents and the most frequently observed are: their memories (26,97%), people in the room (14%), life conditions in the nursing home (8,94%) and about family (8,59%).

Conclusion: psychosocial stimulation seems to have an impact on the length of the interaction of people with dementia. Persons with dementia are able to speak about several themes. Further studies are needed to confirm these results with a control group without explicit stimulation. Length and content of interaction might be a new and objective outcome measure of the effectiveness of psychosocial interventions. These results might encourage facilitating a stimulating environment for social engagement of nursing home residents.

 

 
 

Last Updated: Tuesday 10 January 2017

 

 
  • Acknowledgements

    The 26th AE Conference in Copenhagen received funding under an operating grant from the European Union’s Health Programme (2014-2020). Alzheimer Europe and Alzheimerforeningen gratefully acknowledge the support of all conference sponsors.
  • European Union
  • Roche
 
 

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