Attitudes to dementia and dementia care held by nursing staff in U.K. “non-EMI” care homes: what difference do they make?

2005 ◽  
Vol 17 (3) ◽  
pp. 383-391 ◽  
Author(s):  
A. J. D. Macdonald ◽  
R. T. Woods
Keyword(s):  
Cognitive Impairment ◽  
Nursing Homes ◽  
Medication Use ◽  
Dementia Care ◽  
Care Homes ◽  
Care Practice ◽  
Senior Nurse ◽  
South East England ◽  
Training And Support ◽  
State Examination

Background: There is doubt about the value of training in dementia care in U.K. nursing homes. We decided to estimate the association between nursing staff's attitudes to dementia and dementia care and their recognition of cognitive impairment in residents and other indicators of care practice in nonspecialist nursing homes derived from a probability sample of 445 residents in South-East England, and to relate this to previous training.Methods: Prospective survey. The most senior nurse on duty was interviewed about each resident sampled, about their own training and experience, their attitude to restriction of egress and covert medication use, and asked to complete the Attitudes to Dementia Questionnaire (ADQ) and the dementia Care Styles Questionnaire (CSQ). Nurses were also asked about care practices in relation to restriction of egress and covert medication use in the home. Residents were interviewed using the Mini-mental State Examination (MMSE).Results: One hundred and fifty-eight nurses were interviewed. Increased person-centered attitudes seem to be associated with better recognition of cognitive impairment independent of training and experience. The espousal of restrictive practices was also associated with better recognition, but only when analysis included nurses reporting on only one impaired resident.Conclusions: More person-centered attitudes are associated with better recognition of cognitive impairment, despite perverse U.K. regulatory incentives; the need for training and support in developing person-centered dementia care for staff in “non-Elderly Mentally Infirm” (“non-EMI”) care homes is supported by these results.

scholarly journals Increasing prevalence of anticholinergic medication use in older people in England over 20 years: Cognitive Function and Ageing Study I and II

2019 ◽  
Author(s):  
Carlota Grossi ◽  
Kathryn Richardson ◽  
George Savva ◽  
Chris Fox ◽  
Antony Arthur ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Cognitive Function ◽  
Older People ◽  
Mini Mental State Examination ◽  
Medication Use ◽  
Anticholinergic Medication ◽  
Older Population ◽  
Clinically Significant ◽  
State Examination ◽  
Anticholinergic Burden

Abstract Background: Anticholinergic medication use is linked with increased cognitive decline, dementia, falls and mortality. The characteristics of the population who use anticholinergic medication are not known. Here we estimate the prevalence of anticholinergic use in England’s older population in 1991 and 2011, and describe changes in use by participant’s age, sex, cognition and disability. Methods: We compared data from participants aged 65+ years from the Cognitive Function and Ageing Studies (CFAS I and II), collected during 1990-1993 (N=7,635) and 2008-2011 (N=7,762). We estimated the prevalence of potent anticholinergic use (Anticholinergic Cognitive Burden [ACB] score=3) and average anticholinergic burden (sum of ACB scores), using inverse probability weights standardised to the 2011 UK population. These were stratified by age, sex, Mini-Mental State Examination score, and activities of daily living (ADL) or instrumental ADL (IADL) disability. Results: Prevalence of potent anticholinergic use increased from 5.7% (95% Confidence Interval [CI] 5.2-6.3%) of the older population in 1990-93 to 9.9% (9.3-10.7%) in 2008-11, adjusted odds ratio of 1.90 (95%CI 1.67 – 2.16). People with clinically significant cognitive impairment (MMSE [Mini Mental State Examination] 21 or less) were the heaviest users of potent anticholinergic in CFAS II (16.5% [95%CI 12.0-22.3%]). Large increases in the prevalence of the use medication with ‘any’ anticholinergic activity were seen in older people with clinically significant cognitive impairment (53.3% in CFAS I to 71.5% in CFAS II). Conclusions: Use of potent anticholinergic medications nearly doubled in England’s older population over 20 years with some of the greatest increases amongst those particularly vulnerable to anticholinergic side-effects. Key words: cognitive impairment, anticholinergic burden, polypharmacy

Nonparametric parameters of 24-hour rest-activity rhythms and long-term cognitive decline and incident cognitive impairment in older men

2021 ◽  
Author(s):  
Qian Xiao ◽  
Joshua N Sampson ◽  
Andrea Z LaCroix ◽  
Aladdin H Shadyab ◽  
Jamie M Zeitzer ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Mini Mental State Examination ◽  
Activity Patterns ◽  
Medication Use ◽  
Older Men ◽  
Activity Rhythms ◽  
Early Biomarkers ◽  
State Examination ◽  
Rest Activity

Abstract Altered 24-hour rest-activity rhythms may be associated with cognitive impairment in older adults, but evidence from prospective studies is limited. Non-parametric methods were used to assess actigraphy-based activity patterns in 2,496 older men. Incident cognitive impairment was assessed four times over 12 years using the Modified Mini Mental State Examination (3MS) and Trails B tests, self-reported medication use, and clinical diagnosis. The highest quartile (vs. the lowest) of intradaily variability and the lowest quartiles (vs. the highest) of interdaily stability and relative amplitude were associated with incident cognitive impairment ((Hazard ratio (95% confidence interval): 1.82 (1.31, 2.53)), 1.36 (0.99, 1.86), and 1.85 (1.33, 2.56), respectively). A larger increase in intradaily variability over 7.5 years was associated with a greater subsequent decline in 3MS scores but not in Trails B performance. In conclusion, less stable and more variable rest-activity rhythms may represent early biomarkers of cognitive impairment in older men.

scholarly journals Person-centered, non-pharmacological intervention in reducing psychotropic medication use among residents with dementia in Australian rural aged care homes

2021 ◽  
Author(s):  
Daya Ram Parajuli ◽  
Abraham Kuot ◽  
Mohammad Hamiduzzaman ◽  
Justin Gladman ◽  
Vivian Isaac
Keyword(s):  
Nursing Homes ◽  
Psychotropic Medication ◽  
Qualitative Data ◽  
Medication Use ◽  
Aged Care ◽  
Psychotropic Medications ◽  
Care Homes ◽  
Pharmacological Intervention ◽  
Post Intervention ◽  
Rural Nursing

Abstract Background High rates of psychotropic medications are prescribed in aged care homes despite their limited effectiveness and associated adverse effects. We aim to evaluate the changes in prescription patterns for elderly residents with dementia in the ‘Harmony in the Bush Dementia Study’. Harmony in the Bush is a person-centered model of dementia care in nursing homes, based on the principles of Progressively Lowered Stress Threshold and person-centered music intervention. Methods Our larger study (12 weeks period) was a quasi-experimental design conducted in five rural nursing homes in Australia. Medication charts (n=31) were collected retrospectively from three rural aged care facilities. Medication data for each resident was collected from a three-month medication charts, pre-intervention, and post-intervention. Fifty-three staff participated in 31 semi-structured interviews and 8 focus groups at post-intervention, and at 1-month and 3-months follow up.Results The median age of the participants was 83 years, and 68% of them were female. Polypharmacy was measured in 87% (n=27) of the participants. Hypertension, hyperlipidemia, diabetes, and the Alzheimer’s disease were the major comorbidities identified in residents. None of the residents received more than the maximum dose of psychotropic medications recommended by the guidelines. There was a reduction of 22.4% (77.4% vs 55%) in the use of at least any psychotropic medication, 19.6% (39% vs, 19.4%) reduction in antipsychotics and benzodiazepines (39% vs 19.4%), and 6.5% (42% vs 35.5%) reduction in antidepressants prescription medicines, when comparing residents’ medication charts data covering 3-months pre- and post-intervention, however, these changes were not statistically significant. Additionally, there was a decreasing trend in the use of inappropriate medications. Psychotropic medications were prescribed in up to 43% and anti-dementia medications in 44% of participants for more than 6 months. Three themes extracted from qualitative data include decrease behavioral and psychiatric symptoms of dementia due to medication weaning or dose tapering, other strategies to reduce medication use, and environmental or noise control. Conclusions Our findings indicate that the Harmony in the Bush model as a non-pharmacological approach reduces the prescription of psychotropic medications in rural nursing homes as supported by findings from both quantitative and qualitative data. Trial registration: ANZCTR, ACTRN12618000263291. Registered on 20th February 2018. http://www.ANZCTR.org.au/ACTRN12618000263291p.aspx).

scholarly journals A different story: exploring patterns of communication in residential dementia care

2008 ◽  
Vol 28 (5) ◽  
pp. 629-651 ◽  
Author(s):  
RICHARD WARD ◽  
ANTONY A. VASS ◽  
NEERU AGGARWAL ◽  
CYDONIE GARFIELD ◽  
BEAU CYBYK
Keyword(s):  
Dementia Care ◽  
Care Homes ◽  
Care Practice ◽  
People With Dementia ◽  
Effective Care ◽  
Care Workers ◽  
Key Skills ◽  
Constituent Elements ◽  
Provision Of Care

ABSTRACTThis article reports findings from a three-year project on ‘Communication patterns and their consequences for effective care’ that explored communication in dementia-care settings. As the proportion of people with dementia living in British care-homes continues to grow, there is a need to understand better their care. Using a range of qualitative methods, the project set out to identify the constituent elements of dementia-care practice and the patterns that characterise day-to-day relations in care homes. The tightly prescribed and standardised nature of the interactions between staff and residents is described: it raises questions about the capacity for dementia care to be truly person-centred. The project found that people with dementia are both capable of communication, and invest much effort in seeking to engage those around them, but are excluded from the monitoring, planning and provision of care in ways that we argue are discriminatory. The case is made for promoting and supporting communication as key skills and competencies for care workers. The value of measuring the level and quality of communication as a means to evaluate care is demonstrated. The authors question the priorities that currently guide care practice and argue that we need to listen to people with dementia and rethink what lies at the heart of dementia care.

scholarly journals HUBUNGAN FUNGSI KOGNITIF DENGAN KEPATUHAN PENGGUNAAN MEDIKASI PADA LANSIA DI KELURAHAN GIRIAN PERMAI KOTA BITUNG

2019 ◽  
Vol 5 (2) ◽  
pp. 185-192
Author(s):  
Abigail Asfas Tandilangi ◽  
Regina Makawimbang
Keyword(s):  
Cognitive Impairment ◽  
Medication Adherence ◽  
Cognitive Function ◽  
Mini Mental State Examination ◽  
Medication Use ◽  
The Elderly ◽  
Cross Sectional ◽  
Moderate Cognitive Impairment ◽  
Adherence Scale ◽  
State Examination

Elderly is a life process that is characterized by a decline in cognitive function that can cause the inability to carry out activities, especially for the elderly who are undergoing treatment. The purpose of this study was to determine whether there is a relationship between cognitive function and compliance with the use of medication in the elderly in Girian Permai Village. The methods used were observational analytic and cross-sectional. Data were collected using a Mini-Mental State Examination (MMSE) questionnaire for cognitive function and the Morisky Medication Adherence Scale (MMAS) for compliance with medication use. The results showed 26 (52%) elderly experienced moderate cognitive impairment, and 38 (76%) elderly had low adherence to the use of medication, while the results of the correlation test between cognitive function and compliance with the use of medication showed significant values ​​p = (0.008). Researchers' recommendations for the community is to pay more attention and provide support to the elderly who are around the neighborhood, especially specifically for the elderly who are undergoing treatment, so that they can use the drug obediently.

scholarly journals Increasing prevalence of anticholinergic medication use in older people in England over 20 years: Cognitive Function and Ageing Study I and II

2020 ◽  
Author(s):  
Carlota Grossi ◽  
Kathryn Richardson ◽  
George Savva ◽  
Chris Fox ◽  
Antony Arthur ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Cognitive Function ◽  
Older People ◽  
Mental State ◽  
Mini Mental State Examination ◽  
Medication Use ◽  
Anticholinergic Medication ◽  
Older Population ◽  
Clinically Significant ◽  
State Examination

Abstract Background: Anticholinergic medication use is linked with increased cognitive decline, dementia, falls and mortality, and their use should be limited in older people. Here we estimate the prevalence of anticholinergic use in England’s older population in 1991 and 2011, and describe changes in use by participant’s age, sex, cognition and disability.Methods: We compared data from participants aged 65+ years from the Cognitive Function and Ageing Studies (CFAS I and II), collected during 1990-1993 (N=7,635) and 2008-2011 (N=7,762). We estimated the prevalence of potent anticholinergic use (Anticholinergic Cognitive Burden [ACB] score=3) and average anticholinergic burden (sum of ACB scores), using inverse probability weights standardised to the 2011 UK population. These were stratified by age, sex, Mini-Mental State Examination score, and activities of daily living (ADL) or instrumental ADL (IADL) disability. Results: Prevalence of potent anticholinergic use increased from 5.7% (95% Confidence Interval [CI] 5.2-6.3%) of the older population in 1990-93 to 9.9% (9.3-10.7%) in 2008-11, adjusted odds ratio of 1.90 (95%CI 1.67 – 2.16). People with clinically significant cognitive impairment (MMSE [Mini Mental State Examination] 21 or less) were the heaviest users of potent anticholinergic in CFAS II (16.5% [95%CI 12.0-22.3%]). Large increases in the prevalence of the use medication with ‘any’ anticholinergic activity were seen in older people with clinically significant cognitive impairment (53.3% in CFAS I to 71.5% in CFAS II). Conclusions: Use of potent anticholinergic medications nearly doubled in England’s older population over 20 years with some of the greatest increases amongst those particularly vulnerable to anticholinergic side-effects.

scholarly journals Increasing prevalence of anticholinergic medication use in older people in England over 20 years: Cognitive Function and Ageing Study I and II

2020 ◽  
Author(s):  
Carlota Grossi ◽  
Kathryn Richardson ◽  
George Savva ◽  
Chris Fox ◽  
Antony Arthur ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Cognitive Function ◽  
Older People ◽  
Mental State ◽  
Mini Mental State Examination ◽  
Medication Use ◽  
Anticholinergic Medication ◽  
Older Population ◽  
Clinically Significant ◽  
State Examination

Abstract Background: Anticholinergic medication use is linked with increased cognitive decline, dementia, falls and mortality, and their use should be limited in older people. Here we estimate the prevalence of anticholinergic use in England’s older population in 1991 and 2011, and describe changes in use by participant’s age, sex, cognition and disability. Methods: We compared data from participants aged 65+ years from the Cognitive Function and Ageing Studies (CFAS I and II), collected during 1990-1993 (N=7,635) and 2008-2011 (N=7,762). We estimated the prevalence of potent anticholinergic use (Anticholinergic Cognitive Burden [ACB] score=3) and average anticholinergic burden (sum of ACB scores), using inverse probability weights standardised to the 2011 UK population. These were stratified by age, sex, Mini-Mental State Examination score, and activities of daily living (ADL) or instrumental ADL (IADL) disability. Results: Prevalence of potent anticholinergic use increased from 5.7% (95% Confidence Interval [CI] 5.2-6.3%) of the older population in 1990-93 to 9.9% (9.3-10.7%) in 2008-11, adjusted odds ratio of 1.90 (95%CI 1.67 – 2.16). People with clinically significant cognitive impairment (MMSE [Mini Mental State Examination] 21 or less) were the heaviest users of potent anticholinergic in CFAS II (16.5% [95%CI 12.0-22.3%]). Large increases in the prevalence of the use medication with ‘any’ anticholinergic activity were seen in older people with clinically significant cognitive impairment (53.3% in CFAS I to 71.5% in CFAS II). Conclusions: Use of potent anticholinergic medications nearly doubled in England’s older population over 20 years with some of the greatest increases amongst those particularly vulnerable to anticholinergic side-effects.

scholarly journals Dementia Care Across Long-Term Settings: Similar but Not Equal

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 669-669
Author(s):  
Sheryl Zimmerman ◽  
Christine Kistler ◽  
Jessica Scott ◽  
Kimberly Ward ◽  
Robin Zeigler ◽  
...  
Keyword(s):  
Nursing Homes ◽  
Assisted Living ◽  
Complex Adaptive Systems ◽  
Adaptive Systems ◽  
Dementia Care ◽  
Care Practice ◽  
Mouth Care ◽  
Complex Adaptive ◽  
Using Data

Abstract Nursing homes and assisted living (AL) communities are similar but not equal, and addressing the needs of residents with dementia differs across settings. It is important to appreciate that both settings are complex adaptive systems; as such, care intended to have widespread impact must be mindful of stakeholders, understand existing practices, and be pragmatic. This session will present an evidence-based program developed in nursing homes – Mouth Care Without a Battle, which teaches staff to provide daily, personalized mouth care to persons with cognitive and physical impairment – and considerations relevant for implementation in AL. Using data from more than 2,000 AL trainees and also AL administrators, supervisors, residents, family members, and trainers, it will situate findings in the context of implementation science and the NIH Stage Model, thereby making them applicable to any dementia care practice regardless its focus and the setting in which it is to be used.

scholarly journals Person-centered, non-pharmacological intervention in reducing psychotropic medication use among residents with dementia in Australian rural aged care homes

2020 ◽  
Author(s):  
Daya Ram Parajuli ◽  
Abraham Kuot ◽  
Mohammad Hamiduzzaman ◽  
Justin Gladman ◽  
Vivian Isaac
Keyword(s):  
Nursing Homes ◽  
Psychotropic Medication ◽  
Medication Use ◽  
Aged Care ◽  
Psychotropic Medications ◽  
Care Homes ◽  
Pharmacological Intervention ◽  
Post Intervention ◽  
Rural Nursing ◽  
Limited Effectiveness

Abstract BackgroundHigh rates of psychotropic medications are prescribed in aged care homes despite their limited effectiveness and associated adverse effects. We aim to evaluate the changes in prescription patterns for elderly residents with advanced dementia in the ‘Harmony in the Bush Dementia Study’. Harmony in the Bush is a person-centered model of dementia care in nursing homes, based on the principles of Progressively Lowered Stress Threshold (PLST) and person-centered music intervention.MethodsOur larger study was a quasi-experimental design conducted in five rural nursing homes in Queensland and South Australia. Medication charts (n = 31) were collected retrospectively from three Australian rural aged care facilities through contacting the facility managers before the intervention and after 6 months. Fifty-three staff participated in 31 semi-structured interviews and 8 focus group at post-intervention, and at 1-month and 3-months follow up.ResultsThe median age of the participants was 83 years, and 68% of them were female. Polypharmacy was measured in 87% of the participants. Hypertension, hyperlipidemia, diabetes, and the Alzheimer’s disease were the major comorbidities identified in residents. None of the residents received more than the maximum dose of psychotropic medications recommended by the guidelines. There was a reduction of 22.4% in the use of at least any psychotropic medication, 19.6% reduction in antipsychotics and benzodiazepines, and 6.5% reduction in antidementia medicines prescription from baseline to at post-intervention, however, these were not statistically significant. There was a decreasing trend in the use of inappropriate use of medications. Psychotropic medications were prescribed up to 43% and antidementia in 45% of participants for more than 6 months. Major themes extracted from qualitative data were reduced/decreased/cessation of medication use, introducing a rest period and the music intervention combined was an alternative approach for medications use, and less behaviors, and ultimately the less use of medications.ConclusionsOur findings indicate that the Harmony in the Bush model as a non-pharmacological approach reduces the prescription of psychotropic medications and inappropriate medications in rural nursing homes as supported by findings from both quantitative and qualitative data.Trial registration: ANZCTR, ACTRN12618000263291. Registered on 20th February 2018. http://www.ANZCTR.org.au/ACTRN12618000263291p.aspx).

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