scholarly journals Factors related to sense of competence in family caregivers of people living with dementia in the community: a narrative synthesis

2018 ◽  
Vol 31 (06) ◽  
pp. 799-813 ◽  
Author(s):  
Jacki Stansfeld ◽  
Nadia Crellin ◽  
Martin Orrell ◽  
Jennifer Wenborn ◽  
Georgina Charlesworth ◽  
...  
Keyword(s):  
Psychological Symptoms ◽  
Future Research ◽  
Narrative Synthesis ◽  
Review Of The Literature ◽  
Factors Associated ◽  
Sense Of Competence ◽  
Proposed Model ◽  
Quality Rating ◽  
Clinical Concept ◽  
Behavioral And Psychological Symptoms

ABSTRACTObjectives:Sense of competence defines a caregiver’s feeling of being capable to manage the caregiving task and is an important clinical concept in the caregiving literature. The aim of this review was to identify the factors, both positive and negative, associated with a caregiver’s perception of their sense of competence.Design:A systematic review of the literature was conducted, retrieving both quantitative and qualitative papers from databases PsycINFO, CINAHL, EMBASE, and Medline. A quality assessment was conducted using the STROBE and CASP checklists, and the quality rating informed the inclusion of papers ensuring the evidence was robust. Narrative synthesis was employed to synthesize the findings and to generate an updated conceptual model of sense of competence.Results:Seventeen papers were included in the review, all of which were moderate to high quality. These included 13 quantitative, three mixed-methods and one qualitative study. Factors associated with sense of competence included: behavioral and psychological symptoms of dementia (BPSD), caregiver depression, gratitude, and the ability to find meaning in caregiving.Conclusions:The results of this review demonstrate that both positive and negative aspects of caring are associated with caregiver sense of competence. Positive and negative aspects of caregiving act in tandem to influence caregiver perception of their competence. The proposed model of sense of competence aims to guide future research and clinical interventions aimed at improving this domain but requires further testing, as due to the observational nature of the include papers, the direction of causality could not be inferred.

scholarly journals Factors Associated With Behavioral and Psychological Symptoms of Dementia: Prospective Observational Study Using Actigraphy (Preprint)

2021 ◽  
Author(s):  
Eunhee Cho ◽  
Sujin Kim ◽  
Sinwoo Hwang ◽  
Eunji Kwon ◽  
Seok-Jae Heo ◽  
...  
Keyword(s):  
Physical Activity ◽  
Older Adults ◽  
Prospective Observational Study ◽  
Psychological Symptoms ◽  
Information Criterion ◽  
Activity Levels ◽  
Contributing Factors ◽  
Factors Associated ◽  
Physical Activity Levels ◽  
Behavioral And Psychological Symptoms

BACKGROUND Although disclosing the predictors of different behavioral and psychological symptoms of dementia (BPSD) is the first step in developing person-centered interventions, current understanding is limited, as it considers BPSD as a homogenous construct. This fails to account for their heterogeneity and hinders development of interventions that address the underlying causes of the target BPSD subsyndromes. Moreover, understanding the influence of proximal factors—circadian rhythm–related factors (ie, sleep and activity levels) and physical and psychosocial unmet needs states—on BPSD subsyndromes is limited, due to the challenges of obtaining objective and/or continuous time-varying measures. OBJECTIVE The aim of this study was to explore factors associated with BPSD subsyndromes among community-dwelling older adults with dementia, considering sets of background and proximal factors (ie, actigraphy-measured sleep and physical activity levels and diary-based caregiver-perceived symptom triggers), guided by the need-driven dementia-compromised behavior model. METHODS A prospective observational study design was employed. Study participants included 145 older adults with dementia living at home. The mean age at baseline was 81.2 (SD 6.01) years and the sample consisted of 86 (59.3%) women. BPSD were measured with a BPSD diary kept by caregivers and were categorized into seven subsyndromes. Independent variables consisted of background characteristics and proximal factors (ie, sleep and physical activity levels measured using actigraphy and caregiver-reported contributing factors assessed using a BPSD diary). Generalized linear mixed models (GLMMs) were used to examine the factors that predicted the occurrence of BPSD subsyndromes. We compared the models based on the Akaike information criterion, the Bayesian information criterion, and likelihood ratio testing. RESULTS Compared to the GLMMs with only background factors, the addition of actigraphy and diary-based data improved model fit for every BPSD subsyndrome. The number of hours of nighttime sleep was a predictor of the next day’s sleep and nighttime behaviors (odds ratio [OR] 0.9, 95% CI 0.8-1.0; <i>P</i>=.005), and the amount of energy expenditure was a predictor for euphoria or elation (OR 0.02, 95% CI 0.0-0.5; <i>P</i>=.02). All subsyndromes, except for euphoria or elation, were significantly associated with hunger or thirst and urination or bowel movements, and all BPSD subsyndromes showed an association with environmental change. Age, marital status, premorbid personality, and taking sedatives were predictors of specific BPSD subsyndromes. CONCLUSIONS BPSD are clinically heterogeneous, and their occurrence can be predicted by different contributing factors. Our results for various BPSD suggest a critical window for timely intervention and care planning. Findings from this study will help devise symptom-targeted and individualized interventions to prevent and manage BPSD and facilitate personalized dementia care.

scholarly journals Person-Centered Assessment of Behavior Changes in People With Dementia

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 263-263
Author(s):  
Benjamin Mast ◽  
Gail Mountain ◽  
Ann Kolanowski ◽  
Esme Moniz-Cook ◽  
Margareta Halek ◽  
...  
Keyword(s):  
Unmet Needs ◽  
Psychological Symptoms ◽  
Contextual Factors ◽  
Reliability And Validity ◽  
Behavior Changes ◽  
Good Reliability ◽  
Factors Associated ◽  
People With Dementia ◽  
Behavioral Expression ◽  
Behavioral And Psychological Symptoms

Abstract Behavioral and psychological symptoms of dementia are increasingly being reconceptualized as expressions of distress and unmet needs. Measures that evaluate context are needed to increase our understanding of factors that influence these expressions. This review evaluated measures for two common behavioral states that are experienced as challenging for caregivers: apathy and resistance to care. A systematic literature search identified measures of apathy or resistance to care for people living with dementia. Eight measures of apathy and three measures of resistance to care were identified. Reliability and validity of these measures were evaluated using the COSMIN framework, as well as reported contextual factors within which the behavior occurs. The identified measures had fair to good reliability and validity in people living with dementia. However, available measures need to move beyond symptomatic constructs for this complex paradigm, and toward the varied interpersonal and contextual factors associated with behavioral expression.

Vocally disruptive behavior: A case report and literature review

2019 ◽  
pp. 1-6
Author(s):  
Barry McCarthy ◽  
Anna Boland ◽  
Sinead Murphy ◽  
Colm Cooney
Keyword(s):  
Drug Treatment ◽  
Disruptive Behavior ◽  
Challenging Behavior ◽  
Psychological Symptoms ◽  
Treatment Strategies ◽  
Pharmacological Profile ◽  
Current Management ◽  
Management Guidelines ◽  
Factors Associated ◽  
Behavioral And Psychological Symptoms

Vocally disruptive behavior (VDB) is a common and particularly difficult symptom to manage in dementia. VDB is usually considered collectively with agitation and aggression as a component of behavioral and psychological symptoms in dementia and is therefore poorly understood as an individual symptom. A review of the literature is described where VDB as a challenging behavior has been individually examined as a symptom. A case of VDB occurring in patient with dementia is described where the patient’s repetitive vocalizations responded to treatment with pregabalin. This has not been previously reported in the literature. The prevalence of VDB, the factors associated with it and the current management guidelines for clinicians are outlined with a review of the drug treatment strategies for VDB. Pregabalin with its unique pharmacological profile and excellent tolerability should be considered as a possible treatment for VDB where drug treatment is indicated.

Effectiveness of the On-the-Spot-EMDR Method for the Treatment of Behavioral Symptoms in Patients With Severe Dementia

2014 ◽  
Vol 8 (2) ◽  
pp. 50-65 ◽  
Author(s):  
Tamaki Amano ◽  
Motomi Toichi
Keyword(s):  
Psychological Symptoms ◽  
Behavioral Symptoms ◽  
Future Research ◽  
Long Term Memory ◽  
Therapeutic Effects ◽  
Severe Dementia ◽  
Traumatic Symptoms ◽  
Behavioral And Psychological Symptoms

Although the main symptoms of dementia consist of neuropsychological impairment, particularly long-term memory, dementia often involves severe behavioral and psychological symptoms of dementia (BPSD). There are quite a few patients whose BPSD are untreatable with medication. Such BPSD often have some characteristics similar to traumatic symptoms and appear related to the recollection of disturbing past traumatic events. Because the standard protocol of eye movement desensitization and reprocessing (EMDR) is not directly applicable to patients with dementia, we developed a modified protocol, the on-the-spot-EMDR method. This study describes the protocol and evaluates its application to three patients with moderate to severe dementia. Clear therapeutic effects were evident, and all three individuals showed pronounced improvement in BPSD, with results maintained at 6-month follow-up. The relevance of these findings is discussed and suggestions made for future research.

scholarly journals A systematic review of the relationship between behavioral and psychological symptoms (BPSD) and caregiver well-being

2016 ◽  
Vol 28 (11) ◽  
pp. 1761-1774 ◽  
Author(s):  
Alexandra Feast ◽  
Esme Moniz-Cook ◽  
Charlotte Stoner ◽  
Georgina Charlesworth ◽  
Martin Orrell
Keyword(s):  
Systematic Review ◽  
Motor Behavior ◽  
Psychological Symptoms ◽  
Meta Analysis ◽  
Well Being ◽  
Future Research ◽  
The Individual ◽  
The Impact ◽  
Behavioral And Psychological Symptoms

ABSTRACTBackground:Behavioral and psychological symptoms in dementia (BPSD) are important predictors of institutionalization as well as caregiver burden and depression. Previous reviews have tended to group BPSD as one category with little focus on the role of the individual symptoms. This review investigates the role of the individual symptoms of BPSD in relation to the impact on different measures of family caregiver well-being.Methods:Systematic review and meta-analysis of papers published in English between 1980 and December 2015 reporting which BPSD affect caregiver well-being. Paper quality was appraised using the Downs and Black Checklist (1998).Results:Forty medium and high quality quantitative papers met the inclusion criteria, 16 were suitable to be included in a meta-analysis of mean distress scores. Depressive behaviors were the most distressing for caregivers followed by agitation/aggression and apathy. Euphoria was the least distressing. Correlation coefficients between mean total behavior scores and mean distress scores were pooled for four studies. Irritability, aberrant motor behavior and delusions were the most strongly correlated to distress, disinhibition was the least correlated.Conclusions:The evidence is not conclusive as to whether some BPSD impact caregiver well-being more than others. Studies which validly examined BPSD individually were limited, and the included studies used numerous measures of BPSD and numerous measures of caregiver well-being. Future research may benefit from a consistent measure of BPSD, examining BPSD individually, and by examining the causal mechanisms by which BPSD impact well-being by including caregiver variables so that interventions can be designed to target BPSD more effectively.

scholarly journals INTEREST GROUP SESSION—NURSING CARE OF OLDER ADULTS: MAKING IT HAPPEN: PERSON-CENTERED DEMENTIA CARE FOR BEHAVIORAL AND PSYCHOLOGICAL SYMPTOMS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S557-S558
Author(s):  
Ann M Kolanowski ◽  
Barbara Bowers
Keyword(s):  
Psychological Symptoms ◽  
Pragmatic Trial ◽  
Direct Care ◽  
High Rate ◽  
Care Staff ◽  
Future Research ◽  
Prescribing Practices ◽  
Person Centered Care ◽  
Centered Care ◽  
Behavioral And Psychological Symptoms

Abstract Person-centered care is the standard of practice in communal living sites, yet many facilities struggle to make this a reality. Both direct care staff and administrators find residents’ behavioral and psychological symptoms of dementia (BPSD) particularly challenging. Our research team is conducting a pragmatic trial, the goal of which is to help staff use person-centered, non-pharmacological approaches for these symptoms. During the past three years we have gained insights into what may affect the ability of staff to deliver high quality person-centered care. We share these insights in this symposium. In the first paper, the investigators present data indicating that a high rate of psychotropic drug use among residents with dementia persists despite little association to BPSD, and bring into question the need for education around de-prescribing practices. In the second paper, the investigators discuss the conceptual basis and empirical evidence for using affect balance, in addition to symptom reduction, as an important and meaningful outcome for residents. The third paper examines gender differences in the expression of BPSD and how these differences may work to limit staff ability to identify treatment approaches for women who, nonetheless, have significant symptoms. In the final paper the psychometric properties and results of a new Knowledge of Person-centered Approaches for BPSD Test, that was developed by the team and given to staff, are examined and the implications of the findings for the delivery of person-centered care are considered. The discussant will reflect on these findings and provide direction for future research and practice.

scholarly journals Factors Associated With Behavioral and Psychological Symptoms of Dementia: Prospective Observational Study Using Actigraphy

10.2196/29001 ◽  
2021 ◽  
Vol 23 (10) ◽  
pp. e29001
Author(s):  
Eunhee Cho ◽  
Sujin Kim ◽  
Sinwoo Hwang ◽  
Eunji Kwon ◽  
Seok-Jae Heo ◽  
...  
Keyword(s):  
Physical Activity ◽  
Older Adults ◽  
Prospective Observational Study ◽  
Psychological Symptoms ◽  
Information Criterion ◽  
Activity Levels ◽  
Contributing Factors ◽  
Factors Associated ◽  
Physical Activity Levels ◽  
Behavioral And Psychological Symptoms

Background Although disclosing the predictors of different behavioral and psychological symptoms of dementia (BPSD) is the first step in developing person-centered interventions, current understanding is limited, as it considers BPSD as a homogenous construct. This fails to account for their heterogeneity and hinders development of interventions that address the underlying causes of the target BPSD subsyndromes. Moreover, understanding the influence of proximal factors—circadian rhythm–related factors (ie, sleep and activity levels) and physical and psychosocial unmet needs states—on BPSD subsyndromes is limited, due to the challenges of obtaining objective and/or continuous time-varying measures. Objective The aim of this study was to explore factors associated with BPSD subsyndromes among community-dwelling older adults with dementia, considering sets of background and proximal factors (ie, actigraphy-measured sleep and physical activity levels and diary-based caregiver-perceived symptom triggers), guided by the need-driven dementia-compromised behavior model. Methods A prospective observational study design was employed. Study participants included 145 older adults with dementia living at home. The mean age at baseline was 81.2 (SD 6.01) years and the sample consisted of 86 (59.3%) women. BPSD were measured with a BPSD diary kept by caregivers and were categorized into seven subsyndromes. Independent variables consisted of background characteristics and proximal factors (ie, sleep and physical activity levels measured using actigraphy and caregiver-reported contributing factors assessed using a BPSD diary). Generalized linear mixed models (GLMMs) were used to examine the factors that predicted the occurrence of BPSD subsyndromes. We compared the models based on the Akaike information criterion, the Bayesian information criterion, and likelihood ratio testing. Results Compared to the GLMMs with only background factors, the addition of actigraphy and diary-based data improved model fit for every BPSD subsyndrome. The number of hours of nighttime sleep was a predictor of the next day’s sleep and nighttime behaviors (odds ratio [OR] 0.9, 95% CI 0.8-1.0; P=.005), and the amount of energy expenditure was a predictor for euphoria or elation (OR 0.02, 95% CI 0.0-0.5; P=.02). All subsyndromes, except for euphoria or elation, were significantly associated with hunger or thirst and urination or bowel movements, and all BPSD subsyndromes showed an association with environmental change. Age, marital status, premorbid personality, and taking sedatives were predictors of specific BPSD subsyndromes. Conclusions BPSD are clinically heterogeneous, and their occurrence can be predicted by different contributing factors. Our results for various BPSD suggest a critical window for timely intervention and care planning. Findings from this study will help devise symptom-targeted and individualized interventions to prevent and manage BPSD and facilitate personalized dementia care.

scholarly journals Post-COVID-19 Fatigue: Potential Contributing Factors

2020 ◽  
Vol 10 (12) ◽  
pp. 1012
Author(s):  
Thorsten Rudroff ◽  
Alexandra C. Fietsam ◽  
Justin R. Deters ◽  
Andrew D. Bryant ◽  
John Kamholz
Keyword(s):  
Psychological Symptoms ◽  
Mental Capacity ◽  
Task Environment ◽  
Future Research ◽  
Contributing Factors ◽  
Mental Performance ◽  
Physiological Factors ◽  
Proposed Model ◽  
Potential Factors ◽  
Conditional Dependency

Much of the spotlight for coronavirus disease 2019 (COVID-19) is on the acute symptoms and recovery. However, many recovered patients face persistent physical, cognitive, and psychological symptoms well past the acute phase. Of these symptoms, fatigue is one of the most persistent and debilitating. In this “perspective article,” we define fatigue as the decrease in physical and/or mental performance that results from changes in central, psychological, and/or peripheral factors due to the COVID-19 disease and propose a model to explain potential factors contributing to post-COVID-19 fatigue. According to our model, fatigue is dependent on conditional and physiological factors. Conditional dependency comprises the task, environment, and physical and mental capacity of individuals, while physiological factors include central, psychological, and peripheral aspects. This model provides a framework for clinicians and researchers. However, future research is needed to validate our proposed model and elucidate all mechanisms of fatigue due to COVID-19.

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