Challenging situations and competence of nursing staff in nursing homes for older people with dementia

Abstract Background Physiotherapists need to use pedagogical approaches and strategies in their work. However, there is no previous definition of what a pedagogical approach in physiotherapy means neither in general nor specifically to dementia. The purpose of this study was therefore to gain greater insight into physiotherapists’ pedagogical approach to dementia by investigating physiotherapists’ views and working methods in contact with older people with dementia, relatives, and nursing staff in elderly care. Methods This was a qualitative study with an inductive approach. Semi-structured individual interviews were conducted with 15 physiotherapists with experience of working with older people with dementia in elderly care. The interviews were analyzed with qualitative content analysis. Results The term “pedagogical approach” could sometimes be experienced as “vague” or “hard to grasp”. Our research nonetheless identified one overarching theme To see, meet and adapt which is based on insights from the interviews grouped in to five categories. This theme can be seen as an expression of the physiotherapists’ pedagogical approach in contact with older people with dementia, relatives, and nursing staff. It captures the participants’ desire to always see the person in front of them, meet them where they are and adapt their own way of working accordingly. Creating a trusting relationship was described as important and made it easier for the participants to adapt their working methods. The participants’ adaptations could apply to the way they communicated with people with dementia, and how they organized tutoring/education of relatives and nursing staff to maximize learning. Learning through experience and reflection was described as a key to advancing the pedagogical approach and the participants experienced their own learning as constantly ongoing. Conclusions This study provides increased understanding into physiotherapists’ pedagogical approach in contact with older people with dementia, relatives, and nursing staff in elderly care and shows that learning through experience and reflection can contribute to the development of the pedagogical approach. Thus, opportunity for reflection should be accommodated in the physiotherapists’ work. The importance of more pedagogical education for physiotherapists both in bachelor and master level were also highlighted. Increasing mobility and physical activity in older people with dementia is important since physical inactivity and sedentary behavior is common. Future research may be directed at further exploring physiotherapists’ pedagogical approach in tutoring/education of nursing staff, with the aim of increasing physical activity among older people with dementia.

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Cortisol levels among older people with and without depression and dementia

International Psychogeriatrics ◽

10.1017/s1041610218001199 ◽

2018 ◽

Vol 31 (04) ◽

pp. 597-601 ◽

Cited By ~ 3

Author(s):

Maria Lage Barca ◽

Rannveig S. Eldholm ◽

Karin Persson ◽

Guro Hanevold Bjørkløf ◽

Tom Borza ◽

...

Keyword(s):

Nursing Homes ◽

Older People ◽

Reference Group ◽

Mmse Score ◽

Cross Sectional Study ◽

Cross Sectional ◽

People With Dementia ◽

Specialized Care ◽

Cortisol Levels ◽

Cortisol Ratio

ABSTRACTCortisol dysregulation has been reported in dementia and depression. Cortisol levels and its associates were investigated among older people living at home and in nursing homes, in a cross-sectional study. A sample of 650 older people, from the community (home and nursing homes) and specialized care (memory clinics and old age psychiatry wards), mean age 76.8 (SD = 10.3) (dementia n = 319, depression, n = 154, dementia plus depression n = 53, and reference group n = 124), was included. Assessment included the Mini Mental State Examination (MMSE), Cornell scale for depression in dementia, activities of daily living scales, and salivary cortisol. Number of drugs was registered. The results showed that the cortisol ratio was highest among patients with dementia and co-morbid depression in comparison to those with either depression or dementia and the reference group. Characteristics significantly associated with cortisol levels were higher MMSE score (in patients with dementia and co-morbid depression), male gender (in people with dementia), and number of medications (in the reference group). We conclude that the cortisol ratio was highest among patients with dementia and co-morbid depression in comparison to those with either depression or dementia and the reference group. The association of cortisol level with MMSE score among patients with dementia and depression could further indicate that increased stress is related to cognitive function.

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Motivation to participate in high-intensity functional exercise compared with a social activity in older people with dementia in nursing homes

PLoS ONE ◽

10.1371/journal.pone.0206899 ◽

2018 ◽

Vol 13 (11) ◽

pp. e0206899 ◽

Cited By ~ 6

Author(s):

Anna Sondell ◽

Erik Rosendahl ◽

Johan Nilsson Sommar ◽

Håkan Littbrand ◽

Lillemor Lundin-Olsson ◽

...

Keyword(s):

Nursing Homes ◽

Older People ◽

High Intensity ◽

Social Activity ◽

People With Dementia ◽

Functional Exercise ◽

Motivation To Participate

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Adverse Events in Italian Nursing Homes During the COVID-19 Epidemic: A National Survey

Frontiers in Psychiatry ◽

10.3389/fpsyt.2020.578465 ◽

2020 ◽

Vol 11 ◽

Cited By ~ 2

Author(s):

Flavia L. Lombardo ◽

Emanuela Salvi ◽

Eleonora Lacorte ◽

Paola Piscopo ◽

Flavia Mayer ◽

...

Keyword(s):

Nursing Homes ◽

Adverse Events ◽

Older People ◽

National Survey ◽

Physical Restraint ◽

National Health System ◽

Online Questionnaire ◽

North West ◽

North East ◽

People With Dementia

Older people living in nursing homes (NHs) are particularly vulnerable in the ongoing COVID-19 pandemic, due to the high prevalence of chronic diseases and disabilities (e.g., dementia). The phenomenon of adverse events (AEs), intended as any harm or injury resulting from medical care or to the failure to provide care, has not yet been investigated in NHs during the pandemic. We performed a national survey on 3,292 NHs, either public or providing services both privately and within the national health system, out of the 3,417 NHs covering the whole Italian territory. An online questionnaire was addressed to the directors of each facility between March 24 and April 27, 2020. The list of NHs was provided by the Dementia Observatory, an online map of Italian services for people with dementia, which was one of the objectives of the implementation of the Italian National Dementia Plan. About 26% of residents in the Italian NHs for older people listed within the Dementia Observatory site had dementia. The objective of our study was to report the frequency of AEs that occurred during the months when SARS-CoV-2 spreading rate was at its highest in the Italian NHs and to identify which conditions and attributes were most associated with the occurrence of AEs by means of multivariate regression logistic analysis. Data are referred to 1,356 NHs that participated in the survey. The overall response rate was 41.2% over a time-period of six weeks (from March 24 to May 5). About one third of the facilities (444 out of 1,334) (33.3%) reported at least 1 adverse event, with a total of 2,000 events. Among the included NHs, having a bed capacity higher than the median of 60 beds (OR=1.57, CI95% 1.17–2.09; p=0.002), an observed increased in the use of psychiatric drugs (OR=1.80, CI95% 1.05–3.07; p=0.032), adopting physical restraint measures (OR=1.97, CI95% 1.47–2.64; p<0.001), residents hospitalized due to flu-like symptoms (OR =1.73, CI95% 1.28–2.32; p<0.001), and being located in specific geographic areas (OR=3.59, CI95% 1.81–7.08; OR = 2.90, CI95% 1.45–5.81 and OR = 4.02, CI05% 2.01–8.04 for, respectively, North-West, North-East and Centre vs South, p<0.001) were all factors positively associated to the occurrence of adverse events in the facility. Future recommendations for the management and care of residents in NHs during the COVID-19 pandemic should include specific statements for the most vulnerable populations, such as people with dementia.

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The Effects of Exercise on Falls in Older People With Dementia Living in Nursing Homes: A Randomized Controlled Trial

Journal of the American Medical Directors Association ◽

10.1016/j.jamda.2018.10.009 ◽

2019 ◽

Vol 20 (7) ◽

pp. 835-842.e1 ◽

Cited By ~ 3

Author(s):

Annika Toots ◽

Robert Wiklund ◽

Håkan Littbrand ◽

Ellinor Nordin ◽

Peter Nordström ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Nursing Homes ◽

Older People ◽

Controlled Trial ◽

Randomized Controlled ◽

People With Dementia

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The care of older people with dementia in surgical wards from the point of view of the nursing staff and physicians

Journal of Clinical Nursing ◽

10.1111/jocn.12669 ◽

2014 ◽

Vol 24 (1-2) ◽

pp. 192-201 ◽

Cited By ~ 22

Author(s):

Nina Hynninen ◽

Reetta Saarnio ◽

Arja Isola

Keyword(s):

Older People ◽

Nursing Staff ◽

Point Of View ◽

People With Dementia

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Implementation of a complex intervention to improve participation in older people with joint contractures living in nursing homes: A process evaluation of a cluster-randomised pilot trial

10.21203/rs.2.14602/v2 ◽

2019 ◽

Author(s):

Hanna Klingshirn ◽

Martin Müller ◽

Katrin Beutner ◽

Julian Hirt ◽

Ralf Strobl ◽

...

Keyword(s):

Nursing Home ◽

Nursing Homes ◽

Older People ◽

Nursing Staff ◽

Complex Intervention ◽

Implementation Strategy ◽

Peer Mentoring ◽

Pilot Trial ◽

Joint Contractures ◽

Cluster Randomised

Abstract Background: Joint contractures in frail older people are associated with serious restrictions in participation. We developed the Participation Enabling CAre in Nursing (PECAN) intervention, a complex intervention to enable nurses to promote participation in nursing home residents with joint contractures. The aim of this study was to examine the feasibility of the implementation strategy and to identify enablers and barriers for a successful implementation. Methods: The implementation of PECAN was investigated in a 6-month pilot cluster-randomised controlled trial (c-RCT). As a key component of the implementation strategy, nominated nurses were trained as facilitators in a one-day workshop and supported by peer-mentoring (visit, telephone counselling). A mixed-methods approach was conducted in conjunction with the pilot trial and guided by a framework for process evaluations of c-RCTs. Data were collected using standardised questionnaires (nursing staff), documentation forms, problem-centred qualitative interviews (facilitators, therapists, social workers, relatives, peer-mentors), and a group discussion (facilitators). A set of predefined criteria on the nursing home level was examined. Quantitative data were analysed using descriptive statistics. Qualitative data were analysed using directed content analysis. Results: Seven nursing homes (n=4 intervention groups, n=3 control groups) in two German regions took part in the study. Facilitators responded well to the qualification measures (workshop participation: 14/14; workshop rating: “good”; peer-mentor visit participation: 10/14). The usage of peer-mentoring via telephone varied (one to seven contacts per nursing home). Our implementation strategy was not successful in connection with supplying the intervention to all the nursing staff. The clear commitment of the entire nursing home and the respect for the expertise of different healthcare professionals were emphasised as enablers, whereas a lack of impact on organisational conditions and routines and a lack of time and staff competence were mentioned as barriers. Conclusion: The PECAN intervention was delivered as planned to the facilitators but was unable to produce comprehensive changes in the nursing homes and subsequently for the residents. Strategies to systematically include the management and the nursing team from the beginning, are needed to support the facilitators during implementation in the main trial. Trial Registration: German clinical trials register, DRKS00010037. Registered 12 February 2016.

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Is the Effect of a High-Intensity Functional Exercise Program on Functional Balance Influenced by Applicability and Motivation among Older People with Dementia in Nursing Homes?

The journal of nutrition health & aging ◽

10.1007/s12603-019-1269-8 ◽

2019 ◽

Vol 23 (10) ◽

pp. 1011-1020

Author(s):

Anna Sondell ◽

H. Littbrand ◽

H. Holmberg ◽

N. Lindelöf ◽

E. Rosendahl

Keyword(s):

Nursing Homes ◽

Older People ◽

High Intensity ◽

Exercise Program ◽

Target Variable ◽

Functional Balance ◽

People With Dementia ◽

Point Increase ◽

Functional Exercise

Abstract Background and Objectives Exercise can be an important way of maintaining balance function in people with dementia, but further investigation is needed to determine the optimal way of exercising. The objective was to evaluate whether exercise applicability (i.e., attendance, exercise intensity, and adverse events) and motivation were associated with the effect on functional balance of a high-intensity functional exercise program for older people with dementia in nursing homes. Design, Setting and Participants Exercise intervention participants (n = 81; 60 women, 21 men) from a randomized controlled trial (UMDEX) were included. Their mean age was 84 and mean Mini-Mental State Examination score was 15. Intervention Groups of 3–8 participants participated in the High-Intensity Functional Exercise (HIFE) Program, with 5 sessions per 2-week period, for 4 months (total, 40 sessions). Measurements Outcome was the Berg Balance Scale (BBS), assessed at baseline and follow up, and the score difference, dichotomized to classify participants into two groups: responders (≥5-point increase) and non-responders (<5-point increase). Target variables were measures of applicability and motivation. Associations between each target variable and the outcome were analyzed using multivariable logistic regression. Baseline characteristics and new medical conditions developing during the intervention period were compared between responders and non-responders and included in the analyses when p < 0.10. Results The BBS score was 28.6 ± 14.3 at baseline and 31.2 ± 15.3 at follow up, with the difference between follow-up and baseline scores ranging from −35 to 24. Twenty-nine (35.8%) participants were responders. The multivariable models showed no significant association between responders vs. non-responders and any target variable. Conclusion Participation in a 4-month high-intensity functional exercise program can improve balance in many individuals with dementia in nursing homes, despite the progressiveness of dementia disorders and several co-existing medical conditions. Predicting balance exercise response based on applicability and motivation seem not to be possible, which lends no support for excluding this group from functional exercise, even when exercise intensity or motivation is not high.

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