scholarly journals Low investment non-pharmacological approaches implemented for older people experiencing responsive behaviours of dementia

2020 ◽  
Vol 6 ◽  
pp. 237796082096462
Author(s):  
Marie-Lee Yous ◽  
Lori Schindel Martin ◽  
Sharon Kaasalainen ◽  
Jenny Ploeg
Keyword(s):  
Older People ◽  
Acute Care ◽  
Interpersonal Relationships ◽  
Interpersonal Relationship ◽  
Secondary Analysis ◽  
Secondary Data ◽  
Primary Study ◽  
Allied Health Professionals ◽  
Medical Settings ◽  
People With Dementia

Introduction The acute care setting is not ideal for older people with dementia; responsive behaviours may be triggered when care is delivered within a strange environment by staff with limited knowledge of life history and personal preferences. Responsive behaviours (e.g., yelling, hitting, restlessness) are used by older people with dementia to communicate their needs and concerns. It is unknown whether non-pharmacological approaches used by nurses support the development of a meaningful interpersonal relationship between nurses and older people with dementia. Aims: The aims of this study were to explore: (a) the types of low investment non-pharmacological approaches (e.g., music, social activities) used by nurses caring for older people experiencing responsive behaviours of dementia in acute medical settings and (b) the factors that influence the decisions of these nurses to implement these approaches. Methods We present a qualitative secondary analysis of data from a primary study using Thorne’s interpretive description approach. Interviews were conducted with 11 nurses and four allied health professionals from acute medical settings in Canada. A qualitative secondary data analytic approach was used, specifically analytic expansion, and experiential thematic analysis. Findings: egardless of the educational preparation of nurses, the decision to use specific types of low investment non-pharmacological approaches were influenced by the perfunctory development of the interpersonal relationships in acute care hospitals. The factors that led nurses to use limited approaches (e.g., turning on the TV and providing a newspaper) were lack of dementia care education and attending to other acutely ill clients. Conclusions: This study revealed that nurses in acute medical settings require greater practice growth to deliver relational care which is crucial to supporting older people with dementia. Nurses need education and knowledge translation support to use creative low investment non-pharmacological approaches with the intent on upholding the quality of life older people with dementia.

scholarly journals 171 Programme Theory to Guide the Adoption of Assisted Decision Making with Older People in Acute Healthcare: Realist Evaluation

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii1-iii16
Author(s):  
Carmel Davies ◽  
Deirdre O'Donnell ◽  
Éidín Ní Shé ◽  
Sarah Donnelly ◽  
Francesco Fattori ◽  
...  
Keyword(s):  
Decision Making ◽  
Older People ◽  
Acute Care ◽  
Professional Training ◽  
Legal Framework ◽  
Realist Evaluation ◽  
Shared Responsibility ◽  
Programme Theory ◽  
Key Informants ◽  
People With Dementia

Abstract Background In Ireland, the Assisted Decision-Making (ADM) (Capacity) Act and emerging Codes of Practice provide a legal framework for Healthcare Professionals (HCPs) to enable ADM for patients with impaired capacity. ADM ensures that a person’s will and preference is at the centre of all decisions related to their care. This study conducted a realist evaluation and developed a Programme Theory (PT) to highlight how ADM for older people can be operationalised within an Acute Care (AC) context. Methods Key informants with interest in ADM informed this evaluation. Interviews were conducted in two Acute Care (AC) sites with multidisciplinary HCPs working within older person services (n=20). Interviews with informants that recently received care within an AC setting involved older people (n=3) people with dementia (n=4) and family carers (n=5). Ethnographic observations from AC multidisciplinary team meetings also informed the review. The framework that guided the qualitative analysis was from a PT informed by literature on ADM implementation in healthcare (O'Donnell, Ní Shé, Davies et al.2018). Results The refined PT is supported by credible evidence that is informed by authentic experiences of decision making support in the AC setting. Validation groups (n=4) with the key informants verified the PT. Three mechanisms were identified as a positive climate and receptive environment for the adoption of formal ADM. These are: AC settings that adopt inter-professional accountability and shared responsibility for patient care that is guided by a clear policy process. Acute care and practice that is informed by a shared commitment to person-centred care and shared decision making. HCPs that operate within an AC setting where organisational learning informs practice through inter-professional training, mentorship and peer support. Conclusion Involving stakeholders in PT development enhances the utility, feasibility and applicability of the results. This PT provides a framework for those planning ADM implementation within the AC settings.

scholarly journals An analysis of equity in treatment of hip fractures for older patients with dementia in acute care hospitals: observational study using nationwide hospital claims data in Japan

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Shinichi Tomioka ◽  
Megumi Rosenberg ◽  
Kiyohide Fushimi ◽  
Shinya Matsuda
Keyword(s):  
Hip Fracture ◽  
Older People ◽  
Acute Care ◽  
Waiting Time ◽  
Older Patients ◽  
Acute Care Hospitals ◽  
Care Quality ◽  
Severe Dementia ◽  
People With Dementia ◽  
Acute Care Settings

Abstract Background Globally, and particularly in countries with rapidly ageing populations like Japan, there are growing concerns over the heavy burden of ill health borne by older people, and the capacity of the health system to ensure their access to quality care. Older people with dementia may face even greater barriers to appropriate care in acute care settings. Yet, studies about the care quality for older patients with dementia in acute care settings are still few. The objective of this study is to assess whether dementia status is associated with poorer treatment by examining the association of a patient’s dementia status with the probability of receiving surgery and the waiting time until surgery for a hip fracture in acute care hospitals in Japan. Methods All patients with closed hip fracture were extracted from the Diagnosis Procedure Combination (DPC) database between April 2014 and March 2018. After excluding complicated cases, we conducted regressions with multilevel models. We used two outcome measures: (i) whether the patient received a surgery or was treated by watchful waiting; and (ii) number of waiting days until surgery after admission. Results Two hundred fourteen thousand six hundred one patients discharged from 1328 hospitals were identified. Among them, 159,173 patients received surgery. Both 80–89 year-olds (OR 0.87; 95% CI, 0.84, 0.90) and those 90 years old and above (OR 0.67; 95% CI, 0.65, 0.70) had significantly lower odds ratios for receiving surgery compared to 65–79 year-olds. Those with severe dementia had a significantly greater likelihood of receiving surgery compared to those without dementia (OR 1.21; 95% CI, 1.16, 1.25). Patients aged 90 years old and above had shorter waiting time for surgery (Coef. -0.06; 95% CI, − 0.11, − 0.01). Mild dementia did not have a statistically significant impact on the number of waiting days until surgery (P = 0.34), whereas severe dementia was associated with shorter waiting days (Coef. -0.08; 95% CI, − 0.12, − 0.03). Conclusions These findings suggest physicians may be taking proactive measures to preserve physical function for those with severe dementia and to avoid prolonged hospitalization although there are no formal guidelines on prioritization for the aged and dementia patients.

Acute care management of older people with dementia: a qualitative perspective

2010 ◽  
Vol 20 (3-4) ◽  
pp. 420-428 ◽  
Author(s):  
Wendy Moyle ◽  
Sally Borbasi ◽  
Marianne Wallis ◽  
Rachel Olorenshaw ◽  
Natalie Gracia
Keyword(s):  
Older People ◽  
Acute Care ◽  
Care Management ◽  
People With Dementia

scholarly journals Nurses' Experiences in Caring for Older Adults With Responsive Behaviors of Dementia in Acute Care

2019 ◽  
Vol 5 ◽  
pp. 237796081983412 ◽  
Author(s):  
Marie-Lee Yous ◽  
Jenny Ploeg ◽  
Sharon Kaasalainen ◽  
Lori Schindel Martin
Keyword(s):  
Older Adults ◽  
Acute Care ◽  
Health Professionals ◽  
Health Care Professionals ◽  
Allied Health ◽  
Care Delivery ◽  
Dementia Care ◽  
Annual Review ◽  
Allied Health Professionals ◽  
Medical Settings

Introduction: Approximately 56,000 individuals with dementia were admitted to Canadian hospitals in 2016, and 75% of them experience responsive behaviors. Responsive behaviors are words or actions used to express one's needs (e.g., wandering, yelling, hitting, and restlessness). Health-care professionals perceive these behaviors to be a challenging aspect in providing care for persons with dementia. Aims: This study explores the perceptions of nurses about (a) caring for older adults with dementia experiencing responsive behaviors in acute medical settings and (b) recommendations to improve dementia care. Methods: Thorne's interpretive description approach was used. In-person, semistructured interviews were conducted with 10 nurses and 5 allied health professionals from acute medical settings in an urban hospital in Ontario. Interviews were conducted with allied health professionals to understand their perspectives regarding care delivery for persons with responsive behaviors of dementia. Data were analyzed using Braun and Clarke's experiential thematic analysis. Findings: Themes related to caring for individuals with responsive behaviors included (a) delivering care is a complex experience, (b) using pharmacological strategies and low investment nonpharmacological strategies to support older adults with responsive behaviors, (c) acute medical settings conflicted with principles of dementia care due to a focus on acute care priorities and limited time, and (d) strong interprofessional collaboration and good continuity of care were facilitators for care. Conclusions: Findings provide guidance for improved support for nurses who provide care for individuals experiencing responsive behaviors in acute medical settings such as increasing staffing and providing educational reinforcements (e.g., annual review of dementia care education and in-services).

Three Nursing Home Residents Speak About Meaning At the End of Life

2008 ◽  
Vol 15 (1) ◽  
pp. 97-109 ◽  
Author(s):  
Lise-Lotte Dwyer ◽  
Lennart Nordenfelt ◽  
Britt-Marie Ternestedt
Keyword(s):  
Nursing Home ◽  
Older People ◽  
Everyday Life ◽  
Secondary Analysis ◽  
Nursing Home Residents ◽  
Primary Study ◽  
Physical Capability ◽  
Cognitive Capability ◽  
Hermeneutic Approach ◽  
Inner Dialogue

This article provides a deeper understanding of how meaning can be created in everyday life at a nursing home. It is based on a primary study concerning dignity involving 12 older people living in two nursing homes in Sweden. A secondary analysis was carried out on data obtained from three of the primary participants interviewed over a period of time (18—24 months), with a total of 12 interviews carried out using an inductive hermeneutic approach. The study reveals that sources of meaning were created by having a sense of: physical capability, cognitive capability, being needed, and belonging. Meaning was created through inner dialogue, communication and relationships with others. A second finding is that the experience of meaning can sometimes be hard to realize.

scholarly journals Factors associated with improved walking in older people during hospital rehabilitation: secondary analysis of a randomized controlled trial

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Catherine M Said ◽  
Jennifer L McGinley ◽  
Cassandra Szoeke ◽  
Barbara Workman ◽  
Keith D. Hill ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Older People ◽  
Gait Speed ◽  
Controlled Trial ◽  
Secondary Analysis ◽  
Secondary Data ◽  
Trial Registration ◽  
Factors Associated ◽  
Rehabilitation Outcomes ◽  
Randomized Controlled

Abstract Background Older people are often admitted for rehabilitation to improve walking, yet not everyone improves. The aim of this study was to determine key factors associated with a positive response to hospital-based rehabilitation in older people. Methods This was a secondary data analysis from a multisite randomized controlled trial. Older people (n= 198, median age 80.9 years, IQR 76.6- 87.2) who were admitted to geriatric rehabilitation wards with a goal to improve walking were recruited. Participants were randomized to receive additional daily physical therapy focused on mobility (n = 99), or additional social activities (n = 99). Self-selected gait speed was measured on admission and discharge. Four participants withdrew. People who changed gait speed ≥0.1 m/s were classified as ‘responders’ (n = 130); those that changed <0.1m/s were classified as ‘non-responders’ (n = 64). Multivariable logistic regression explored the association of six pre-selected participant factors (age, baseline ambulation status, frailty, co-morbidities, cognition, depression) and two therapy factors (daily supervised upright activity time, rehabilitation days) and response. Results Responding to rehabilitation was associated with the number of days in rehabilitation (OR 1.04; 95% CI 1.00 to 1.08; p = .039) and higher Mini Mental State Examination scores (OR 1.07, 95% CI 1.00 – 1.14; p = .048). No other factors were found to have association with responding to rehabilitation. Conclusion In older people with complex health problems or multi-morbidities, better cognition and a longer stay in rehabilitation were associated with a positive improvement in walking speed. Further research to explore who best responds to hospital-based rehabilitation and what interventions improve rehabilitation outcomes is warranted. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12613000884707; ClinicalTrials.gov Identifier NCT01910740.

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