scholarly journals The Outcomes of a Person-centered, Non-Pharmacological Intervention in Reducing Behavioral and Psychiatric Symptoms in Residents With Advanced Dementia in Australian Rural Nursing Homes

2020 ◽  
Author(s):  
Vivian Isaac ◽  
Abraham Kuot ◽  
Mohammad Hamiduzzaman ◽  
Edward Strivens ◽  
Jennene Greenhill
Keyword(s):  
Nursing Homes ◽  
Psychiatric Symptoms ◽  
Trial Registration ◽  
Advanced Dementia ◽  
Aggressive Behaviors ◽  
Rural Nursing ◽  
Stress Threshold ◽  
Progressively Lowered Stress Threshold ◽  
Stress Inventory ◽  
Rural Australia

Abstract BackgroundThere is limited best- practice evidence to address behavioral and psychiatric symptoms for those with advanced dementia in Australian rural nursing homes. This study aims to evaluate the outcomes of a person-centered, non-pharmacological dementia care model, ‘Harmony in the Bush’, based on the Progressively Lowered Stress Threshold principles and person-centered music in rural Australia.MethodsA quasi-experimental study was conducted in five rural nursing homes in Queensland and South Australia. Seventy-four residents with advanced dementia participated in this intervention study, which yielded a sample power of 80%. Eighty-seven staff completed the Caregiver Stress Inventory at pre-post four-weeks of intervention. Staff training workshops focusing on the theory and delivery of the Progressively Lowered Stress Threshold principles and a music intervention. We used reported changes in agitation of the residents, measured using Cohen- Mansfield Agitation Inventory, and staff’s caregiving stress, using Caregivers Stress Inventory. Triangulation using post- intervention qualitative evaluation from 13 focus group discussion and 38 staff interviews. This study adheres to the CONSORT guidelines.ResultsMean age of residents with advanced dementia was 82.4 (7.7) years and 69% were females. The mean age of admission was 80.1(8.4) years. Baseline measures indicated that 32.7% had mild- severe pain and 30.5% reported mild-severe sadness. The results showed statistically significant decline in aggressive behaviors, physically non-aggressive behaviors, verbally agitated behavior and hiding and hoarding. There was comparable reduction in staff stress in the domains of aggressive behaviors, inappropriate behaviors, resident safety, and resource deficiency.ConclusionsThe Harmony in the Bush model is effective in reducing behavioral and psychiatric symptoms in advanced dementia with significant reduction in staff stress levels in nursing homes in rural Australia.Trial Registration: Australian and New Zealand Clinical Trials Registry (ANZCTR) on 20/2/2018 (Registration No: ACTRN12618000263291p). https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374458

scholarly journals The outcomes of a person-centered, non-pharmacological intervention in reducing agitation in residents with dementia in Australian rural nursing homes

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Vivian Isaac ◽  
Abraham Kuot ◽  
Mohammad Hamiduzzaman ◽  
Edward Strivens ◽  
Jennene Greenhill
Keyword(s):  
Nursing Homes ◽  
Intervention Study ◽  
Trial Registration ◽  
Pharmacological Intervention ◽  
Aggressive Behaviors ◽  
Rural Nursing ◽  
Stress Threshold ◽  
Progressively Lowered Stress Threshold ◽  
Stress Inventory ◽  
Rural Australia

Abstract Background There is limited best- practice evidence to address behavioral and psychiatric symptoms for those with dementia in Australian rural nursing homes. This study aims to evaluate the outcomes of a person-centered, non-pharmacological dementia care model, ‘Harmony in the Bush’, based on the Progressively Lowered Stress Threshold principles and person-centered music in rural Australia. Methods A quasi-experimental (nonrandomized, pre-post) intervention study was conducted in five rural nursing homes in Queensland and South Australia. Seventy-four residents with dementia participated in this intervention study, which yielded a sample power of 80%. Eighty-seven staff completed the Caregiver Stress Inventory at pre-post four-weeks of intervention. Staff training workshops focused on the theory of the Progressively Lowered Stress Threshold principles and delivery of person-centered care plan with integrated music intervention. We used reported changes in agitation of the residents, measured using Cohen- Mansfield Agitation Inventory, and staff’s caregiving stress, using Caregivers Stress Inventory. This study adheres to the CONSORT guidelines. Results Mean age of residents with dementia was 82.4 (7.7) years and 69% were females. The mean age of admission was 80.1(8.4) years. Baseline measures indicated that 32.7% had mild- severe pain and 30.5% reported mild-severe sadness. The results showed statistically significant decline in aggressive behaviors, physically non-aggressive behaviors, verbally agitated behavior and hiding and hoarding. There was similar reduction in staff stress in the domains of aggressive behaviors, inappropriate behaviors, resident safety, and resource deficiency. Conclusions The Harmony in the Bush model is effective in reducing agitation among dementia residents with significant reduction in staff stress levels in nursing homes in rural Australia. Trial registration Australian and New Zealand Clinical Trials Registry (ANZCTR) on 20/2/2018 (Registration No: ACTRN12618000263291p). https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374458

scholarly journals The outcomes of a person-centered, non-pharmacological intervention in reducing agitation in residents with dementia in Australian rural nursing homes

2020 ◽  
Author(s):  
Vivian Isaac ◽  
Abraham Kuot ◽  
Mohammad Hamiduzzaman ◽  
Edward Strivens ◽  
Jennene Greenhill
Keyword(s):  
Nursing Homes ◽  
Intervention Study ◽  
Trial Registration ◽  
Pharmacological Intervention ◽  
Aggressive Behaviors ◽  
Rural Nursing ◽  
Stress Threshold ◽  
Progressively Lowered Stress Threshold ◽  
Stress Inventory ◽  
Rural Australia

Abstract BackgroundThere is limited best- practice evidence to address behavioral and psychiatric symptoms for those with dementia in Australian rural nursing homes. This study aims to evaluate the outcomes of a person-centered, non-pharmacological dementia care model, ‘Harmony in the Bush’, based on the Progressively Lowered Stress Threshold principles and person-centered music in rural Australia.MethodsA quasi-experimental (nonrandomized, pre-post) intervention study was conducted in five rural nursing homes in Queensland and South Australia. Seventy-four residents with dementia participated in this intervention study, which yielded a sample power of 80%. Eighty-seven staff completed the Caregiver Stress Inventory at pre-post four-weeks of intervention. Staff training workshops focused on the theory of the Progressively Lowered Stress Threshold principles and delivery of person-centered care plan with integrated music intervention. We used reported changes in agitation of the residents, measured using Cohen- Mansfield Agitation Inventory, and staff’s caregiving stress, using Caregivers Stress Inventory. This study adheres to the CONSORT guidelines.ResultsMean age of residents with dementia was 82.4 (7.7) years and 69% were females. The mean age of admission was 80.1(8.4) years. Baseline measures indicated that 32.7% had mild- severe pain and 30.5% reported mild-severe sadness. The results showed statistically significant decline in aggressive behaviors, physically non-aggressive behaviors, verbally agitated behavior and hiding and hoarding. There was similar reduction in staff stress in the domains of aggressive behaviors, inappropriate behaviors, resident safety, and resource deficiency.ConclusionsThe Harmony in the Bush model is effective in reducing agitation among dementia residents with significant reduction in staff stress levels in nursing homes in rural Australia.Trial Registration: Australian and New Zealand Clinical Trials Registry (ANZCTR) on 20/2/2018 (Registration No: ACTRN12618000263291p). https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374458

scholarly journals The Nexus of ‘Music, Mind, and Well-being’: Effects of Harmony in the Bush Music Intervention for Residents with Advanced Dementia in Australian Rural Nursing Homes

2020 ◽  
Author(s):  
Mohammad Hamiduzzaman ◽  
Abraham Kuot ◽  
Jennene Greenhill ◽  
Edward Strivens ◽  
Daya Ram Parajuli ◽  
...  
Keyword(s):  
Nursing Homes ◽  
Qualitative Data ◽  
Psychiatric Symptoms ◽  
Behavioural Change ◽  
Well Being ◽  
T Test ◽  
Advanced Dementia ◽  
Music Intervention ◽  
Time Points ◽  
Rural Nursing

Abstract BackgroundPersons with dementia often show aggression, depression, and anxiety and these symptoms and behaviours escalate overtime without treatment. Music has been found to be useful for managing these symptoms and behaviours and can significantly improve well-being. This paper reports the effect of music on residents with advanced dementia in rural nursing homes, as a key part of the Harmony in the Bush study.MethodsWe conducted a quasi-experimental research in five Australian rural nursing homes. Managers of nursing homes were contacted to select residents with advanced dementia, resulted in 74 residents who participated in person-centred music and culturally-appropriate group music sessions. Staff (104) and musicians (6) participated in 65 interviews and 20 focus groups. One-Way ANOVA and paired-samples t-test were performed to understand Music in Dementia Assessment Scale (MiDAS) scores. Qualitative data were thematically analysed.ResultsSeventy-four residents participated in an average of 9.5 [SD 4.73] person-centred music sessions and most of them were female (n = 52/70%). Analysis revealed the overall mean effect of the person-centred music at two-time points as 67% [during-70% {351.22 (SD:93.51)}; and after-63% {315.09 (SD:98.52)}]. The residents with (moderate to severe) pain, anxiety, sadness, and agitation at pre-intervention, presented an improvement in their levels of interest, response, initiation, involvement, and enjoyment at different time-points. The t-test showed that the MiDAS sub-categories’ mean scores differed significantly between the time-points: interest [t = 2.75, p = 0.001]; response [t = 2.94, p = 0.005]; initiation [t = 2.41, p = 0.019]; and involvement [t = 2.78, p = 0.007]. Additionally, the residents were observed at post-intervention with a reduction of agitation (87.5%), low in mood (87.5%), and anxiousness (70.3%); and an improvement in relaxation (75.5%), attentiveness (56.5%), and smiling (56.9%). Themes from qualitative data were behavioural change, meaningful interaction, being initiative, increased participation, and contentment.ConclusionFindings suggest the music intervention probably reduce the residents’ psychiatric symptoms and behaviours and improve well-being.Clinical RegistrationThe study is registered with the Australian and New Zealand Clinical. Trials Registry (ANZCTR) on 20/2/2018 (Registration No: ACTRN12618000263291p; http://www.ANZCTR.org.au/ACTRN12618000263291p.aspx).

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

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Daya Ram Parajuli ◽  
Abraham Kuot ◽  
Mohammad Hamiduzzaman ◽  
Justin Gladman ◽  
Vivian Isaac
Keyword(s):  
Nursing Homes ◽  
Qualitative Data ◽  
Psychiatric Symptoms ◽  
Aged Care ◽  
Psychotropic Medications ◽  
Care Homes ◽  
Pharmacological Intervention ◽  
Post Intervention ◽  
Rural Nursing ◽  
Limited Effectiveness

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 medications, 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.

scholarly journals Person-centered, non-pharmacological intervention in reducing psychotropic medication use among residents with advanced 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 ◽  
Qualitative Data ◽  
Medication Use ◽  
Aged Care ◽  
Psychotropic Medications ◽  
Advanced Dementia ◽  
Music Intervention ◽  
Post Intervention ◽  
Rural Nursing

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 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. 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.ResultsThe 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 use of medications. Psychotropic medications were prescribed in 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 combination was an alternative approach for medications use, and resulting in 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).

scholarly journals The Impact of Nursing Homes Staff Education on End-of-Life Care in Residents With Advanced Dementia: A Quality Improvement Study

2019 ◽  
Vol 57 (1) ◽  
pp. 93-99 ◽  
Author(s):  
Paola Di Giulio ◽  
Silvia Finetti ◽  
Fabrizio Giunco ◽  
Ines Basso ◽  
Debora Rosa ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Nursing Homes ◽  
End Of Life ◽  
End Of Life Care ◽  
Life Care ◽  
Advanced Dementia ◽  
Staff Education ◽  
The Impact

Interorganizational Linkages and Service and Personnel Shortages in Rural Nursing Homes

1996 ◽  
Vol 15 (2) ◽  
pp. 172-187 ◽  
Author(s):  
Diane Brannon ◽  
Kathryn Dansky ◽  
Cathy Kassab ◽  
Larry Gamm
Keyword(s):  
Nursing Homes ◽  
Rural Nursing ◽  
Personnel Shortages

scholarly journals Complementary therapy for advanced dementia palliation in nursing homes

2020 ◽  
Vol 28 (4) ◽  
pp. 419-432
Author(s):  
Bryan Mitchell ◽  
Graham A. Jackson ◽  
Barbara Sharp ◽  
Debbie Tolson
Keyword(s):  
Nursing Home ◽  
Action Research ◽  
Nursing Homes ◽  
Care Home ◽  
Nursing Home Residents ◽  
Objective Measure ◽  
Complementary Therapy ◽  
Advanced Dementia ◽  
Content Type ◽  
Care Home Staff

PurposeThis paper reports on an action research study that aimed to collaboratively develop a complementary therapy care intervention to augment palliative care choices available to nursing home residents with advanced dementia.Design/methodology/approachAn action research design was adopted that consisted of a series of action cycles involving collaborative exploration, problem-solving planning, development and evidence gathering. A combination of mixed methods was used when gaining data at the different stages, including face to face delivered questionnaires, observational notes, focus groups, and the objective measure of the Neuropsychiatric Inventory adapted for Nursing Homes (NPI-NH).FindingsCare home staff and relatives considered the use of Complementary Therapy to be a helpful intervention promoting that it can reduce a sense of loneliness and provide companionship for residents experiencing distress. Analysis of NPI-NH scores showed a reduction in presenting neuropsychiatric behaviours associated with stress and distress.Research limitations/implicationsDiffering levels of participant group engagement may affect this study’s findings as it was noted that care home staff provided a fuller contribution to the project in comparison to relatives.Practical implicationsImplementation guidance is needed when implementing complementary therapy within the nursing home practice to promote consistency and successful integration of an intervention that is not provided as routine care.Originality/valueThe findings of this study are encouraging and demonstrate the acceptability of complementary therapies to residents with advanced dementia, where positive impacts on otherwise difficult to address dementia symptoms related to stress and distress are highlighted.

Antimicrobial stewardship in rural nursing homes: Impact of interprofessional education and clinical decision tool implementation on urinary tract infection treatment in a cluster randomized trial

2019 ◽  
Vol 40 (4) ◽  
pp. 432-437 ◽  
Author(s):  
Darren K. Pasay ◽  
Micheal S. Guirguis ◽  
Rhonda C. Shkrobot ◽  
Jeremy P. Slobodan ◽  
Adrian S. Wagg ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Nursing Homes ◽  
Antimicrobial Stewardship ◽  
Hospital Admissions ◽  
Urine Culture ◽  
Intervention Group ◽  
Clinical Decision ◽  
Rural Nursing ◽  
Antimicrobial Prescribing ◽  
Cluster Randomized

AbstractObjectives:To measure the impact of an antimicrobial stewardship initiative on the rate of urine culture testing and antimicrobial prescribing for urinary tract infections (UTIs) between control and intervention sites. Secondary objectives included evaluation of potential harms of the intervention and identifying characteristics of the population prescribed antimicrobials for UTI.Design:Cluster randomized controlled trial.Setting:Nursing homes in rural Alberta, Canada.Participants:The study included 42 nursing homes ranging from 8 to 112 beds.Methods/interventions:Intervention sites received on-site staff education, physician academic detailing, and integrated clinical decision-making tools. Control sites provided standard care. Data were collected for 6 months prior to and 12 months after the intervention.Results:Resident age (83.0 vs 83.8 years) and sex distribution (female, 62.5% vs 64.5%) were similar between the groups. Statistically significant decreases in the rate of urine culture testing (−2.1 tests per 1,000 resident days [RD]; 95% confidence interval [CI], −2.5 to −1.7;P< .001) and antimicrobial prescribing for UTIs (−0.7 prescriptions per 1,000 RD; 95% CI, −1.0 to −0.4;P< .001) were observed in the intervention group. There was no difference in hospital admissions (0.00 admissions per 1,000 RD; 95% CI, −0.4 to 0.3;P= .76), and the mortality rate decreased by 0.2 per 1,000 RD in the intervention group (95% CI, −0.5 to −0.1;P= .002). Chart reviews indicated that UTI symptoms were charted in 16% of cases and that urine culture testing occurred in 64.5% of cases.Conclusion:A multimodal antimicrobial stewardship intervention in rural nursing homes significantly decreased the rate of urine culture testing and antimicrobial prescriptions for UTI, with no increase in hospital admissions or mortality.

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