Determining the Impacts of Educational Intervention based on PLST Extended Care on Caregiving Methods and Improved Exposure to Challenging Behaviors of People with Dementia (PWD): A mixed-methods study

BackgroundPsychological events in people with dementia (PWD) lead to behavioral disorders that require targeted planning for caregivers on how to adapt to these behaviors. A progressively lowered stress threshold (PLST) model provides effective interventions for caregivers to adapt to the behaviors of people with dementia (PWD). Therefore, this study aims to determine the impacts of educational intervention based on the progressively lowered stress threshold extended (PLSTE) model on the caregiving of people with dementia (PWD) in Isfahan, Iran.MethodsThis exploratory mixed methods study was initially conducted with a qualitative approach to content analysis type from May 2016 to June 2018. Data were collected in a qualitative stage through in-depth nonstructured interviews with 29 People with Dementia (PWD)'s caregivers using the "new comment" command and then analyzed. The researcher designed a multisectional questionnaire, including demographic characteristics, knowledge measurement, and monitoring the practice of caregivers. The validity of the questionnaire was verified by a panel of experts, and its reliability was confirmed using the Cronbach alpha coefficient (knowledge section 0.838 and practice section 0.802). To adjust the intervention program, the educational content based on the PLSTE model was used for 38 caregivers available at two elderly nursing centers in Isfahan. This educational intervention was designed and managed for the first time in our community. None of the caregivers agreed to refuse to receive the educational content, So the evaluation of the program lacks a randomized controlled group. The data were collected immediately and one month after the educational intervention using a questionnaire.ResultsAccording to the results of the qualitative section of this study, the researcher was able to add a cultural and belief class and then the related intervention method to the PLST model. In the quantitative part, paired t-test indicated that the mean scores of knowledge, caregiving practice, and exposure to Challenging Behaviors (CB) in all dimensions of practice immediately and one a month after intervention were significantly higher than the mean scores before intervention (P < 0.05).ConclusionConsidering the impacts of this intervention, educating caregivers with PLST extended the care model is recommended, with a specific focus on cultural and traditional issues of society, to improve the knowledge and practice of caregivers in caregiving skills and appropriate exposure to challenging behaviors people with dementia (CBPWD).Trial registration No. IRCT20180421039370N1 -2019-01-11-http://www.irct.ir

Determining The Impacts of Educational Intervention Based on PLST Extended Care On Caregiving Methods and Improved Exposure To Challenging Behaviors of People With Dementia (PWD): A Mixed-Methods Study

Background: Psychological events in people with dementia (PWD) lead to behavioral disorders that require targeted planning for caregivers on how to adapt to these behaviors. A progressively lowered stress threshold (PLST) model provides effective interventions for caregivers to adapt to the behaviors of people with dementia (PWD). Therefore, this study aims to determine the impacts of educational intervention based on the progressively lowered stress threshold extended (PLSTE) model on the caregiving of people with dementia (PWD) in Isfahan, Iran.Methods: This exploratory mixed methods study was initially conducted with a qualitative approach to content analysis type from May 2016 to June 2018. Data were collected in a qualitative stage through in-depth nonstructured interviews with 29 People with Dementia (PWD)'s caregivers using the "new comment" command and then analyzed. The researcher designed a multisectional questionnaire, including demographic characteristics, knowledge measurement, and monitoring the practice of caregivers. The validity of the questionnaire was verified by a panel of experts, and its reliability was confirmed using the Cronbach alpha coefficient (knowledge section 0.838 and practice section 0.802). To adjust the intervention program, the educational content based on the PLSTE model was used for 38 caregivers available at two elderly nursing centers in Isfahan. The data were collected immediately and one month after the educational intervention using a questionnaire.Results: According to the results of the qualitative section of this study, the researcher was able to add a cultural and belief class and then the related intervention method to the PLST model. In the quantitative part, paired t-test indicated that the mean scores of knowledge, caregiving practice, and exposure to Challenging Behaviors (CB) in all dimensions of practice immediately and one a month after intervention were significantly higher than the mean scores before intervention (P < 0.05).Conclusion: Considering the impacts of this intervention, educating caregivers with PLST extended the care model is recommended, with a specific focus on cultural and traditional issues of society, to improve the knowledge and practice of caregivers in caregiving skills and appropriate exposure to challenging behaviors people with dementia (CBPWD).Trial registration No. IRCT20180421039370N1 -2019-01-11-http://www.irct.ir

Determining the Impacts of Educational Intervention based on PLST Extended Care model on Caregiving Methods and Improved Exposure to Challenging Behaviors of People with Dementia (PWD): A mixed-methods study

Background: Psychological events in People with Dementia (PWD) lead to behavioral disorders which require targeted planning for caregivers on how to adapt to these behaviors. Progressively lowered stress threshold (PLST) model provides effective interventions for caregivers to adapt to the behaviors of People with Dementia (PWD). Therefore, this study aims to determine the impacts of educational intervention based on the progressively lowered Stress threshold extended (PLSTE) model on the caregiving of People with Dementia (PWD) in Isfahan, Iran. Methods: This exploratory mixed methods study was initially conducted with a qualitative approach to content analysis type from May 2016 to June 2018. Data were collected in a qualitative stage through in-depth non-structured interviews with 29 People with Dementia (PWD)'s caregivers using the "new comment" command in a word and then analyzed. The researcher designed a multi-sectional questionnaire, including demographic characteristics, knowledge measurement, and monitoring the practice of caregivers. The validity of the questionnaire was verified by the panel of experts and its reliability was confirmed using the Cronbach alpha coefficient (knowledge section 0.838 and practice section 0.802). To adjust the intervention program, the educational content based on the PLSTE model was used for 38 caregivers available at two elderly nursing centers in Isfahan. The data were collected immediately and one month after the educational intervention using a questionnaire. Results: According to the results of the qualitative section of this study, the researcher was able to add a cultural and belief class, and then the related Intervention method to the PLST model. In the quantitative part, paired t-test indicated that the mean scores of knowledge, caregiving practice, and exposure to Challenging Behaviors (CB) in all dimensions of practice immediately and one a month after intervention were significantly higher than the mean scores before intervention (P < 0.05).Conclusion: Considering the impacts of this intervention, educating the caregivers with PLST extended the care model is recommended, with a specific focus on cultural and traditional issues of the society, to improve knowledge and practice of caregivers in caregiving skills and appropriate exposure to Challenging Behaviors People with Dementia (CBPWD).

Determining the Impacts of Educational Intervention based on PLST Extended Care model on Caregiving Methods and Improved Exposure to Challenging Behaviors of People with Dementia (PWD): A mixed-methods study

Background: Psychological events in People with Dementia (PWD) lead to behavioral disorders which require targeted planning for caregivers on how to adapt to these behaviors. Progressively lowered stress threshold (PLST) model provides effective interventions for caregivers to adapt to the behaviors of People with Dementia (PWD). Therefore, this study aims to determine the impacts of educational intervention based on the progressively lowered Stress threshold extended (PLSTE) model on the caregiving of People with Dementia (PWD) in Isfahan, Iran. Methods: This exploratory mixed methods study was initially conducted with a qualitative approach to content analysis type from May 2016 to June 2018. Data were collected in a qualitative stage through in-depth non-structured interviews with 29 People with Dementia (PWD)'s caregivers using the "new comment" command in a word and then analyzed. The researcher designed a multi-sectional questionnaire, including demographic characteristics, knowledge measurement, and monitoring the practice of caregivers. The validity of the questionnaire was verified by the panel of experts and its reliability was confirmed using the Cronbach alpha coefficient (knowledge section 0.838 and practice section 0.802). To adjust the intervention program, the educational content based on the PLSTE model was used for 38 caregivers available at two elderly nursing centers in Isfahan. The data were collected immediately and one month after the educational intervention using a questionnaire. Results: According to the results of the qualitative section of this study, the researcher was able to add a cultural and belief class, and then the related Intervention method to the PLST model. In the quantitative part, paired t-test indicated that the mean scores of knowledge, caregiving practice, and exposure to Challenging Behaviors (CB) in all dimensions of practice immediately and one a month after intervention were significantly higher than the mean scores before intervention (P < 0.05).Conclusion: Considering the impacts of this intervention, educating the caregivers with PLST extended the care model is recommended, with a specific focus on cultural and traditional issues of the society, to improve knowledge and practice of caregivers in caregiving skills and appropriate exposure to Challenging Behaviors People with Dementia (CBPWD). Trial registration No. IRCT20180421039370N1 -2019-01-11-http://www.irct.ir

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

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

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

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

The Half Life of Stress: Caregiver Stress Increases Next-Day Severity of Behavioral Symptoms of Dementia

The progressively lowered stress threshold theory posits that behavioral symptoms of dementia (BSD) are reactions to environmental and care related stressors. In line with this theory, this study tests whether the stress experienced the caregiver impacts BSD expression. Caregivers to persons with dementia recruited online completed daily diary surveys for 21 days reporting on daily contextual and environmental factors of caregiving life. Using multi-level modeling of diaries (n=911) nested within participants (N=51), two daily caregiver stressors (conflict with someone other than the person with dementia, stress about own personal health) were examined as predictors of BSD. The outcome of BSD was measured as severity (a rating on a Likert scale of 1-5 that was then person-centered to represent deviations from average severity). Covariates in the model included relationship type, caregiver age, as well as stressors to the care recipient known to increase BSD. On days when a caregiver had a conflict with others the severity of the care recipient’s BSD increased by 1.44 points from average (p&lt;.001, CI 1.05-1.75). In a time-lagged model, we observe that a caregiver having a conflict yesterday impacts today’s BSD severity by an increase of 0.43 points from average (p = 0.027, CI 0.05-0.81). Caregivers’ stress about their own health did not have a significant impact on the same day or next day BSD severity rating. These findings demonstrate that the well-being of the caregiver has measurable immediate impacts on the well-being of the person living with dementia, and suggests not all stress is equal.

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

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

Outcomes of a Two-Component Intervention on Behavioral Symptoms in Persons With Dementia and Symptom Response in Their Caregivers

Purpose: This study evaluated the longitudinal influence of an individualized evidence-based psychoeducational intervention for caregivers on frequency of behavioral symptoms in persons with dementia (PWD) and caregiver reaction to these symptoms. The intervention included information about the disease process using Progressively Lowered Stress Threshold (PLST) content and a family meeting based on Mittelman’s New York University Intervention. Method: A quasi-experimental study design was implemented. The Revised Memory and Behavior Problems Checklist was administered to N = 127 caregiver/care recipient dyads at baseline, 6, 12, and 18 months follow-up. All caregivers were enrolled in the intervention at baseline and followed over 18 months. Linear mixed models were developed to evaluate effects on frequency of behavioral symptoms in PWD and caregiver response. Results: The most frequently occurring behavior was memory problems, although depressive behaviors produced the most negative caregiver responses. Between baseline and 6-month follow-up, there was a significant decrease in frequency of behavioral symptoms. Overall, there was a significant decrease in caregiver’s reaction to behavioral symptoms from baseline to 18-month follow-up.