Dementia in Nursing Homes

von: Sandra Schüssler, Christa Lohrmann

Springer-Verlag, 2017

ISBN: 9783319498324

Sprache: Englisch

244 Seiten, Download: 3523 KB

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Dementia in Nursing Homes

	Contents	5
	1: Introduction	7
	References	10
	2: Meaningful Activities	11
	2.1 Introduction	12
	2.2 Impact of Inactivity	12
	2.3 Life in a Care Home	13
	2.4 What Makes Activity Meaningful?	15
	2.5 Providing Meaningful Activity	15
	2.5.1 The Individual’s Life Story	17
	2.5.2 Measuring Capacity for Activity: The Pool Activity Level (PAL) Instrument	17
	2.6 Impact of the Environment on Activity Provision	18
	2.6.1 Physical Environment	18
	2.6.2 Social and Organisational Environment	19
	2.7 Successful Activity Provision	20
	2.7.1 Reducing Challenging Behaviour	20
	2.8 Interventions	21
	References	23
	3: Patient-/Person-Centered Care	27
	3.1 Introduction	27
	3.2 Background	28
	3.3 Implementation	29
	3.4 PCC Models/Frameworks	29
	3.5 Current Research Evidence About PCC	30
	3.5.1 Effects of PCC on Persons with Dementia	30
	3.5.2 Effects of PCC on Formal/Professional Caregivers of Persons with Dementia	31
	3.5.3 Effects of the Physical Environment on the Provision of PCC	31
	3.6 Conclusion	32
	3.7 Resources	32
	References	32
	4: Psychosocial Interventions	34
	4.1 Section A: Coping with Dementia – Integrated Emotion-Oriented Care for Nursing Home Residents	35
	4.1.1 The Adaptation-Coping Model	35
	4.1.2 Integrated Emotion-Oriented Care	37
	4.1.2.1 Phases of Ego-Experience and Perceptions	38
	4.1.2.2 Care Needs and Care Objectives	39
	4.1.2.3 Methods in the Different Phases of Dementia and Phases of Ego-Experience	39
	4.1.2.4 Care in the Phase of Threatened Ego-Experience	40
	4.1.2.5 Care in the Phase of Wandering Ego-Experience	41
	4.1.2.6 Care in the Phase of Hidden Ego-Experience	42
	4.1.2.7 Care in the Phase of Sunken Ego-Experience	43
	4.1.3 How Integrated Emotion-Oriented Care Can Influence Adaptation	43
	4.1.3.1 Integrated Emotion-Oriented Care and Cognitive Adaptation	43
	Coping with the Own Invalidity	43
	Developing an Adequate Care Relationship with the Staff	44
	4.1.3.2 Integrated Emotion-Oriented Care and Emotional Adaptation	46
	Maintaining an Emotional Balance	46
	Maintaining a Positive Self-Image	46
	Preparing for an Uncertain Future	48
	4.1.3.3 Integrated Emotion-Oriented Care and Social Adaptation	49
	Coping with the Nursing Home Environment	49
	Developing and Maintaining Social Relationships	50
	4.1.4 Finally	51
	4.2 Section B: Implementing Psychosocial Interventions	52
	4.2.1 Introduction	52
	4.2.2 Building Trust	52
	4.2.3 Enhancing Integrity Through Reminisces and Self-Reflection	53
	4.2.4 Multigenerational Programs	54
	4.2.5 Summary	55
	References	55
	Section A: Coping with Dementia: Integrated Emotion-Oriented Care for Nursing Home Residents	55
	Section B: Implementing Psychosocial Interventions	57
	5: Challenging Behavior in Nursing Home Residents with Dementia	59
	5.1 Introduction	60
	5.2 Getting Grips on Challenging Behavior	60
	5.2.1 Definition	60
	5.2.2 Detection	61
	5.2.3 Analysis	61
	5.2.3.1 Unmet Needs	62
	5.2.3.2 Progressively Lowered Stress Threshold	62
	5.2.3.3 Model of Functional Analysis	63
	5.2.3.4 Combining Several Views: The Biopsychosocial Model	64
	Biological Factors	64
	Psychological Factors	64
	Social Factors	64
	5.3 Treatment	64
	5.3.1 Treatment of Physical Factors	65
	5.3.2 Functional Analysis-Based Interventions	65
	5.3.3 Music Therapy	66
	5.3.4 Training Staff	66
	5.3.5 Sensory Interventions	66
	5.3.6 Pharmacological Interventions for Challenging Behavior	66
	5.3.6.1 Symptoms of Psychosis (Hallucinations/Delusions)	67
	5.3.6.2 Depression or Depressive Symptoms	67
	5.3.6.3 Anxiety or Anxiety Symptoms	68
	5.4 Evaluation	68
	5.5 Requirements to Get Grips on Challenging Behavior in the NH	68
	References	69
	6: Inclusion and Support of Family Members in Nursing Homes	71
	6.1 Family Involvement in Nursing Homes	71
	6.2 Dilemmas in Care Practice	73
	6.2.1 Attitude and Role Conflict	73
	6.2.2 Communication	74
	6.2.3 Organization	76
	6.3 Good Practice Programs Building Partnerships	76
	References	79
	7: Pain in Dementia	81
	7.1 A Brief Explanation on Pain	81
	7.2 Presence of Pain in Dementia	82
	7.3 Assessing Pain in Dementia	83
	7.3.1 Self-Report of Pain	84
	7.3.2 Behavioral Assessment of Pain	85
	7.4 Management of Pain in Older People	87
	7.5 Future Directions	88
	References	89
	8: Staff Training and Education	92
	8.1 Introduction	92
	8.2 Philosophy, Mission, and Values	93
	8.3 Long-Term Care Facilities and Resources	94
	8.4 Models of Care	96
	8.5 Staff Educational Needs Assessment	97
	8.6 Coordination of Training for Dementia Care	98
	8.7 Dementia-Specific Competencies	98
	8.8 Formal Training	101
	8.9 Ongoing Inservice	102
	8.10 Self-Instruction Modules	103
	8.11 Resources	104
	References	105
	9: Communication in Dementia	108
	9.1 Communication in Dementia	109
	9.2 Verbal and Non-verbal Communication	109
	9.3 The Consequences of Poor Communication in Dementia	110
	9.4 Possible Barriers to Communication in Dementia	111
	9.4.1 Barriers in the Physical and Sociocultural Environment	111
	9.4.2 Physiological Impact of the Disease on Understanding and Communication	112
	9.4.3 Different Realities: Understanding the Person Affected by Dementia	114
	9.5 The Benefits of Positive Communication	114
	9.5.1 Truth or Lies? The Value of Therapeutic Deception	114
	9.5.2 The Value of Reorientation Strategies	115
	9.6 Positive Communication: Seeking to Meet Underlying Need	116
	9.7 Effective Listening	118
	9.8 Person-Centred Communication	120
	9.8.1 Know the Person	120
	9.8.2 Attentive Patience	120
	9.8.3 Simplify Choices to Enable Control	121
	9.9 Improving Our Practice: The Importance of Reflection	121
	References	123
	10: Polypharmacy in Nursing Home Residents with Dementia	125
	10.1 The Problem of Polypharmacy in Nursing Home Residents with Dementia	126
	10.1.1 Polypharmacy and the Risk of Side Effects	126
	10.1.2 Inappropriate Drug Use in Nursing Home Residents with Dementia	128
	10.2 Prescribing in Dementia Patients: The WHO Six Step	129
	10.3 Performing a Medication Review	132
	10.4 Decision-Making Based on Evidence-Based Medicine	134
	10.5 Screening Tools	135
	10.6 The Problem of Stopping Medication	135
	References	138
	11: Quality of Life of People with Dementia in Nursing Homes	140
	11.1 Introduction	141
	11.2 Models of Quality of Life for People with Dementia in Nursing Homes	142
	11.3 Measuring of Dementia-Specific Quality of Life in Nursing Homes	143
	11.3.1 Different Measurement Perspectives	144
	11.3.2 Quality of Life Measurements for People with Dementia in Nursing Homes	145
	11.3.2.1 AAIQOL (Activity and Affect Indicator Quality of Life)	146
	11.3.2.2 CBS-QoL (Cornell-Brown Scale for Quality of Life in Dementia)	146
	11.3.2.3 DEMQOL and DEMQOL-Proxy (Dementia Quality of Life Questionnaire)	146
	11.3.2.4 H.I.L.DE (Heidelberg Instrument for the Assessment of Quality of Life in Dementia)	147
	11.3.2.5 QoL-AD (Quality of Life in Alzheimer’s Disease)	147
	11.3.2.6 QoL-AD NH (Quality of Life in Alzheimer’s Disease Nursing Home Version)	147
	11.3.2.7 QOLAS (Quality of Life Assessment Schedule)	148
	11.3.2.8 ADRQL (Alzheimer Disease-Related Quality of Life)	148
	11.3.2.9 DCM (Dementia Care Mapping)	148
	11.3.2.10 OQOLD (Observing Quality of Life in Dementia) and OQOLDA (Observed Quality of Life in Dementia Advanced)	148
	11.3.2.11 QoL-D (Quality of Life for Dementia)	149
	11.3.2.12 QUALID (Quality of Life in Late-Stage Dementia Scale)	149
	11.3.2.13 QUALIDEM	149
	11.3.2.14 Vienna List	150
	11.3.2.15 Selection of the Appropriate Measurement	150
	11.4 Factors Associated with Quality of Life of People with Dementia in Nursing Homes	151
	11.4.1 Personal Characteristics Not Related to Dementia	151
	11.4.2 Personal Factors Related to Dementia	151
	11.4.3 Challenging Behavior and Mood	152
	11.4.4 Pain	152
	11.5 Effectiveness of Non-pharmacological Interventions Targeting Quality of Life of People with Dementia in Nursing Homes	153
	11.6 Summary	153
	References	154
	12: End-of-Life Care and Advance Care Planning in Dementia	159
	12.1 Introduction	160
	12.2 What Is End-of-Life Care?	160
	12.3 Prognostication and Timely Recognition of Dying	162
	12.4 Optimal Treatment of Symptoms in People with Dementia	163
	12.4.1 The Consequences of Poor Prognostication in Dementia Care	163
	12.4.2 Polypharmacy and Inappropriate Interventions at the End of Life	164
	12.4.3 The Benefits of Hospice or Specialist Palliative Care Interventions at the End of Life in Dementia	166
	12.5 Continuity of Care	168
	12.5.1 Hospice Versus Residential Home Deaths	169
	12.5.2 Education and Training for Care Home Staff	169
	12.6 Communication, Shared Decision Making and Advance Care Planning	170
	12.6.1 Engaging in Advance Care Planning Discussions	171
	12.6.2 When Is It Best to Initiate Advance Care Planning Discussions?	172
	References	175
	13: Depression in Nursing Home Residents with Dementia	178
	13.1 Introduction	179
	13.2 How to Act in Case of Depression in Dementia?	180
	13.2.1 Element 1: Stepwise Depression Assessment	180
	13.2.2 Element 2: Treatment Strategies	182
	13.2.3 Element 3: Monitoring and Evaluation	183
	13.2.4 Apathy and Depression	184
	13.3 Requirements for Appropriate Treatment of Depression in NH Residents with Dementia	184
	References	186
	14: Delirium	189
	14.1 Introduction	190
	14.2 Categorisation of Delirium	190
	14.3 Distinguishing Delirium from Dementia	191
	14.4 Incidence	192
	14.5 Causes	192
	14.6 Pathophysiology	193
	14.7 Diagnosis	193
	14.8 Outcomes	195
	14.9 Management of DSD	195
	14.9.1 Non-pharmacological Interventions	195
	14.9.2 Pharmacological Interventions	196
	14.9.2.1 Prevention of Delirium	197
	References	198
	15: Dementia Care in Nursing Homes Requires a Multidisciplinary Approach	200
	15.1 Introduction	201
	15.2 The Necessity of Integrated Multidisciplinary Care for Residents with Dementia	201
	15.3 Theoretical Aspects of Multidisciplinary Care	203
	15.3.1 The Process of Collaboration	203
	15.3.2 Collaborative Competences in Daily Practice and Education	204
	15.3.3 Quality of Multidisciplinary Care	205
	15.4 The Dutch Nursing Home as Interesting Example	207
	15.4.1 The Multidisciplinary Care Concept of Dutch Nursing Homes	208
	15.4.2 Employing the Multidisciplinary Team in a Setting in which Learning Is Leading	210
	15.4.3 Future Developments in Dutch Multidisciplinary Nursing Home Care	212
	References	213
	16: The Prevention and Reduction of Physical Restraint Use in Long-Term Care	215
	16.1 Physical Restraints	216
	16.2 Determinants and Consequences of Restraint Use	216
	16.3 Approaches Aiming at the Reduction of Physical Restraints	217
	16.4 EXBELT	218
	16.4.1 Effectiveness of EXBELT	219
	16.4.1.1 Restraint Reduction	219
	16.4.1.2 Restraint Prevention	220
	16.4.1.3 Long-Term Effects	220
	16.4.2 Conclusions: Restraint Reduction and Prevention	220
	16.5 New Challenges: Physical Restraint Use in the Community	221
	References	222
	17: Care Dependency	225
	17.1 Introduction	226
	17.2 Care Dependency: Conceptualization	226
	17.2.1 Introduction	226
	17.2.2 Data Sources	227
	17.2.3 Sociological Perspective	229
	17.3 Care Dependency: Operationalization	229
	17.3.1 Introduction	229
	17.3.2 Frame of Reference	229
	17.3.3 Operationalizing Nursing Concepts	230
	17.3.4 Developing the Theoretical Definition	230
	17.3.5 Specifying Variable Dimensions	232
	17.3.6 Identifying Observable Indicators	235
	17.3.7 Developing Means for Measuring the Indicators	236
	17.4 Care Dependency Scale: Utilization	237
	17.4.1 Introduction	237
	17.4.2 Instruction for Use in Clinical Practice	237
	17.4.3 Clinical Reasoning	238
	17.4.4 Care Dependency and Nursing Care Problems	239
	17.4.5 Practical Application of the CDS	240
	References	241

Dementia in Nursing Homes

von: Sandra Schüssler, Christa Lohrmann

Dementia in Nursing Homes

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