Dementia in Nursing Homes
von: Sandra Schüssler, Christa Lohrmann
Springer-Verlag, 2017
ISBN: 9783319498324
Sprache: Englisch
244 Seiten, Download: 3523 KB
Format: PDF, auch als Online-Lesen
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 |