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Management of challenging behaviour in dementia

Michael J Annear
OBJECTIVES: Best-evidence dementia knowledge has the potential to improve care practices in aged care settings, although limited research has explored understanding among the Japanese workforce. This study examines the knowledge of dementia and educational needs among aged care professionals across Japan. METHODS: An online survey methodology was used to assess the dementia experiences and knowledge among a national, random sample of 117 Japanese aged care professionals...
March 14, 2018: Australasian Journal on Ageing
John Grundy, Kon Mouzakis, Rajesh Vasa, Andrew Cain, Maheswaree Curumsing, Mohamed Abdelrazek, Niroshine Fernando
By the 2050, it is estimated that the proportion of people over the age of 80 will have risen from 3.9% to 9.1% of population of Organisation for Economic Cooperation and Development countries. A large proportion of these people will need significant help to manage various chronic illnesses, including dementia, heart disease, diabetes, limited physical movement and many others. Current approaches typically focus on acute episodes of illness and are not well designed to provide adequately for daily living care support...
2018: Studies in Health Technology and Informatics
J Kim, A De Bellis, L Xiao
PURPOSE: The South Korean government introduced the universal Long-Term Care Insurance (LTCI) program in 2008 that created a new employment category of 'paid family care worker' to assist the elderly with chronic illnesses including dementia. The aim of this study was to understand the lived experience of paid family care workers of people with dementia in South Korea. METHODS: The study was a qualitative research design underpinned by Interpretive Description principles involving eight paid family care workers...
February 5, 2018: Asian Nursing Research
Olga Solomon, Mary C Lawlor
Research on autism spectrum disorder (ASD) and on Alzheimer's Disease (AD) and other types of dementia describes a behaviour called 'wandering', a term that denotes movement through space lacking intention or exact destination, as when a person is disoriented or not self-aware. In the U.S., 'wandering' in both ASD and AD has been examined mostly from a management and prevention perspective. It prioritizes safety while primarily overlooking personal experiences of those who 'wander' and their families, thus limiting the range of potentially effective strategies to address this issue...
January 24, 2018: Culture, Medicine and Psychiatry
Aisling A Jennings, Tony Foley, Sheena McHugh, John P Browne, Colin P Bradley
Background: general practitioners (GPs) have identified the management of behavioural and psychological symptoms of dementia (BPSD) as a particularly challenging aspect of dementia care. However, there is a paucity of research on why GPs find BPSD challenging and how this influences the care they offer to their patients with dementia. Objectives: to establish the challenges GPs experience when managing BPSD; to explore how these challenges influence GPs' management decisions; and to identify strategies for overcoming these challenges...
March 1, 2018: Age and Ageing
Charlotte Griffioen, Bettina S Husebo, Elisabeth Flo, Monique A A Caljouw, Wilco P Achterberg
Background: Although proper pain treatment may require opioids, discussion continues about possible undertreatment or overtreatment in persons with advanced dementia. Objective: To investigate the prevalence of pain, frequency of opioid prescription use, and factors associated with strong opioid prescription use in nursing homes. Design: Cross-sectional study. Setting and Subjects: Eighteen Norwegian nursing homes; 327 persons with advanced dementia and behavioral disturbances participated...
November 9, 2017: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
C Clifford, O Doody
WHAT IS KNOWN ON THE SUBJECT?: Caring for people with dementia and responsive behaviours is challenging; however, little is known of nurses' experiences of responsive behaviours. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: To demonstrate understanding nurses need to be aware of their own actions, thoughts, attitudes and reactions. Time, education and management support are essential in enabling a person-centred approach. A decision regarding the place of care is difficult to come to, and given the drive to a person-centred approach, there is a need to consider the views of people with dementia...
October 5, 2017: Journal of Psychiatric and Mental Health Nursing
Agnieszka Bratek, Krzysztof Krysta, Krzysztof Kucia
BACKGROUND: The population of older adults with intellectual disability (ID) is large and growing due to a significant increase of life expectancy caused by improvements in health and social care. Multimorbidity is highly prevalent in this population and co-morbid psychiatric disorders are especially frequent. SUBJECT AND METHODS: The aim of this article is to review the prevalence and consequences of psychiatric comorbidity in the population of older adults with ID...
September 2017: Psychiatria Danubina
C M P M Hertogh, J Klijnman, J F Bastiaans
Behavioural changes, often resulting in negative or challenging behaviour, are highly prevalent in patients with dementia. Here we describe two patients in whom challenging behaviour was the first sign of an evolving dementia process. We discuss the relevance of a multifactorial approach in analysis and treatment, starting from a biopsychosocial model of behaviour in dementia. One pitfall is underestimating the contribution of physical co-morbidity to challenging behaviour in these patients; a further pitfall is the 'attribution phenomenon', i...
2017: Nederlands Tijdschrift Voor Geneeskunde
Kirsi M Kinnunen, Anastasia Vikhanova, Gill Livingston
PURPOSE OF REVIEW: Sleep disorders in dementia cause distress and may lead to families being unable to care for someone with dementia at home. Recent Cochrane reviews found no interventions of proven effectiveness. There was no effect of light therapy and moderate evidence that melatonin was ineffective both given without knowledge of the patient's circadian rhythm. The current article updates this review by considering newer publications on interventions for sleep disorders or abnormalities of the sleep-wake cycle in people with dementia living in the community...
November 2017: Current Opinion in Psychiatry
Miharu Nakanishi, Kaori Endo, Kayo Hirooka, Eva Granvik, Lennart Minthon, Katarina Nägga, Atsushi Nishida
Little is known about the effectiveness of a psychosocial behaviour management programme on home-dwelling people with dementia. We developed a Behaviour Analytics & Support Enhancement (BASE) programme for care managers and professional caregivers of home care services in Japan. We investigated the effects of BASE on challenging behaviour of home-dwelling people with dementia. METHODS: A cluster-randomized controlled trial was conducted with home care providers from 3 different districts in Tokyo...
August 31, 2017: International Journal of Geriatric Psychiatry
Margareta Halek, Daniela Holle, Sabine Bartholomeyczik
BACKGROUND: One of the most difficult issues for care staff is the manifestation of challenging behaviour among residents with dementia. The first step in managing this type of behaviour is analysing its triggers. A structured assessment instrument can facilitate this process and may improve carers' management of the situation. This paper describes the development of an instrument designed for this purpose and an evaluation of its content validity and its feasibility and practicability in nursing homes...
August 14, 2017: BMC Health Services Research
Claire Goodman, Christine Norton, Marina Buswell, Bridget Russell, Danielle Harari, Rowan Harwood, Brenda Roe, Jo Rycroft-Malone, Vari M Drennan, Mandy Fader, Michelle Maden, Karen Cummings, Frances Bunn
BACKGROUND: Eighty per cent of care home residents in the UK are living with dementia. The prevalence of faecal incontinence (FI) in care homes is estimated to range from 30% to 50%. There is limited evidence of what is effective in the reduction and management of FI in care homes. OBJECTIVE: To provide a theory-driven explanation of the effectiveness of programmes that aim to improve FI in people with advanced dementia in care homes. DESIGN: A realist synthesis...
August 2017: Health Technology Assessment: HTA
Barbara K Sharp
Health and social care research on stress in dementia has predominantly considered the stress experienced by family and professional carers. Focus on the person with dementia has frequently laid emphasis on the impact of stress-related behaviour on others and how such behaviour might be 'managed'. This paper describes a qualitative study which gives voice to people with dementia on the subject of stress and responds to the need for a better understanding of stress as it is experienced by people with dementia themselves...
January 1, 2017: Dementia
Matteo Bauckneht, Dario Arnaldi, Flavio Nobili, Dag Aarsland, Silvia Morbelli
The term Lewy body diseases (LBDs) refers to a subset of neurodegenerative disorders that share the accumulation of the so-called Lewy bodies (LB) including: Parkinson's disease (PD), dementia with Lewy bodies (DLB), and PD later characterized by the occurrence of dementia (PDD). Moreover, multiple system atrophy (MSA) and idiopatic Rem Sleeping behaviour disorders (RBD) complete the group of synucleinopathies and have also common symptoms with respect to LBDs. The clinical diagnosis of LBDs can be challenging for physicians, particularly in the early stages of disease...
June 8, 2017: Current Medicinal Chemistry
Miharu Nakanishi, Kaori Endo, Kayo Hirooka, Taeko Nakashima, Yuko Morimoto, Eva Granvik, Lennart Minthon, Katarina Nägga, Atsushi Nishida
OBJECTIVES: Care managers and professional caregivers of home care services are sometimes unaware of the psychosocial approaches to the challenging behaviour of dementia. Therefore, we developed a Behaviour Analytics & Support Enhancement (BASE) programme. We investigated the effects of the programme on the attitudes towards dementia care among professionals. METHOD: Forty-six participants in Japan received training in August 2016. The ongoing monitoring and assessment system was introduced to the participants for repeated measures of challenging behaviour...
May 29, 2017: Aging & Mental Health
Tony Foley, Siobhán Boyle, Aisling Jennings, W Henry Smithson
BACKGROUND: Rising dementia prevalence rates rise combined with the policy objective of enabling people with dementia to remain living at home, means that there will be a growing demand for dementia care in the community setting. However, GPs are challenged by dementia care and have identified it as an area in which further training is needed. Previous studies of GPs dementia care educational needs have explored the views of GPs alone, without taking the perspectives of people with dementia and family carers into account...
May 22, 2017: BMC Family Practice
José M Aravena, Cecilia Albala, Laura N Gitlin
OBJECTIVE: Few instruments evaluate family caregiver perceptions of challenges caring for persons with dementia and improvement or worsening in these areas. To address this measurement gap, we examine psychometric properties of a Spanish version of the 13-item Perceived Change Index (PCI-S), originally validated with English-speaking caregivers. METHODS: Cross-sectional study with 94 caregivers of persons with mild to moderate dementia in Chile. Interviews included caregiver demographics, burden, health perception, distress with behaviours, dementia severity, behavioural symptoms and functionality...
May 16, 2017: International Journal of Geriatric Psychiatry
Maj Britt D Nielsen, Susie Kjær, Per T Aldrich, Ida E H Madsen, Maria K Friborg, Reiner Rugulies, Anna P Folker
BACKGROUND: Care workers are often exposed to sexual harassment from patients. Research shows that such exposure may have detrimental effects on mental health of the care workers. Inappropriate sexual behaviour from patients is a particular challenge for formal and informal care workers alike. There is a scarceness of studies investigating the experience and the handling of sexual harassment from patients. OBJECTIVES: To investigate the experience and handling of sexual harassment from patients in care work...
February 24, 2017: International Journal of Nursing Studies
Katherine Brittain, Cathrine Degnen, Grant Gibson, Claire Dickinson, Louise Robinson
Dementia is linked to behavioural changes that are perceived as challenging to care practices. One such behavioural change is 'wandering', something that is often deeply feared by carers and by people with dementia themselves. Understanding how behavioural changes like wandering are experienced as problematic is critically important in current discussions about the behavioural and psychological symptoms of dementia. In this article we draw on our secondary analysis of qualitative interviews and focus groups with carers of people with dementia to critically question 'when does walking become wandering'? Drawing on theoretical perspectives from anthropology, sociology and human geography to explore experiences of carers and of people with dementia, we argue that a conceptual shift occurs in how pedestrian activity, usually represented as something purposeful, meaningful and healthy (walking) is seen as something threatening that needs managing (wandering)...
February 2017: Sociology of Health & Illness
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