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Caring for people with dementia in residential aged care: Successes with a composite person-centered care model featuring Montessori-based activities

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Abstract

Person-centered models of dementia care commonly merge aspects of existing models with additional influences from published and unpublished evidence and existing government policy. This study reports on the development and evaluation of one such composite model of person-centered dementia care, the ABLE model. The model was based on building the capacity and ability of residents living with dementia, using environmental changes, staff education and organizational and community engagement. Montessori principles were also used. The evaluation of the model employed mixed methods. Significant behavior changes were evident among residents of the dementia care Unit after the model was introduced, as were reductions in anti-psychotic and sedative medication. Staff reported increased knowledge about meeting the needs of people with dementia, and experienced organizational culture change that supported the ABLE model of care. Families were very satisfied with the changes. Copyright © 2014 Elsevier Inc. All rights reserved.

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... The beneficial effects of the Montessori method, such as increased independence in feeding, higher levels of engagement, improved mood during activities, and enhanced mental health outcomes among residents, have been documented in three systematic reviews (Mahendra et al., 2006;Sheppard et al., 2016;Yan et al., 2023) and two meta-analyses (Sun et al., 2022;Xu et al., 2022). It also yields positive effects on professionals, including an increase in job satisfaction (Booth et al., 2020;Brush et al., 2018;Sterns et al., 2011;Witt-Hoblit et al., 2016) and a decrease in turnover rate (Roberts et al., 2015). Nevertheless, the level of evidence supporting its effectiveness remains insufficient, particularly concerning enhancements in cognitive abilities, quality of life and independence in activities of daily living (Sheppard et al., 2016;Yan et al., 2023). ...
... Among works focused on Montessori-based activity programs, implementation varies in terms of content, number of sessions, and personnel responsible for residents (Hitzig & Sheppard, 2017). Three studies propose interventions centered around a comprehensive, global reorganization of care facilities grounded in a person-centered approach based on Montessori principles (Brush et al., 2018;Roberts et al., 2015;Witt-Hoblit et al., 2016). These interventions differ significantly from Montessori activity programs. ...
... A qualitative study conducted in the United Kingdom involving eight professionals working in nursing homes also yields results that are broadly akin to our own findings (Raghuraman & Tischler, 2021). Similarly, the intervention aligns with studies implementing comprehensive Montessoribased care restructuring (Brush et al., 2018;Roberts et al., 2015;Witt-Hoblit et al., 2016). For instance, our results highlight the Montessori method as a holistic, continuous approach involving professionals, residents, and families. ...
Article
The Montessori method applied in nursing homes is a person-centered approach targeting the enhancement of autonomy, well-being, and quality of life for older adults with dementia. Despite its potential in the aging field, its operationalization remains unclear in the context of institutionalization. This study aims to outline the method’s components and adoption factors using a behavior change intervention framework among professionals from a French institution demonstrating a high level of method application. We employed a qualitative descriptive approach based on thematic analysis. Nine professionals from the same institution underwent a semi-structured individual interview within the facility. The findings were modeled using the Behavior Change Intervention Ontology. We obtained a final framework defining the intervention, mechanisms of action, exposure, contextual factors, and behavioral outcomes. The method is based on values, principles, and techniques such as facilitation, choice, meaningful activities, environmental adjustments, and specific tools. Applied continuously to residents, families, and professionals, its implementation is influenced by several contextual factors leading to practice changes at various levels. This study constitutes both a theoretical and practical contribution, providing a better definition of the method and the key factors influencing its appropriation.
... Concernant les aidants professionnels tout d'abord, certaines études ont mis en évidence une amélioration de la satisfaction au travail de professionnels mettant en oeuvre des activités Montessori, tant en institution [13,33,34,45,46], qu'à domicile [21,22]. Dans une autre étude, si la satisfaction au travail n'a pas été spécifiquement mesurée, la mise en place de la méthode Montessori s'est traduite par une réduction significative du turn-over des professionnels [47]. ...
... Des impacts positifs au niveau des aidants familiaux et des proches ont également été soulignés, que soit lors d'interactions avec leur proche ayant des troubles cognitifs après formation, ou lors de la mise en oeuvre en globale de la méthode Montessori au sein d'une institution [23,24,34,46]. ...
... En 2015, Roberts et collaborateurs présentent leur modèle d'accompagnement centré sur les personnes basé sur les principes Montessori et appliqués à l'échelle d'une unité de 14 personnes présentant des troubles cognitifs en Australie [46]. L'accompagnement avait pour objectif clairement énoncé de permettre aux résidents d'être aussi indépendants que possible, de contribuer au quotidien et d'avoir une place au sein de leur communauté. ...
Article
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During the last ten years, the Montessori method has become a popular approach for the care of older adults living with dementia, with a growing number of institutions claiming its use. In this context, this narrative review aims at summarizing the research on its effects, benefits, and potential limits. Since the end of the 90s, a growing number of researchers across the world have investigated the Montessori method applied to dementia. Most of those studied the effects of Montessori activities. A few putted their focus on Montessori as a global, person-centered model of care. In general, research shows significant positive effects of Montessori on engagement, behaviors, affects, and functional abilities, as, for example, eating abilities. Benefits for caregivers have also been demonstrated. However, an important part of this research suffers from methodological weaknesses. In the future, other research is necessary to better understand the effects and best application conditions of Montessori method, especially in French speaking countries. Qualitative studies also seem to be a promising path to better understand where this new model of care can best lead those who apply it.
... The characteristics of the 15 included studies are presented in Table 1. Five (n = 5, 33.3%) were conducted in Taiwan (Kao et al., 2016;Lin et al., 2010Lin et al., , 2011Wu and Lin, 2013;Wu et al., 2014), four (n = 4, 26.7%) in the United States (Gaspar & Westberg, 2020;Skrajner et al., 2012Skrajner et al., , 2014Wilks et al., 2019); two (n = 2, 13.3%) in China (Chan et al., 2021;Yuen and Kwok, 2019), two (n = 2, 13.3%) in Australia (Mbakile-Mahlanza et al., 2020;Roberts et al., 2015), one (n = 1, 6.7%) in Figure 1. Ã Consider, if feasible to do so, reporting the number of records identified from each database or register searched (rather than the total number across all databases/registers). ÃÃ If automation tools were used, indicate how many records were excluded by a human and how many were excluded by automation tools Feeding difficulty (EdFED): M group showed significant reduction of feeding difficulty score post-test (MD = À1.57 ...
... Table 2 summaries the interventions in the included studies. Of the 15 studies, eight programmes (n = 8, 53.3%) employed the individual format of intervention (Giroux et al., 2010;Kao et al., 2016;Lin et al., 2010Lin et al., , 2011Mbakile-Mahlanza et al., 2020;Roberts et al., 2015;Wu and Lin, 2013;Wu et al., 2014). Of the four (n = 4, 26.7%) studies adopting a group format (Chaudhry et al., 2020;Skrajner et al., 2012Skrajner et al., , 2014Yuen and Kwok, 2019), three (n = 3, 20%) were in a mixed format of intervention (Chan et al., 2021;Gaspar and Westberg, 2020;Wilks et al., 2019). ...
... • activities were integrated with daily life activities and ranged from 8 months to 18 months (Gaspar and Westberg, 2020;Roberts et al., 2015;Wilks et al., 2019). Only one programme examined the instant effect of the Montessori-based programme using a once only activity (Giroux et al., 2010). ...
Article
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Objectives This systematic review examined the effectiveness of Montessori-based programmes for individuals with dementia living in residential aged care. Methods Nine databases were searched between January 2010 to October 2021, including Scopus, CINAHL, MEDLINE, Web of Science, SocINDEX with Full Text, PubMed, PsycINFO, Cochrane library and Cochrane Registry. Publications were included if they used Montessori-based programmes as interventions for individuals with dementia living in residential aged care and were qualitative, quantitative, mixed-method, or pilot studies. The quality of eligible studies was assessed using Joanna Briggs Institute critical appraisal instruments and the Mixed Method Critical Appraisal Tool. The findings were tabulated and narratively synthesised. Results Fifteen studies were included in this review. The quality scores of the 15 studies ranged from 62 to 100 out of 100. Four key categories of outcomes were observed: (1) significantly improved engagement; (2) significantly improved mental health outcomes, including affect, depression, agitation, excessive eating and psychotropic medication prescriptions; (3) significantly improved feeding difficulty but mixed results regarding nutritional status; and (4) no significant changes in the activities of daily living and quality of life of individuals with dementia. Conclusion Cognitive capacity, personal preferences, individual care needs and the design of Montessori-based activities are pivotal to tailoring personalised Montessori-based activities for individuals with dementia in residential aged care and to maximise intervention outcomes. The synergistic effect of integrating Spaced Retrieval with Montessori-based activities in improving the eating ability and nutritional status of individuals with dementia was also noticed. The study summarised evidence about the effectiveness of Montessori-based programmes for individuals with dementia and informed healthcare professionals about how to implement individualised Montessori-based programmes.
... Ten studies were rated as low quality and subsequently excluded. Roberts et al. (Roberts et al., 2015) was graded as low quality, but as stated in the MMAT user-guide, lowquality mixed-methods studies should be not excluded from a review. As a result, this study was still included in this review. ...
... There were 23 validated frameworks, models of care, or programs used to deliver person-centred care across the included studies (Ballard et al., 2018;Ballard et al., 2016;Berendonk et al., 2019;Boersma et al., 2017;Booth et al., 2020;Chenoweth et al., 2015;Chenoweth et al., 2009;Ducak et al., 2018;Froggatt et al., 2020;Gillis et al., 2019;Goodall et al., 2021;Goossens et al., 2020;Halek et al., 2013;Jeon et al., 2012;Kontos et al., 2016;Kontos et al., 2010;Passalacqua & Harwood, 2012;Quasdorf et al., 2017;Resnick et al., 2021;Roberts et al., 2015;Thoft et al., 2021;van der Ploeg et al., 2013;van Weert et al., 2006;Williams et al., 2013;Williams et al., 2018;Yasuda & Sakakibara, 2017). Dementia Care Mapping was the most frequently adopted method, found across five studies (Chenoweth et al., 2009;Jeon et al., 2012; A c c e p t e d M a n u s c r i p t 2017; Rokstad et al., 2013;Yasuda & Sakakibara, 2017). ...
... Dementia Care Mapping was the most frequently adopted method, found across five studies (Chenoweth et al., 2009;Jeon et al., 2012; A c c e p t e d M a n u s c r i p t 2017; Rokstad et al., 2013;Yasuda & Sakakibara, 2017). The Montessori for Dementia and Ageing model of care was the next most frequently adopted model, employed across four studies (Booth et al., 2020;Ducak et al., 2018;Roberts et al., 2015;van der Ploeg et al., 2013). ...
Article
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Background and objectives: Person-centred care is the gold standard of care for people living with dementia, yet few systematic reviews have detailed how it is delivered in practice. This mixed-methods review aimed to examine the delivery of person-centred care, and its effectiveness, for people living with dementia in residential aged care. Research design and methods: A systematic review and meta-analysis. Eligible studies were identified across four databases. Quantitative and qualitative studies containing data on person-centred care delivered to people with dementia living in residential aged care were included. Meta-analysis using a random effects model was conducted where more than three studies measured the same outcome. A narrative meta-synthesis approach was undertaken to categorise verbatim participant quotes into representative themes. Risk of bias was undertaken using quality appraisal tools from the Joanna Briggs Institute. Results: Forty-one studies were identified for inclusion. There were 34 person-centred care initiatives delivered, targeting 14 person-centred care outcomes. Three outcomes could be pooled. Meta-analyses demonstrated no reduction in agitation (standardised mean difference -0.27, 95% CI -0.58, 0.03), improvement in quality of life (standardised mean difference -0.63, 95% CI -1.95, 0.70), or reduced neuropsychiatric symptoms (mean difference -1.06, 95% CI -2.16, 0.05). Narrative meta-synthesis revealed barriers (for example, time constraints) and enablers (for example, staff collaboration) to providing person-centred care from a staff perspective. Discussion and implications: The effectiveness of person-centred care initiatives delivered to people with dementia in residential aged care is conflicting. Further high-quality research over an extended time is required to identify how person-centred care can be best implemented to improve resident outcomes.
... In one study, both nurses and residents reported increased satisfaction in their relationship after the continuing education intervention and residents reported a closer relationship with nurses [57]. Nurses reported increased knowledge about meeting the needs of people with dementia and organizational culture change experiences and next of kin were also satisfied with these changes and quality of care [69]. Also, positive effects on care providers' mood, burden [67] and residents' behaviour were reported [63]. ...
... In this review, after the continuing education, nurses: increased the number of positive interactions with residents [38], improved person-centered care delivery [42], communication [44], and satisfaction in relationship with older people [46,57], and increased their knowledge about meeting the needs of people with dementia [69]. Other improvements delivered by the outcomes of the reviewed studies were: a reduction in the use of medicines [36,73]; improved behavioral symptoms [38,56,62,69,71] and relationships with nurses [57,64,72,74] improved the quality of life for the older people [48,67,75]; and increased the number of support for daily activities [66,70]. ...
... In this review, after the continuing education, nurses: increased the number of positive interactions with residents [38], improved person-centered care delivery [42], communication [44], and satisfaction in relationship with older people [46,57], and increased their knowledge about meeting the needs of people with dementia [69]. Other improvements delivered by the outcomes of the reviewed studies were: a reduction in the use of medicines [36,73]; improved behavioral symptoms [38,56,62,69,71] and relationships with nurses [57,64,72,74] improved the quality of life for the older people [48,67,75]; and increased the number of support for daily activities [66,70]. These results demonstrate the usefulness of research of continuing education interventions, especially when these changes have been brought about in work practice: reduce nurses burnout [46,47,65] have positive effects on nurses mood and burden [67]; and influence organizational culture, changing nurses experiences for the better [48,69]. ...
Article
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Background Person-Centered Care is often seen as an indicator of quality of care. However, it is not known whether and to what extent person-centered care can be enhanced by continuing education interventions in older people’s long-term care settings. This systematic review aimed to analyze and synthesize the existing research literature about person-centered care-based continuing educational interventions for nurses working in long-term care settings for older people. Methods Five databases were searched 6/2019 and updated 7/2020; PubMed (Medline), CINAHL, PsycINFO, Cochrane and Eric using the keywords person-centered car* OR person-centred car * OR patient-centered car* OR client-centered car* OR tailored car* OR resident-centered car* OR individualized car* AND older* OR elder* OR old person* AND Long-Term Care OR Nursing home OR 24-h treatment OR long-term treatment. Twenty-seven full texts from 2587 initially retrieved citations were included. Results The continuing educational interventions found were divided into five themes: person-centered interventions focusing on medication; interaction and caring culture; nurses’ job satisfaction; nursing activities; and older people’s quality of life. The perspective of older people and their next of kin about the influence of continuing education interventions were largely absent. The background theories about interventions, the measurements taken, and the clarity around the building blocks of the continuing-care interventions need further empirical verification. The pedagogical methods used were mainly quite behavioristic mostly lectures and seminars. Conclusion Most of person-centered care continuing education interventions are effective. Still more empirical research-based continuing education interventions are needed that include learner-centered pedagogical methods, with measurable outcomes that consider the opinions of older people and their next of kin. Continuing educational interventions for nurses need to be further developed to strengthen nurse’s competence in person-centered care, job satisfaction and for better quality of care.
... The importance of environmental modifications that promote orientation and decrease negative stimulation can influence older people with dementia to move around without feeling confined or being restrained [14]. This supports the persons in everyday life and enables them to live with meaning and purpose [32], which is also reflected in the health-related quality of life of family members and caregivers [33]. The person-centred nursing framework comprises four constructs -prerequisites, which focus on the attributes of the nurse; the care environment, which focuses on the context in which care is delivered; person-centred processes, which focus on delivering care through a range of activities; and expected outcomes, which are the results of effective personcentred nursing. ...
... With this philosophy, elders may continue to care for themselves with as much independence as possible in order to maintain self-respect and dignity [34]. Two models developed in Australia, the ABLE model developed an Australian geriatric health service and outlined the four core areas of the model are (A) abilities and capabilities of the resident; (B) background of the resident; (L) leadership, cultural change, and education; and (E) physical environment changes [33]. ...
... Principles of the PLST model are used to equip caregivers with the knowledge and skills to recognize the subtle behavioural changes indicative of heightened anxiety in an effort to provide timely and appropriate intervention [20]. The HELP program highlights the importance of educated and adequately supervised volunteers [37], and models based on Montessori activities emphasize the active role and involvement of family members in daily care and education [8,28,33]. Regardless of which model of care is used, it is especially important to engage family members as soon as cognitive impairment is suspected. To improve the level of dementia care also a number of system changes at an organizational level is required, which includes staff education, environmental changes and a new philosophy of care that identified, emphasized and built upon the current abilities of people with dementia [8,33]. ...
Article
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Aim. The study highlights the different concepts of dementia care models which are used in different care settings and determine the effectiveness and contribute to a better quality of life for people with dementia. Methods. This literature review use PRISMA process for data collection and analysis. Scientific and professional publications in English were searched through international specialized databases; EBSCO HOST, CINAHL, MEDLINE, PubMed and Wiley Online Library. The review results were founded by key words and then selected according to the publication time frame and other shaped criteria. Results. In total 1998 references were identified for the thematic content analysis, in the final review we included 29 studies. Two thematic areas were identified according to the keywords and literature search strategy: dementia care models and geriatric models of care. Further, we formed four concepts highlighted in models that reflect the specific characteristics and principles of care: biopsychosocial approach, person-centred care practice, environment of care, and Montessori for dementia care. Conclusions. Most of featured models advocated the implementation of comprehensive, integrated and person-centred care, focused to honour and integrate an individual’s life story with their needs into daily care as much as possible in an appropriate and customized environment. Currently the most innovative model is based on implementation of Montessori approach into person’s daily activities.
... Roberts G, Morley C, Walters W, Malta S, Doyle C. 2015 (16) . ...
... Apenas quando escolhidas com base nas preferências individuais, as atividades terão efeito positivo e promoverão o bem-estar do idoso. A equipe de enfermagem deve ainda estabelecer expectativas realísticas quanto às possíveis ações a serem realizadas, pautadas nas habilidades remanescentes do idoso e na sua capacidade de interação e comunicação (10,(12)(13)16,19,22,39) . ...
... Esse investimento na formação dos profissionais envolvidos no cuidado possibilita que as mudanças ocorram. O treinamento da equipe deve ocorrer continuamente e incluir todos os profissionais que trabalham em ILPIs (12,14,(16)(17)32,51) . ...
Article
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Objective: To ascertain the characteristics of the nursing care provided to institutionalized elderly people with dementia. Methods: Integrative review of studies published between 2013 and 2017, in English, Spanish, and Portuguese, from the databases BDENF, LILACS, CINAHL, PubMed, SciELO, TRIP, and National Guideline Clearing House. Thematic data analysis was used. Results: From the data collected in the 41 included studies, three themes emerged: Care with a focus on the needs of elderly people in LTCIEs; Care based on the work process of the nursing team; and Shared care. Final considerations: Elderly care can take place from different perspectives: that of the elderly; the nursing team; and it can be shared among the different parties involved. The importance of communication must be stressed, as do the development of skills and attitudes of the team, as well as proper training and support, good environment in the care process, and an approach centered on the institutionalized elderly.
... Nevertheless, they have been tested numerous intervention strategies based on the principles of the PCC, among which are the use of biographical information [5], sessions of reminiscence and the approach of meaningful activities from the perspective of resident [6], customizing environments [6] or the resident inclusion in the decision on its activities [7]. In residents with advanced dementia, the implementation of PCC interventions able to reduce some behavioral symptoms of dementia, such as agitation or aggression, and reduces the use of neuroleptics [8]. However, studies about its effects on quality of life are much less frequent and more questionable results [8]. ...
... In residents with advanced dementia, the implementation of PCC interventions able to reduce some behavioral symptoms of dementia, such as agitation or aggression, and reduces the use of neuroleptics [8]. However, studies about its effects on quality of life are much less frequent and more questionable results [8]. In this sense, encouraging participation is one of the foundations of the PCC, a more direct way to involve the person in decisions concerning them is invite him/her to participate in the individualized care plan (ICP). ...
... Include the person with dementia in this meeting not only supposed involve him in decisions that concern them, but also make professionals more aware of who bears the decisions taken, which can increase locality of care provided. Although this participation of the resident in his care plan has been highlighted as a good gerontological practice [8], so far rarely been implemented and there are few studies to empirically assess the potential impact on quality of life of patients with dementia in Spain [9,10]. That justifies the necessary studies to assess the impact of this model and the participation of users with dementia in their own care plan. ...
... The three other studies pertaining to staffdirected MBP had an emphasis on implementation, which included examining staff perceptions on MBP (Ducak et al., 2016;Sterns et al., 2011), and the benefits of a staffrun facility-wide, sustained, coordinated activity program, Memory in Rhythm (MIR), that included MBP throughout the day (De Witt-Hoblit, Miller, & Camp, 2016). The remaining articles were commentaries and reviews on MBP implementation approaches (Bourgeois et al., 2015;Camp, 2006Camp, , 2010Orsulic-Jeras et al., 2001;Roberts, Morley, Walters, Malta, & Doyle, 2015). ...
... Other broad implementation considerations include making use of materials that are familiar and accessible to the participants (Camp, 2006(Camp, , 2010 and the activities should take place in a structured environment where the participant is able to demonstrate competency (Lee et al., 2007). Although Orsulic-Jeras and colleagues (2001) note that modifications to the activity room may be needed, other researchers have stressed that a true application of Montessori principles will require changes to the entire care environment, including interior and exterior rooms (Bourgeois et al., 2015;Roberts et al., 2015). This may include having everyone wear name tags, putting up large print signs, and having areas in the facility designated to specific activities (Roberts et al., 2015). ...
... Although Orsulic-Jeras and colleagues (2001) note that modifications to the activity room may be needed, other researchers have stressed that a true application of Montessori principles will require changes to the entire care environment, including interior and exterior rooms (Bourgeois et al., 2015;Roberts et al., 2015). This may include having everyone wear name tags, putting up large print signs, and having areas in the facility designated to specific activities (Roberts et al., 2015). Similarly, Camp (2006) suggested that activities be regularly replaced with new ones to promote engagement. ...
Article
Purpose of the Study A scoping review was conducted to develop an understanding of Montessori-based programing (MBP) approaches used in dementia care and to identify optimal ways to implement these programs across various settings. Design and Methods Six peer-reviewed databases were searched for relevant abstracts by 2 independent reviewers. Included articles and book chapters were those available in English and published by the end of January 2016. Twenty-three articles and 2 book chapters met the inclusion criteria. Results Four approaches to implementing MBP were identified: (a) staff assisted (n = 14); (b) intergenerational (n = 5); (c) resident assisted (n = 4); and (d) volunteer or family assisted (n = 2). There is a high degree of variability with how MBP was delivered and no clearly established “best practices” or standardized protocol emerged across approaches except for resident-assisted MBP. Implications The findings from this scoping review provide an initial road map on suggestions for implementing MBP across dementia care settings. Irrespective of implementation approach, there are several pragmatic and logistical issues that need to be taken into account for optimal implementation.
... Communication and co-operation between staff and family members is critical to foster a supportive housing environment for residents that encourages collaboration, and promotes person-centred care (i.e., considering resident preferences rather than simply performing tasks on their behalf (Majerovitz et al., 2009)). Person-centred care in LTC homes has led to marked improvements in resident well-being via the reduction of anti-psychotic medication (Roberts et al., 2015), and enables the creation of tailored care plans, shared decision-making and greater satisfaction among family, residents and staff regarding care preferences (Roberts et al., 2015;Giosa et al., 2022). ...
... Communication and co-operation between staff and family members is critical to foster a supportive housing environment for residents that encourages collaboration, and promotes person-centred care (i.e., considering resident preferences rather than simply performing tasks on their behalf (Majerovitz et al., 2009)). Person-centred care in LTC homes has led to marked improvements in resident well-being via the reduction of anti-psychotic medication (Roberts et al., 2015), and enables the creation of tailored care plans, shared decision-making and greater satisfaction among family, residents and staff regarding care preferences (Roberts et al., 2015;Giosa et al., 2022). ...
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Context: Communication methods have been trialled to promote staff-family relations and facilitate person-centred care for residents living in long-term care homes. A review and synthesis of the common methods will inform the development of staff-family communication methods, policy and best practice guidelines. Objectives: 1) synthesise and summarise common communication methods, and types(s) of delivery, used for staff-family communication in long-term care homes; and 2) identify any challenges that impacted the implementation of the communication method(s). Methods: An integrative review was employed to incorporate papers with diverse research designs. It involved a comprehensive database and grey literature search, and study selection based on inclusion criteria. Data from included studies were extracted, coded and categorised by common communication method, delivery type(s) and challenges; studies were assessed for quality. Findings: A total of 3,183 potential papers were retrieved from seven international databases. Twenty-four original papers from six countries meeting inclusion criteria were reviewed and assessed for quality (M = 30; SD = 3.8). Common communication methods (structured education, meetings and takeaway resources) and challenges to implementation (confusion, misunderstanding and disagreement; lack of time; and technological difficulties) were identified and summarised. Limitations: The exclusion of papers published more than 20 years ago, geographical concentration of studies in high-income countries, and absence of stakeholder consultation may limit the generalisability and depth of the findings. Implications: Staff professional development and education, technology training and support, and accessibility of information in pamphlets and resources for family are crucial for facilitating staff-family communication in long-term care homes.
... In environmental intervention applications, Roberts et al. [20] enhanced the environmental adaptability and promoted memory recovery of dementia patients by utilizing color-rich, home-style rehabilitation environments. In the United States, the Prosperous Life Center satisfied the wandering needs of dementia patients by setting up circular walking areas, cleverly minimizing the likelihood of them getting lost [21]. ...
... The theory of "Behavioral and Psychological Symptoms of Dementia" (BPSD) [33] posits that wandering behavior, commonly exhibited by patients with dementia [34], is an overt reaction to unmet intrinsic needs [35]. The human cognitive system has a close connection with spatial environments [36], and optimizing the spatial environment can slow the decline of cognitive functions [20]. Research evidence indicates that there is a correlation between spatial environments and pacing, wandering, and roaming behaviors (Table 1). ...
Article
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The global prevalence of dementia is on the rise, and existing medical models can no longer fulfill the pervasive need for intervention. Dementia is incurable, but the identification of Mild Cognitive Impairment (MCI) provides a window of opportunity for early intervention. The environmental therapy theory has been widely adopted, however, the implementation pathways and empirical evidence for cognitive behavioral interventions are still limited. The role of interior layout design as one of the environmental elements in guiding human behavioural patterns has been demonstrated by numerous scholars and extended to be explored in relation to perceptual and cognitive behavioural dimensions. There has been a great deal of research on Wandering Behavior In Patients With Cognitive Disorders in the medical field, but only sporadic reports in the field of design. Employing an “environment-behavior-neuroscience” research approach, this paper constructs the relationship between wandering behavior, cognitive function, and environmental factors, and explores the possibility of environmental intervention to improve cognitive functions. The study shows that: 1) The wandering patterns of dementia patients can be guided through landmarks; 2) There is a direct relationship between the depth of spatial communication and the layout, and optimizing the spatial layout can foster communication and theoretically have a restorative effect on cognitive function; 3) Centripetal layouts are more effective in behavior guidance, while multicore circulation path layouts can accommodate the wandering needs of dementia patients. As dementia is incurable, early intervention is the most effective approach, making this research highly valuable.
... A component that prior research has a tendency to disregard, according to Studer, is "factors influencing a person's behavior also include his hereditary features [21]." Some academics, including Hamilton [22], Jin Huxian [23], Wu Fan [24], Su Xuechen [25], and Roberts [26], have prioritized the environmental adaptation component of patients' pathological characteristics, favoring theoretical studies that still require expansion in terms of the strength of their justification for real-world scenarios. ...
... The nurses' station is set to the left of the entrance (Figure 1), and the overall decoration style is "family style", with wood as the main finish material. The human cognitive system is closely related to space [32]; improving the spatial environment might delay cognitive aging [26,33]. Wandering behavior is a common symptom of patients with cognitive impairments [34] and is positively connected with the severity of the impairment [35]. ...
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Under the dual pressure of the large number of patients and the funding of expensive treatments, the established medical model is no longer able to meet the treatment needs of patients with cognitive disorders. Cognitive disorders cannot be cured, and the proposed MCI stage provides a window of opportunity for early intervention of the condition. Mild cognitive impairment (MCI) is a high-risk potential conversion state prior to a diagnosis of cognitive disorder, where the person still has the ability to live but with the presence of cognitive damage. The theory of environment-facilitated rehabilitation has begun to be applied to the study of cognitive disorders prevention, but its effectiveness and the drivers of its pathological characteristics remain unclear. In this paper, we explore spatial design strategies for the rehabilitation of patients with cognitive disorders based on the adaptability of pathological characteristics, and provide new ideas for spatial interventions to prevent the condition. Firstly, this paper constructs the relationship between behavioral characteristics (roaming), pathological characteristics (cognitive impairment), and environmental factors interacting with cognitive disorder patients. Second, the feasibility of spatial design to assist the rehabilitation of the condition was demonstrated by analyzing spatial accessibility, visual visibility, and walking distance using the environmental modification of Yuexiu Elderly Service Center in Guangzhou as an example. The study concludes that environmental influences to improve the quality of rehabilitation and cognitive function are effective, mainly in the improvement of spatial communication depth and care efficiency variables.
... With an increasing number of people suffering from dementia, considerable attention is currently focused on improving quality of life for people with dementia [66]. Patients and caregivers are the central stakeholders in dementia care and there has been much research on the health status and care needs of elderly patients with dementia [13,14,67,68]. In terms of dementia caregivers, especially informal caregivers, compelling evidence has suggested that they suffer a high level of care burden [40,66]. ...
... In terms of dementia caregivers, especially informal caregivers, compelling evidence has suggested that they suffer a high level of care burden [40,66]. Some care models for people with dementia have received increased attention, such as the ABLE model [67], person-centered care model [68], and personhood model [69]. ...
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Since the early 1960s, long-term care (LTC) has attracted a broad range of attention from public health practitioners and researchers worldwide and produced a large volume of literature. We conducted a comprehensive scientometric review based on 14,019 LTC articles retrieved from the Web of Science Core Collection database from 1963 to 2018, to explore the status and trends of global LTC research. Using CiteSpace software, we conducted collaboration analysis, document co-citation analysis, and keyword co-occurrence analysis. The results showed a rapid increase in annual LTC publications, while the annual citation counts exhibited an inverted U-shaped relationship with years. The most productive LTC research institutions and authors are located primarily in North American and European countries. A simultaneous analysis of both references and keywords revealed that common LTC hot topics include dementia care, quality of care, prevalence and risk factors, mortality, and randomized controlled trial. In addition, LTC research trends have shifted from the demand side to the supply side, and from basic studies to practical applications. The new research frontiers are frailty in elderly people and dementia care. This study provides an in-depth understanding of the current state, popular themes, trends, and future directions of LTC research worldwide.
... In addition to being appealing to elders and their families, Montessori-based interventions additionally boast a strong scientific evidence base. 17,21 For example, a significant reduction in antipsychotic and sedative medication was noted after the implementation of Montessori activities; this reduction in medication was noted to maintain at an 18-month follow-up as well. 21 The implementation of a Montessori environment resulted in more quality communicative interactions as well as improved overall wellbeing. ...
... 17,21 For example, a significant reduction in antipsychotic and sedative medication was noted after the implementation of Montessori activities; this reduction in medication was noted to maintain at an 18-month follow-up as well. 21 The implementation of a Montessori environment resulted in more quality communicative interactions as well as improved overall wellbeing. 17 Similarly, elders who engaged in Montessori training displayed fewer feeding difficulties and an increased ability to feed oneself independently. ...
Article
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The current mandate for person-centered care throughout the health care system, and especially in the nursing home industry, requires that speech–language pathologists ensure that the services they provide to elders with dementia are skilled, person centered, and relevant to positive overall health outcomes. Guidelines developed by the Association Montessori International Advisory Board for Montessori for Aging and Dementia are one avenue toward such skilled and person-centered services. The purpose of this article is to provide clinicians with practical strategies for guiding their assessment, goal writing, and intervention plans to meet the expectations of a person-centered approach to services for elders with dementia, using the Montessori approach as a philosophical guide.
... The benefits of Montessori method applied to dementia include: an increase of engagement and positive affects during Montessori-based activities (see for example Orsulic-Jeras, Judge, & Camp, 2000), an increase in independence of daily living activities, such as eating (Lin, Huang, Watson, Wu, & Lee 2011), and a reduction of behavioral problems (De Witt-Hoblit, Miller, & Camp, 2016;Lin et al., 2009;Roberts, Morley, Walters, Malta, & Doyle, 2015), especially for persons with severe dementia and language issues (Van der Ploeg et al., 2013). Finally, intervention programs based on the Montessori approach also may have positive impact on institutional issues such as satisfaction at work, staff turn-over, residents ' census, or psychotropics' administration (De Witt-Hoblit et al., 2016;Roberts et al., 2015). ...
... The benefits of Montessori method applied to dementia include: an increase of engagement and positive affects during Montessori-based activities (see for example Orsulic-Jeras, Judge, & Camp, 2000), an increase in independence of daily living activities, such as eating (Lin, Huang, Watson, Wu, & Lee 2011), and a reduction of behavioral problems (De Witt-Hoblit, Miller, & Camp, 2016;Lin et al., 2009;Roberts, Morley, Walters, Malta, & Doyle, 2015), especially for persons with severe dementia and language issues (Van der Ploeg et al., 2013). Finally, intervention programs based on the Montessori approach also may have positive impact on institutional issues such as satisfaction at work, staff turn-over, residents ' census, or psychotropics' administration (De Witt-Hoblit et al., 2016;Roberts et al., 2015). Of course, to be most effectively implemented, this person-centered approach must be coupled with an assessment system to identify capacities in persons with dementia and pair these with specific interventions for use in plans of care. ...
... The benefits of Montessori method applied to dementia include: an increase of engagement and positive affects during Montessori-based activities (see for example Orsulic-Jeras, Judge & Camp, 2000), an increase in independence of daily living activities, such as eating (Lin, Huang, Watson, Wu & Lee 2011) and a reduction of behavioral problems (De Witt-Hoblit, Miller & Camp, 2016;Lin, Yang, Kao, Wu, Tang & Lin, 2009;Roberts, Morley, Walters, Malta & Doyle, 2015), especially for persons with severe dementia and language issues (Van der Ploeg et al., 2013). Finally, intervention programs based on the Montessori approach also may have positive impact on institutional issues such as satisfaction at work, staff turn-over, residents' census or psychotropics' administration (De Witth-Hoblit et al., 2016;Roberts et al., 2015). ...
... The benefits of Montessori method applied to dementia include: an increase of engagement and positive affects during Montessori-based activities (see for example Orsulic-Jeras, Judge & Camp, 2000), an increase in independence of daily living activities, such as eating (Lin, Huang, Watson, Wu & Lee 2011) and a reduction of behavioral problems (De Witt-Hoblit, Miller & Camp, 2016;Lin, Yang, Kao, Wu, Tang & Lin, 2009;Roberts, Morley, Walters, Malta & Doyle, 2015), especially for persons with severe dementia and language issues (Van der Ploeg et al., 2013). Finally, intervention programs based on the Montessori approach also may have positive impact on institutional issues such as satisfaction at work, staff turn-over, residents' census or psychotropics' administration (De Witth-Hoblit et al., 2016;Roberts et al., 2015). Of course, to be most effectively implemented, this person-centered approach must be coupled with an assessment system to identify capacities in persons with dementia and pair these with specific interventions for use in plans of care. ...
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ABSTRACT This study evaluated the validity and reliability of the Montessori Assessment System (MAS). The MAS assesses preserved abilities in persons with moderate to severe dementia. In this respect, this instrument provides crucial information for the development of effective person-centered care plans. A total of 196 persons with a diagnosis of dementia in the moderate to severe stages of dementia were recruited in 10 long term care facilities in France. All participants completed the MAS, the Clinical Dementia Rating Scale and/or the Mini Mental State Examination and the Severe Impairment Battery – short form. The internal consistency and temporal stability of the MAS were high. Additionally, good construct and divergent validity were demonstrated. Factor analysis showed a one-factor structure. The MAS demonstrated satisfactory psychometric properties while being a useful instrument to assess capabilities in persons with advanced stages of dementia and hence to develop person-centered plans of care.
... 28 The result is that people living with dementia are able to make useful contributions to their community, and engage in meaningful activities. 41,42 This improves their overall health and leads to better outcomes, such as the elimination (100%) of antipsychotic medication use, a reduction of the use of sedatives (from 67 to 2%), significant reduction of resident responsive behaviors due to unmet needs (from several times an hour to once or twice per day, several times a day to less than once a week, or several times a week to never), and overwhelmingly positive responsive responses on family surveys conducted 20 months after implementation. 15,42 The process begins by learning as much as possible about the person through interviews with the individual and his or her family to identify an elder's wants and needs. ...
... 41,42 This improves their overall health and leads to better outcomes, such as the elimination (100%) of antipsychotic medication use, a reduction of the use of sedatives (from 67 to 2%), significant reduction of resident responsive behaviors due to unmet needs (from several times an hour to once or twice per day, several times a day to less than once a week, or several times a week to never), and overwhelmingly positive responsive responses on family surveys conducted 20 months after implementation. 15,42 The process begins by learning as much as possible about the person through interviews with the individual and his or her family to identify an elder's wants and needs. An individual may want to continue to walk to church on Sunday, volunteer at the rotary club, attend her book club, and cook meals for her family. ...
Article
In the next two decades, there will be advances in the diagnosis and treatment of the disorders of aging that have the potential to change the way speech-language pathologists (SLPs) are trained and provide services to individuals with a continuum of cognitive communication challenges. SLPs will address the needs of the aging adult who continues to reside in the community and desires to maintain an independent and meaningful life, as well as those who require a supportive residential setting to achieve a satisfying quality of life. Evidence-based strategies and intervention approaches for the range of goals that will address the desired functions of a meaningful life for individuals faced with cognitive communicative challenges are outlined. Institutional barriers to the implementation of documented evidence-based approaches will need to be reduced through a variety of organizational and systems changes. The projected outcome of these changes will be the creation of a person-centered culture of care that promotes dignity, choice, and engagement in meaningful activities through the end of life. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
... A 2-year follow-up showed a significant decrease in residents' responsive behaviors, a 40% reduction in the use of psychotropic medications, a reduction in turnover and absenteeism rates, and no staff accident at work over the past 2 years. In a recent article, Roberts, Morley, Walters, Malta, and Doyle (2015) presented the effects of changing the care model from a typical hospital-like model to a person-centered model in an Australian dementia unit with 16 residents in a geriatric health service (i.e., nursing home). Their ABLE model included environmental changes, staff education about dementia care and the Montessori method, and a new philosophy of care that identified, emphasized, and built on the residents' remaining abilities. ...
... Au fil des travaux, les principes Montessori furent affinés, intégrés dans différents projets, tels que des projets intergénérationnels [24][25][26], l'idée d'apprendre à des personnes âgées ayant des troubles cognitifs à présenter des activités Montessori [27,28], ou encore l'utilisation des activités Montessori comme base de programme de rééducation, par exemple à l'alimentation [29,30]. Plus récemment, les principes Montessori furent intégrés conjointement pour proposer un modèle global d'accompagnement visant à soutenir l'autonomie et l'indépendance des personnes âgées ayant des troubles cognitifs, même sévères, à réduire les comportements réactionnels et à favoriser leur bien-être et leur qualité de vie [31][32][33][34]. ...
Article
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While dementia care is going through a major crisis, a strong call for the development of person-centered care for persons with a diagnosis of dementia has recently emerged. Person-centered care (PCC) is a philosophical and theorical intervention framework acknowledging that the individual is still a person who can live positive life experiences and relationships, despite a progressive disease, even at severe stages. It has arisen as a response to a medical model, focused on pathology and deficits. The benefits of PCC have been well documented. However, questions remain about how to concretely provide it. In this context, the Montessori method applied to dementia represents one way to apply person-centered care to person with dementia. Based on the philosophy and principles of the scientific pedagogy developed by Maria Montessori, it integrates PCC principles, associated with rehabilitation techniques, to promote constructive engagement in meaningful activities, to give back sense of control to the person with dementia, and to allow the person to have a role in the community. In this article, we will first present the person-centered care philosophy, its main principles, and effects. Secondly, we will describe a brief historical perspective of the Montessori method for person with dementia. Then, we will present Montessori principles in a detailed and structured way.
... Among the reviewed articles, 18 studies have examined the effect of the Montessori intervention on the quality of life of individuals with dementia. In these studies, hope and optimism, 4 engagement, 21,29,31,36,38,[42][43][44]53,54,58 job satisfaction, 34,36,42,44,48 and other factors of quality of life have been evaluated. [33][34][35]38,42,45,50,57 The psychological capital questionnaire was used to investigate hope and optimism. ...
Article
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The elderly population of the world is growing fast. The aging phenomenon causes changes in the body’s systems, leading to mental and emotional disorders. Dementia is established as one of the most important challenges associated with the aging process. In this respect, the Montessori-based cognitive rehabilitation program is an increasingly popular choice in dementia care. Therefore, we decided to conduct a review study on the effect of Montessori therapy on different psychological aspects of the elderly with dementia. This narrative review was performed using narrative synthesis. An extensive literature search was performed in databases of ScienceDirect, Google Scholar, PubMed, and ISI Web of Knowledge using OR, AND, and NOT operators and the selected keywords. Only studies published in journals between March 2010 and March 2022 were used for this purpose. The articles chosen in this study were those that have studied the effect of a Montessori-based cognitive rehabilitation program on the elderly with dementia. Studies that involved the Montessori program on other neurological disorders were excluded. Finally, 32 articles were selected from the final evaluation. It can be concluded that the Montessori program effectively reduces anxiety, destructive behavior, and agitation, increases pleasure, hope, optimism, job satisfaction, social skills, and cognitive function, and improves the quality of life and feeding capacity.
... MAP for community-based nursing homes promotes residentdirected care that engages persons living with dementia and mitigates responsive behaviors. MAP has been shown to be effective in improving a wide variety of nursing home resident outcomes (e.g., social behavior, basic cognitive abilities, engagement, caloric intake, antipsychotic and sedative use, and behavioral disturbances; Lin et al., 2009;Orsulic-Jeras et al., 2000;Roberts et al., 2015;Sheppard et al., 2016;Vance & Johns, 2003). ...
Article
Background and Objectives Effectively adapting evidence-based interventions for nursing home (NH) implementation is a critical, yet under-examined, component of improving care quality. Montessori-based activity programming (MAP) is an evidence-based intervention that promotes person-centered care, engages persons living with dementia, and mitigates distress behaviors. Currently, there is sparse evidence of MAP in Department of Veterans Affairs NHs (i.e., Community Living Centers, CLCs). CLCs differ significantly from community NHs and require adaptations to support MAP use and sustainability. This study uses the Framework for Reporting Adaptations and Modifications-Enhanced (FRAME) to track changes made to MAP as an exemplar for clinicians and implementation scientists. This work fills a gap on adapting interventions through detailed examination of the adaptation process in NHs. Research Design and Methods Qualitative and quantitative data were collected across eight CLCs (e.g., advisory panel, staff interviews, training evaluations, field notes, fidelity assessments). We used an iterative, rapid content analytic approach to triangulate findings and identify needed adaptations for the CLC setting. Results Thirty-six adaptations were made. Most adaptions occurred during the pre-implementation phase, were reactive, focused on training/evaluation, and involved researchers, intervention developers, and practitioners. All were fidelity-consistent with MAP. The most common goal across adaptations was increased reach/engagement of the intervention. Discussion and Implications CLCs and community NHs can use findings to support intervention adaptation, and adapt and implement MAP to improve meaningful engagement for persons living with dementia and other residents. Future research should further evaluate and standardize FRAME for diverse users of complex interventions.
... [16] In addition, the improvement of dementia-related behaviors may also lead to the decreasing of medication use. [17] In the present research, the intervention duration of the included studies for the behavior-specified analysis was less than 4 weeks, which may lead to a trend favors to Montessori-based activities, rather than statistical difference between the groups. Even so, the results of the meta-analysis suggested that Montessori-based activities might be beneficial and essential as treatment strategy in Asian dementia patients with agitation. ...
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Objectives: Montessori based activity are supposed to be an effective nonpharmacological intervention in the treatment of agitation in western countries. However, most studies conducted to evaluate the effectiveness of Montessori based activities on agitation in Asian patients were small sample size, as well as inconsistent outcomes, which may limit the reliability of the conclusions. The present pooled analysis, hence, was conducted to evaluate the effectiveness of the activity on agitation related with dementia in Asian patients with dementia. Design: Prospective randomized clinical studies were included, of which available data was extracted. Outcomes of physical aggressive behaviors, physical nonaggressive behaviors, and verbal aggressive behaviors were pooled for the analysis by weighted mean differences. Data sources: Medline, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), WanFang, and China Science and Technology Journal Database (VIP). Eligibility criteria: Prospective, randomized, controlled clinical studies, conducted to evaluate the effectiveness of the activity on agitation related with dementia in Asian patients with dementia. Data extraction and synthesis: Available data including baseline characteristics and interested outcomes from the included literature were extracted independently by 2 investigators. Measuring scales including CMAI and NOSIE were adopted for the efficacy comparison between Montessori based activity and standard activity. Weighted mean difference was used for the pooled analysis. Results: A total of 460 participants were included in the present meta-analysis. The pooled mean difference agitation for Montessori based activity was -3.86 (95% CI: -7.38 to -0.34, P = 0.03) comparing to standard activity. The pooled mean differences for physical aggressive behaviors, physical nonaggressive behaviors, and verbal aggressive behaviors in Montessori based activity group were -0.82 (95% CI: -1.10 to -0.55; P < 0.00001), -0.81 (95% CI: -1.68 to 0.55; P = 0.07), and 0.38 (95% CI: -0.92 to 1.68; P = 0.57). Conclusions: Montessori based activities may reduce the frequency of agitation, especially in physical aggressive behaviors comparing to standard activities in Asian patients with dementia. However, the effectiveness of Montessori based activities on reduction of subcategorized agitated behaviors including physical nonaggressive behaviors, and verbal aggressive behaviors may not be reliable as physical aggressive behaviors.
... M ontessori for Dementia and Ageing (MDA) is a philosophy of care that emphasizes person-centeredness, autonomy, and dignity in persons living with dementia (PWD) (Bourgeois et al., 2015;Roberts et al., 2015). Studies have shown positive impacts of MDA, such as improved aff ect, improved quality of life, and decreased negative responsive behaviors for PWD (Brush et al., 2018). ...
Article
Montessori for Dementia and Ageing (MDA) is a philosophy to support person-centered care (PCC) and autonomy of older adults. This quality improvement project documented outcomes of implementation of the MDA philosophy in a long-term care memory neighborhood. After an initial training session, MDA was implemented with weekly, 2-hour on-site coaching sessions over the course of two semesters (28 weeks) with a community of 20 female persons living with dementia (PWD). Primary outcomes were negative responsive behaviors of PWD, whereas the secondary outcome included percentage of active engagement of PWD. Mean number of negative responsive behaviors was 62.21 at baseline, which decreased to 33.82 at the end of the project per the Cohen-Mansfield Agitation Inventory. At baseline, PWD were actively engaged in 18.15% of observed opportunities, according to the Engage portion of the Resident-Centered Assessment of Interactions with Staff and Engagement Tool. At the end of the project, PWD were actively engaged in 40.56% of observed opportunities. Results suggest that MDA is feasible to implement PCC in a long-term care memory neighborhood. [Journal of Gerontological Nursing, 48(8), 6-9.].
... To achieve culture change and facilitate a non-pharmacological approach, the findings suggest that resources and effective leadership will be required to empower staff by providing training, collaboration and decision-making opportunities (Gjerberg et al., 2013;Rapaport et al., 2018;Zeller et al., 2011;Clifford and Doody, 2018;Sawan et al., 2017;Rosenthal et al., 2020). These findings support a study that identified care home culture as a key determinant in whether a non-pharmacological approach is taken (Roberts et al., 2015). ...
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Background Psychotropic drugs are often prescribed to manage behaviour that challenges in care home residents with dementia but contravene guidelines as evidence shows their use increases the risk of strokes and death. Therefore, a review is needed that conceptualises understanding of the pharmacological and non-pharmacological strategies implemented by care home staff to manage behaviour that challenges in dementia and the factors that influence decision-making. This knowledge is important to develop dementia guidelines to implement a sustainable non-pharmacological approach to support residents with behaviour that challenges. Aim To review qualitative studies to synthesise understanding of strategies implemented by care home staff to manage behaviour that challenges in dementia. Methods This systematic review involved a synthesis of qualitative data (PROSPERO protocol registration CRD42020165948). Searches of three electronic databases, PubMed, PsycINFO and CINAHL were conducted from inception until July 2021, supplemented by grey literature searches. Studies were included if they used qualitative methods and explored how care home staff respond to behaviour that challenges; data exploring other aspects of dementia care were excluded. Study quality was assessed using the Critical Appraisal Skills Programme checklist. Thematic synthesis was used to conceptualise understanding of the strategies implemented by care home staff to manage behaviour that challenges in dementia. Findings In total 1151 records were identified of which 34 studies were included in the review. Three themes emerged, ‘Putting out the fires’, refers to reactive strategies, implemented by staff to quell behaviour that challenges. However, if these strategies fail, staff may resort to pharmacological approaches for convenience to suppress these behaviours. The theme ‘Personhood, human rights and respect’ highlights the need for people with dementia to feel valued and useful by engaging residents in meaningful activities. Furthermore, the theme “Person focused approach – A paradigm shift’ reflects changes in culture, required to implement non-pharmacological strategies to behaviour management these include staff training, collaboration and equitable decision-making. Conclusions This review has identified strategies used by care home staff to manage behaviour that challenges. Non-pharmacological approaches to support residents with behaviour that challenges require staff training in behaviour management and psychotropic medicine management as part of their formal education program, and enhanced opportunities for collaboration and decision-making. In addition, residents should receive person focused support to facilitate participation in meaningful activities. These findings will be beneficial in developing guidelines to implement sustainable non-pharmacological approaches to manage behaviour that challenges in dementia. What is already known ▪Most care home residents with dementia exhibit behaviour that challenges including agitation and aggression. ▪Psychotropic drugs are often used to manage behaviour that challenges but are associated with an increased risk of stroke and death in people with dementia; hence, the National Institute for Health and Care Excellence (NICE) guideline on Dementia (2018) recommends taking a non-pharmacological approach. ▪It is imperative to synthesise understanding of the strategies used by care home staff to manage behaviour that challenges and the factors that influence decision-making in order to inform the development of dementia guidelines to facilitate implementation of non-pharmacological strategies to support residents. What this paper adds ▪This systematic review has conceptualised understanding of strategies implemented by care home staff to manage behaviour that challenges; this knowledge is important to assist development of guidelines, such as the NICE guideline on Dementia (2018) to enable implementation of non-pharmacological approaches to behaviour management. ▪This review has identified person focused support as an important strategy to reduce behaviour that challenges by supporting residents with dementia to engage in meaningful activities and occupation, tailored to their personal history. ▪Changes in care home culture and staff attitudes will be required to implement non-pharmacological strategies; this review recommends that care home staff are trained in managing behaviour that challenges and psychotropic medicine management and have opportunities to participate in multidisciplinary collaboration and equitable decision-making.
... The more objective living environment also plays a vital role in residents' QoL with cognitive disorders, mainly when adapted to their disability and facilitates their taking temporospatial bearings [9,81,83]. About the "Self-functioning-related QoL" factor, it is very relevant as the resident can feel that he or she is still able to make choices, that he or she is given a choice, especially in daily activities [80,82,84]; this is what the person-centred care and the Montessori approach applied to the elderly advocate [85][86][87]. Finally, it is not surprising to find a perceived health factor in a health-related quality of life scale that usually contains physical and mental health measures with other elements not directly related to health [53,88]. ...
Article
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Background No specific scale to measure Quality of Life in Alzheimer's Disease in Nursing Homes (QoL-AD NH) exists in French. We aimed to translate and culturally adapt the QoL-AD NH participant scale into a French version and evaluate its psychometric properties with residents in French nursing homes (EHPAD). Methods First, the QoL-AD NH was cross-culturally adapted into French according to guidelines. Secondly, a convenience group of residents with mild to moderate dementia answered the Folstein’s test and the QoL-AD NH. They also answered the Dementia Quality of Life and the Geriatric Depression Scale to test convergent and divergent validity. Known-group validity was tested with a comparison group of residents without dementia. Exploratory Structural Equation Modeling (ESEM) was used after Exploratory Factor Analysis (EFA) to identify factors and measure invariance across age and mental state groups. Reliability (internal consistency, McDonald’s omega and test–retest) were also measured. Results Following successful adaptation of the QoL-AD NH, 174 residents (mean age 86.6) from 7 nursing homes with mild to moderate dementia participated in the validation study. We retained a 3-factor model of the scale after ESEM identifying: “Intra & interpersonal environment-related QoL”, “Self-functioning-related QoL” and “Perceived current health-related QoL” that were invariant across age and mental state groups. The QoL-AD NH had acceptable convergent (ρ range 0.24–0.53) and divergent validity (ρ range − 0.43 to − 0.57) and good known-group validity with 33 residents without dementia ( t (205) = 2.70, p = .007). For reliability, the results revealed very good and adequate internal consistency (α = 0.86 for total scale and ≥ 0.71 for subscales). All total omega values exceeded the threshold 0.70. The hierarchical omega was 0.50, supporting the multidimensionality of the scale. Hierarchical omega subscale values exceeded the minimal level 0.50 except for the third factor, although reliable, would deserve more items. Test–retest was good with ICC (3,1) = 0.76. Conclusions The QoL-AD NH French participant version has globally good reliability and validity for evaluating residents' quality of life. However, further studies must rework and confirm the factor structure, test sensitivity to change and responsiveness.
... Evidence-based recommendations for the management of depression include antidepressants or other medical treatments, psycho-education, social support, and psychological interventions [11]. In general the prescription of psychotropic medication is high among RACF residents [12,13], but older adults have expressed concerns about using anti-depressants due to sideeffects, stigma, fear of addiction and prevention of natural sadness [14]. On the other hand, psychological services can be difficult for RACF residents to access in Australia [15], as psychologists are not typically employed in Australia in such settings [16]. ...
Article
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Background This protocol describes an ongoing study of the impact of befriending on depression, anxiety and loneliness in older people living in residential aged care facilities in Australia. While systematic reviews of befriending have indicated positive benefits of befriending for people in a range of ages and settings, there have been no randomised controlled trials (RCTs) of befriending for older people living in residential aged care with depression and no studies of the cost effectiveness of befriending in residential aged care facilities (RACFs) in Australia. Methods and analysis We are conducting a single blind pragmatic RCT comparing two groups of older people living in RACFs, one receiving an intervention consisting of weekly befriending for 4 months from a trained volunteer and the other receiving treatment as usual. Participants undergo eligibility screening for depression (GDS-15 ≥ 4) and cognitive impairment (GPCog ≥ 4) and assessments at three measurement time points: baseline prior to randomisation, 2 months post-baseline and 4 months post-baseline. The primary outcome measure is depression, and secondary outcome measures are anxiety, loneliness, social isolation and quality of life. The economic evaluation will take the form of a cost-utility analysis based on the outcome of quality of life. The primary and secondary outcomes will be analysed using negative binomial and logistic regressions utilizing the Generalised Estimating Equations approach. Discussion To our knowledge, this is the first RCT evaluating the effectiveness of befriending on older people with depression living in residential aged care. It is expected that the befriending intervention will reduce the severity of depression symptoms experienced by older people living in residential aged care. If the intervention proves effective it may be incorporated into volunteer training programs and adopted as a way of supporting older people’s mental health. Trial registration Trial registered with the Australian and New Zealand Clinical Trial Registry (ANZCTR) Number: ACTRN12619000676112, registered 06/05/2019 – retrospectively registered.
... Studies of these models did not explicitly exclude people with dementia, but most tended to focus on domains of physical health and mental well-being as relevant outcomes and did not explicitly mention residents with dementia. Studies in this group highlighted changes to the physical environment of the care home and to the organisation of care to enable residents to live in 'home like', small-group environments rather than large wards (Yoon et al., 2015, Yoon et al., 2016, Hung et al., 2016, Roberts et al., 2015. ...
... From the staff's perspective, these changes are vital to ensure that the individuals' needs are met (Cleary and Doody, 2017). Moreover, except for the study conducted by Boumans et al. (2005), there is consensus that person-centred care increases the quality of care, with particular reference to the following dimensions: staff's and families' satisfaction with the quality of care (Van Weert et al., 2005;Robinson and Rosher, 2006;Edvardsson et al., 2014;Roberts et al., 2015) and the ability to involve relatives in decisions concerning their relatives (Chenoweth et al., 2015). However, during the implementation of person-centred care models, some critical issues arise. ...
Article
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For many years, dementia care has been dominated by the standard medical approach, in which dementia is treated mainly with drugs, such as anti-anxiety, antidepressant and anti-psychotic medications. With the aim of seeking effective treatments for patients with dementia, over the last years, several contributions have criticised the pervasive use of drugs for the management of behavioural and physiological symptoms related to dementia, proposing personalised interventions aimed at supporting patients and their relatives from diagnosis until death. With particular reference to long-term settings, in this work, we aim at understanding the organisational implications of three types of interventions (labelled supportive care interventions – SCIs) that have characterised this shift in dementia care: person-centred, palliative and multi-disciplinary care. Conducted by following the integrative review method, our review underlines how SCIs have controversial consequences on the quality of care, the care-givers’ quality of life and cultural backgrounds. After an in-depth analysis of selected papers, we offer some considerations about the implications of SCIs for long-term care organisations and future research directions.
... Many successful Montessori-based interventions (MBIs) have been used in care environments in recent decades (Bourgeois et al., 2015;Ducak et al., 2018;Fields et al., 2014;Orsulic-Jeras et al., 2001;Roberts et al., 2015). MBIs are broadly grounded in values of respect, dignity, independence, and adaptable structure (Ducak et al., 2018;Orsulic-Jeras et al., 2001). ...
Article
Montessori methods are used with individuals with dementia to create meaningful, inclusive, failure-free activities that enhance quality of life. This research qualitatively explored the barriers to implementing a Montessori-based intervention for people living with dementia in a 24-hr memory care setting. A lens comprised of key Montessori values and principles guided a content analysis of field note data to create an overall framework for understanding implementation barriers, which are rarely addressed in the literature. Interestingly, the four themes that emerged as barriers—the absence of respect, interdependence, meaningful activity, and structure—permeated implementation efforts and represent the opposite of Montessori principles. These findings confirm literature that identifies similar barriers across diverse interventions. Findings underscore the need for formal documentation of implementation barriers and extensive pre-implementation work to accomplish culture change in long-term care.
... We replicated previous findings that Montessori activities have a positive impact on their engagement and emotions during activities (Camp, 1999;Camp et al., 2006;Orsulic-Jeraset al., 2000;van der Ploeg et al., 2013). When combining these findings with a previous study showing that Montessori activities can reduce the use of antipsychotic and sedative medication (Roberts et al., 2015), we can conclude that there is a growing evidence base that Montessori activities have a positive impact on people with dementia both during the implementation and in general. Future studies should explore possible carryover effects to outside activity times, for example, reductions in BPSD or improvements of mood on days the intervention is delivered. ...
Article
Objectives One-on-one structured Montessori-based activities conducted with people with dementia can improve agitation and enhance engagement. These activities may however not always be implemented by nursing home staff. Family members may present an untapped resource for enabling these activities. This study aimed to evaluate the impact of the Montessori activities implemented by family members on visitation experiences with people who have dementia. Design Cluster-randomized crossover design. Setting General and psychogeriatric nursing homes in the state of Victoria, Australia. Participants Forty participants (20 residents and 20 carers) were recruited. Intervention During visits, family members interacted with their relative either through engaging in Montessori-based activities or reading a newspaper (the control condition) for four 30-minute sessions over 2 weeks. Measurements Residents’ predominant affect and engagement were rated for each 30-second interval using the Philadelphia Geriatric Center Affect Rating Scale and the Menorah Park Engagement Scale. The Pearlin Mastery Scale was used to rate carers satisfaction with visits. The 15-item Mutuality Scale measured the carers quality of their relationship with the resident. Carers’ mood and overall quality of life were measured using the Center for Epidemiological Studies Depression Scale and Carer-QoL questionnaires, respectively. Results Linear regressions within the generalized estimating equations approach assessed residents’ and carers’ outcomes. Relative to the control condition, the Montessori condition resulted in more positive engagement ( b = 13.0, 95%CI 6.3–19.7, p < 0.001) and affect ( b = 0.4, 95%CI 0.2–0.6, p < 0.001) for the residents and higher satisfaction with visits for carers ( b = 1.7, 95%CI 0.45–3.00, p = 0.008). No correction was applied to p -values for multiple comparisons. Conclusion This study strengthens the evidence base for the use of the Montessori programs in increasing well-being in nursing home residents. The findings also provide evidence that family members are an additional valuable resource in implementing structured activities such as the Montessori program with residents.
... There are many difficulties in implementing culture change in LTCFs. Some include technical challenges such as modifying the physical environment or training staff (Roberts, Morley, Walters, Malta, & Doyle, 2015). These problems are straightforward and often tied to resources. ...
Article
Purpose: The purpose of this study was to examine the ability of persons with aphasia to access interaction and be included in social encounters in long-term care facilities (LTCFs). Method: Four persons with aphasia were the focus of this investigation. A qualitative research approach using ethnographic methods was used to conduct participant observation, semistructured interviews, and artifact analysis. Expanded field notes from observations, transcribed interviews, and artifacts were then coded to identify patterns in the data. Results: The interactional context of LTCFs negatively influenced the ability of persons with aphasia to communicate with others and develop meaningful relationships. Three major themes emerged from the data detailing the contextual elements leading to communication accessibility and inclusion: (a) lack of support, (b) social hierarchy, and (c) focus on performance. Conclusions: Findings highlighted several barriers in LTCFs that worked to discourage persons with aphasia from living social and expressive lives. Specific obstacles included a misunderstanding of aphasia and its influence on communicative exchanges and performance-oriented environment that overlooked psychosocial needs. Speech-language pathologists have an important role for advocacy in LTCFs. Clinical implications for assessment and treatment in institutions are discussed.
... Although the published literature includes examples of many engagement and interaction interventions that yielded positive results when the investigator team themselves delivered the intervention (e.g., Barbosa, The Gerontologist, 2018, Vol. 58, No. 4 e298 Marques, Sousa, Nolan, & Figueiredo, 2016;Coleman, Medvene, & Van Haitsma, 2013), studies using internal facilitators are rarer and typically include intensive, multiday trainings provided by external facilitators (Roberts, Morley, Walters, Malta, & Doyle, 2015;Stein-Parbury et al., 2012;van Weert et al., 2006). To the best of our knowledge, the intensity of our external facilitation was less than that described in any other published nursing home interaction or engagement intervention. ...
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Background and objectives: For nursing home residents, positive interactions with staff and engagement in daily life contribute meaningfully to quality of life. We sought to improve these aspects of person-centered care in an opportunistic snowball sample of six Veterans Health Administration nursing homes (e.g., Community Living Centers-CLCs) using an intervention that targeted staff behavior change, focusing on improving interactions between residents and staff and thereby ultimately aiming to improve resident engagement. Research design and methods: We grounded this mixed-methods study in the Capability, Opportunity, Motivation, Behavior (COM-B) model of behavior change. We implemented the intervention by (a) using a set of evidence-based practices for implementing quality improvement and (b) combining primarily CLC-based staff facilitation with some researcher-led facilitation. Validated resident and staff surveys and structured observations collected pre and post intervention, as well as semi-structured staff interviews conducted post intervention, helped assess intervention success. Results: Sixty-two CLC residents and 308 staff members responded to the surveys. Researchers conducted 1,490 discrete observations. Intervention implementation was associated with increased staff communication with residents during the provision of direct care and decreased negative staff interactions with residents. In the 66 interviews, staff consistently credited the intervention with helping them (a) develop awareness of the importance of identifying opportunities for engagement and (b) act to improve the quality of interactions between residents and staff. Discussion and implications: The intervention proved feasible and influenced staff to make simple enhancements to their behaviors that improved resident-staff interactions and staff-assessed resident engagement.
... The introduction of person-centered care (PCC) has resulted in growing importance that people with dementia's experiences should be explored through research [8] as well as the incorporation of patient's opinions in clinical practice. It has been suggested as a way of improving outcomes for people with dementia [9] and was a concept first introduced by Kitwood [10], now reflected in a well-established biopsychosocial approach to diagnosis and management of the care of older people in the UK [11]. While a clear definition of PCC is not established, the principles suggest that patients are people and should not be classified or treated according to their disease alone, but their subjective experiences in relation to their environment, situation and future plans should be considered [12]. ...
Article
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Background: People with dementia may receive physiotherapy for a variety of reasons. This may be for musculoskeletal conditions or as a result of falls, fractures or mobility difficulties. While previous studies have sought to determine the effectiveness of physiotherapy interventions for people with dementia, little research has focused on the experiences of people receiving such treatment. The aim of this study was to gain an in-depth understanding of people's experiences of receiving physiotherapy and to explore these experiences in the context of principles of person-centred care. Methods: Semi-structured interviews were undertaken with people with dementia or their carers between September 2016 and January 2017. A purposive sampling strategy recruited participants with dementia from the South West of England who had recently received physiotherapy. We also recruited carers to explore their involvement in the intervention. Thematic analysis was used to analyse the data. Results: A total of eleven participants were recruited to the study. Six people with dementia were interviewed and five interviews undertaken separately with carers of people with dementia. Three themes were identified. The first explores the factors that enable exercises to be undertaken successfully, the second deals with perceived resource pressures, and the final theme "the physiotherapy just vanished" explores the feeling of abandonment felt when goals and expectations of physiotherapy were not discussed. When mapped against the principles of person-centred care, our participants did not describe physiotherapy adopting such an approach. Conclusion: Lack of a person-centred care approach was evident by ineffective communication, thus failing to develop a shared understanding of the role and aims of physiotherapy. The incorporation of person-centred care may help reduce the frustration and feelings of dissatisfaction that some of our participants reported.
... The introduction of person-centered care (PCC) has resulted in growing importance that people with dementia's experiences should be explored through research [8] as well as the incorporation of patient's opinions in clinical practice. It has been suggested as a way of improving outcomes for people with dementia [9] and was a concept first introduced by Kitwood [10], now reflected in a well-established biopsychosocial approach to diagnosis and management of the care of older people in the UK [11]. While a clear definition of PCC is not established, the principles suggest that patients are people and should not be classified or treated according to their disease alone, but their subjective experiences in relation to their environment, situation and future plans should be considered [12]. ...
... 34 Activities underpinned by the Montessori approach, which focuses on the abilities and capabilities of each resident as well as their background skills, likes and dislikes, were found to enhance the person-centred approach to care for residents with dementia. 40 Alzheimer's Australia recommended that activities should be comprehensive, flexible and diverse, including reminiscence, reality orientation, music therapy, pet/doll therapies and sensory experiences as well as everyday activities such as folding laundry, and be available easily and regularly. 11 12 ...
Technical Report
Literature review: Drivers of choice and quality domains in Aged Care During 2016, the Quality Agency commissioned Professor Yun-Hee Jeon of the University of Sydney to complete a literature review. The focus of the review was on the key drivers of choice and the quality domains of interest to consumers of residential aged care in Australia. TO access the report, click on the following link. http://www.aacqa.gov.au/publications/DriversofChoiceandQualityDomainsinAgedCare.pdf
... V ta program se vključujejo tudi člani osebja, družinski člani in prostovoljci. Za izboljšanje oskrbe pacientov z demenco je bil v Avstraliji zasnovan program »ABLE« (Roberts, et al., 2015), v Kanadi pa DementiAbility Model: the Montessori Way (O'Neill, et al., 2014cited in Bourgeois, et al., 2015. ...
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Uvod: Demenca je kronično obolenje s tendenco upadanja kognitivnih sposobnosti obolelega. Uporaba metod za obvladovanje in trening osnovnih življenjskih aktivnosti, ki omogočajo daljše obdobje samostojnega življenja pacienta z demenco, je v tujini uveljavljena z različnimi novejšimi koomplementarnimi pristopi. Ena izmed uveljavljenih metod je pristop Marie Montessori, prilagojen odraslim pacientom z demenco. V članku je predstavljena metoda montessori pri obravnavi pacienta z demenco in njeni učinki na kakovost življenja pacienta z demenco. Metode: Uporabljena je bila deskriptivna raziskovalna metodologija s pregledom domače in tuje literature. Za prikaz pregleda petih preko spleta dostopnih podatkovnih baz in odločanja o uporabnosti pregledanih virov je bila uporabljena metoda PRISMA. V končni pregled literature je bilo ključenih 19 člankov, objavljenih do maja 2016. Za obdelavo podatkov je bil uporabljen model analize konceptov. Večina zajetih raziskav je bila izvedena v Združenih državah Amerike. Rezultati: Po pregledu raziskav so bila identificirana tri tematska področja: (1) vpliv metode montessori na sodelovanje in prizadevanje, (2) vpliv metode montessori na vedenje, povezano s hranjenjem, in (3) vpliv metode montessori na širšo skupino kognitivnih sposobnosti. Diskusija in zaključek: Kljub majhnemu številu člankov, ki opisujejo uporabo metode montessori pri obravnavi pacientov z demenco, metodo lahko predstavimo kot učinkovito. Avtorji raziskav ugotavljajo, da pristop ne le omogoča ohranjanje kognitivnih sposobnosti, temveč le-te celo izboljšuje.
... L'approche Montessori s'inscrit dans une démarche globale, centrée sur la personne, en incluant des principes fondamentaux, comme favoriser le sentiment de contrôle ou off rir des activités adaptées et porteuses de sens. Aujourd'hui, de nombreuses études ont démontré l'impact de l'utilisation de cette approche sur la diminution de l'apparition des problèmes du comportement [5][6][7] et la baisse des prescriptions médicamenteuses [8]. L'ensemble de l'équipe a pu bénéfi cier, en interne, de la formation intitulée "la méthode Montessori adaptée aux personnes âgées présentant des troubles cognitifs", puis du niveau 2 de la même formation. ...
Article
Trained in the Montessori method, a team takes a very positive approach to their patients. The nurses base their practice on patients' remaining capacities, helping them work around their impairments. They seek to offer each person the possibility to pursue a social life through individualised treatments. Copyright © 2016 Elsevier Masson SAS. All rights reserved.
Article
Background Internationally, person-centred care (PCC) is embedded in the language of regulations and mandated to be practised in residential aged care (RAC). Despite this, PCC has not been fully adopted in RAC in Australia and internationally, and concerns about the quality of care persist. Over the past 2 decades, Montessori for dementia and ageing has been introduced in RAC to support and inform a cultural change towards PCC. This study aimed to examine the intersection between the goals and approaches of Montessori and PCC in RAC. Methods This qualitative descriptive study reports on a secondary analysis of qualitative data from focus groups (FGs) and interviews with residents, family-members, staff, and volunteers from eight RAC homes in Victoria, Australia. Sixteen FGs and 36 interviews were conducted. A qualitative deductive approach using researcher-developed Montessori for dementia and ageing framework for data analysis was applied. Results Findings provide support for the intersection between PCC and Montessori with participants’ descriptions of PCC aligning with many of the goals and approaches of Montessori. Participants most commonly described Montessori approaches of engagement in daily tasks with purposeful roles and promoting cognitive abilities through multi-sensory stimulation. Least frequently-described approaches included focusing on residents’ strengths/abilities, maintaining function, using familiar objects, and guided repetition. Conclusions Findings have important implications for practice to use Montessori as a vehicle that supports and upskills the workforce to deliver care that is person-centred. Future research must examine the resources required to support the implementation and sustainability of Montessori as a vehicle for PCC.
Article
Objective Group activities are commonly offered to residents of nursing homes, and increasingly with a person-centred care approach. The aim of this study is to compare the impacts of a Montessori-based reading activity with a more traditional reading activity. Method A multiple baseline design was used, with 3 groups of 5 older adults with moderate to severe dementia. All sessions were videorecorded and analysed by independent judges, blinded to our hypotheses and conditions. Impacts of the type of activity (storytelling or Montessori-based reading) on verbal interactions, engagement level, affect and behavioural aspects were estimated with both visual analyses and statistical analyses using the between-case standardised mean differences method. Results Significant differences were found in favour of the Montessori-based activities with regard to the number of verbal interactions, constructive and passive engagement and positive affect expressed, with moderate to large effect size (from 0.46 to 1.66). Conclusion The Montessori-based reading group activity really seems to be preferable to a more traditional storytelling activity, with multiple benefits for residents. Depending on the preserved abilities and interests of the participants, it can also be aimed at people with severe dementia.
Article
Background: This paper uses Normalization Process Theory (NPT) to examine staff impressions of Montessori-based program training and implementation at Veterans Affairs Community Living Centers (VA CLCs; nursing homes). Methods: We conducted a mixed-methods evaluation of Montessori Approaches to Person-Centered Care (MAP-VA) at eight VA CLCs. Trainings were conducted as either a live virtual course or a pre-recorded asynchronous class. Two NPT constructs, coherence building and cognitive participation, informed qualitative interview questions, surveys, and analyses focused on staff movement from knowledge to action during initial implementation. Data collection included staff-completed standardized post-training exams ( N = 906), post-training evaluations ( N = 761), and optional validated surveys on perceptions of Montessori training ( N = 307). Champions (peer-leaders) from each CLC completed semi-structured qualitative interviews post-training ( N = 22). Findings: The majority of staff (83%–90%) passed all courses. Staff evaluated the training highly (80%+ agreement) on learning relevant new knowledge and confidence applying new skills. On average, staff felt MAP-VA would become a normal part of their work (7.68/10 scale), and reported increased familiarity with Montessori approaches after training ( p = .002). Qualitative interview data from staff trained in Montessori supported three themes concordant with the NPT dimensions of coherence building and cognitive participation. (1) Coherence regarding Montessori: staff demonstrated an understanding of the program and mentioned the benefits of Montessori compared to their previous usual routines. Cognitive participation or engagement with Montessori: (2) staff had positive feelings about Montessori principles/applications and demonstrated a willingness to try the Montessori approach, and (3) staff made sense of the new intervention through early rehearsal of Montessori principles/practices and recognized opportunities for using Montessori in future interactions. Conclusions: Montessori virtual training resulted in high levels of coherence and cognitive participation among multidisciplinary staff, evidenced by high knowledge, self-efficacy, and readiness to act. The asynchronous and synchronous trainings were accessible, relevant, and supported diverse learners.
Article
Introduction: Nursing home (NH) staff mention knowledge deficits regarding the management of behavioural and psychological symptoms of dementia (BPSDs) in residents with neurocognitive disorders (NCDs). Staff training therefore appears to be necessary, however existing evidence on best training practices and their outcomes remain scattered. This systematic review aimed to: 1) identify the best clinical practices and theoretical bases of staff training interventions on BPSD management in NHs, and 2) summarize the effects of these interventions on resident and staff outcomes. Methods: A mixed methods systematic review was conducted. Two nurse researchers independently searched nine electronic databases to identify studies on the efficacy of staff training interventions aiming BPSD management in NHs, on a variety of resident and staff outcomes. The search was conducted for articles published between 1996 and 2022, using selected keywords, MeSH terms, and predefined eligibility criteria. The methodological quality of the retrieved studies was assessed using JBI checklists. Results: Overall, 39 studies in 47 articles were included. Ten categories of trainings were identified, of which three demonstrated the most promising results on both residents and staff: 1) structured protocols and models, 2) person-centred bathing, and 3) communication techniques. The methodological quality of the retrieved studies was generally weak. Issues with intervention feasibility and reproducibility were also noted. Discussion/conclusion: Training interventions incorporating structured protocols and models, person-centered bathing and communication techniques are associated with better staff and resident outcomes. However, there is a strong need for high-quality research to strengthen existing evidence, ensure feasibility and reproducibility.
Article
Purpose The arts (e.g., music and painting) have received considerable theoretical and observational support as a cognitive stimulation technique for persons living with dementia (PLWD). However, particularly for visual arts, limited empirical support exists. Therefore, the purpose of this study was to pilot a free-form arts program for PLWD in the context of a cognitive stimulation paradigm and measure subsequent engagement, communication, cognitive–linguistic function, and quality of life. Method Three PLWD (one each in mild-to-moderate, moderate, and moderate-to-severe stages) were referred for study participation by a local long-term care facility. A single subject across subjects, ABA reversal design was used to assess intervention effects over a period of 8 weeks, in comparison to an active control condition (cooking activity). Cognitive–linguistic function and quality of life were assessed using standardized measures at baseline and follow-up. Engagement and communication were probed regularly across each study phase. Results Significant changes were seen in participants' engagement and communication during painting sessions compared to the control activity. A nonsignificant positive trend was noted for self-rated quality of life from baseline to follow-up. Pre–post testing revealed nominal change in cognitive–linguistic functions. Conclusions An arts program led to significant increases in constructive engagement and communication and a trend toward increased self-rated quality of life for the three PLWD. The fact that these changes were not sustained outside intervention sessions (i.e., pre–post testing) is consistent with the need for a larger paradigm shift in which rehabilitation specialists—including speech-language pathologists—better integrate creative, meaningful activities into the everyday lives of PLWD to maximize ongoing engagement, communication, and quality of life.
Article
Purpose: This study examined the impact of a Montessori mealtime intervention for people living with dementia to support the mealtime experience of residents and mealtime care practices of staff in a memory support unit. The mealtime intervention was part of a broader culture change project. Method: An observational research design was used to evaluate changes in the mealtime experience and care practices across three time points (baseline, post-implementation, maintenance), spanning 30 months. Five video recordings of the lunch time service (range: 19-32 min) were analysed. The coding protocol comprised pre-determined indicators related to accepted dimensions of person-centred care. Resident and staff behaviours were quantified across four categories: providing choice and preferences, promoting the social side of eating, supporting independence and showing respect towards residents. Staff behaviours that reflected personal enhancing actions and personal detractors were also coded during each mealtime service. Results: A significant increase in staff providing residents with the opportunity for choice and a subsequent significant increase in residents demonstrating choice behaviours was evident. Staff and residents both significantly increased their interactional behaviours, with greater social interaction between staff and residents. Staff further demonstrated greater support for mealtime independence that reached and maintained significance during the final two sampling points. Significant gains observed post implementation were largely maintained and, on specific measures, further increased over time. A significant increase in staff use of personal enhancing actions during mealtime care was also evident. Variability in individual staff and resident behaviour highlighted the complexity of mealtime care and culture change processes. Implications: The study provides novel evidence to support the use of a Montessori mealtime intervention to achieve more person-centred mealtime care, and which resulted in a more respectful, enabling and social dining experience. Clinical implications and direction for future research are presented to build on these findings.
Article
Objectives To identify the core elements of interventions and models that facilitate age‐friendly care for older adults within rural Australian health systems, and assess the extent to which these align with core elements of the Institute for Health Improvement's (IHI) Age‐Friendly Health Systems 4Ms Model. Methods Peer‐reviewed journal articles examining core elements of Australian rural geriatric care models were collected and analysed using an integrative review methodology. Results Identified models and interventions addressed all four core elements of the IHI model—what matters, medications, mobility and mentation. There was more evidence relating to mobility and mentation, with lesser evidence relating to medications and what matters. A series of core elements not aligned with the model were also identified. Conclusions The IHI 4Ms Model appears to be applicable in the rural Australian context. More high‐quality, systematic evidence is needed to investigate the core elements of age‐friendly care across diverse rural contexts.
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The increase in the elderly population is leading care services to reconsider their models of intervention and their practices. When taking care of older adults suffering from Alzheimer’s or dementia, it is fundamental to take into account not only their medical needs, but also any psycho-social dimension that has an impact on their lives and well-being (Kitwood 1997). This contribution presents the first results of an Erasmus+ EU project based on these assumptions. The project, called "SALTO – Social Action for Life Quality Training and Tools" starts by considering that the training of social workers needs to be improved in order to equip professionals with a wider range of approaches and methods to cope with Alzheimer’s and dementia. When dealing with such diseases, it is important to improve people’s quality of life, at the same time minimising the effects of behaviour-related disorders. Long-term care is the responsibility of both medical and social organisations. Elderly care is “medical” because their beneficiaries require care, whether routine or occasional, which is essential for their daily comfort; but they are also “social” because they target protection, independence, social cohesion, active citizenship and the prevention of isolation (Brune 1995, 2011; Calkins 2002; Rahman & Schnelle 2008; Shura, Siders, Dannefer 2010).
Chapter
Person-centered care (PCC) for persons with dementia is based on the belief that personhood can be maintained despite cognitive impairment, and it is considered the gold standard for caring for persons with dementia in long-term care settings. PCC values the individual and honors and facilitates the expression of his/her autonomy. PCC in dementia care is not to be confused with patient-centered care, which is the term used to refer to the engagement of the patient in his/her healthcare in a more general sense. Informal and formal PCC has been utilized in dementia care since the 1990s, with noted differences among countries in implementation, initiatives, progress, and success. This chapter offers an overview of the concept, background, implementation concerns, example PCC models and frameworks, current research evidence, and a list of some useful resources.
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Background: The ability to participate in valued activities, whether for work, leisure or family, is an important aspect of personal identity. In dementia, progressive memory loss means that abilities developed over a lifetime begin to be lost as well, contributing to the loss of self and identity. Some studies have reported that activities or interventions tailored to be meaningful to the person with dementia (defined as any activity important to the individual) are more effective in addressing behavioral and psychological symptoms of dementia (BPSD) and improving quality of life (QoL) than those that are not so tailored. However, the effectiveness of individualizing interventions or activities for this population is not known. Objectives: In response to consumer feedback by the Consumer Dementia Research Network that this question ought to be addressed, this review was undertaken, the aim of which was to determine the effectiveness of meaningful occupation interventions for people living with dementia in residential aged care facilities (RACFs). Inclusion criteria: People living with dementia in RACFs (nursing homes).Any intervention that was individualized to be meaningful to the participant, versus any active control condition or usual care.Experimental and observational studies. Types of outcomes: Quality of life, BPSD (such as agitation, aggression, depression, wandering and apathy), mood, function, cognition and sleep. Search strategy: The search strategy aimed to identify both published and unpublished studies, with the following 12 databases extensively searched: PubMed, CINAHL, PsycINFO, ISI Web of Science, OTSeeker, Embase, Cochrane CENTRAL, clinicaltrials.gov, Mednar, OpenSIGLE, New York Academy of Medicine Library Gray Literature Report, ProQuest Dissertations and Theses. The search strategy was limited to papers published in English between 2004 and January 31, 2015. Methodological quality: All studies were assessed independently by two reviewers for relevance, eligibility and methodological quality. Data extraction: Data from included papers were extracted using a standard data extraction tool. Data synthesis: Where possible, study results were pooled in statistical meta-analysis. Alternatively, results are presented in narrative and tabular form. Results: A total of 5274 citations were identified; after removal of duplicates, assessment for relevance and eligibility, 61 studies underwent critical appraisal. Thirty-four studies met the quality criteria and were included in a quantitative synthesis. A wide range of interventions were evaluated including individualized recreational activities (13 studies), reminiscence therapy (RT) (seven studies), music therapy interventions (six studies), training staff to develop individual care plans using person-centered care (PCC) or similar approaches (three studies), animal-assisted therapy (two studies), multi-sensory interventions (MSIs) (two studies) and social interaction (one study), all of which measured a number of different outcomes. Overall, and in spite of most studies being small-scale and of relatively brief duration, all interventions with the exception of Snoezelen therapy (a MSI) reported some benefits for people with dementia living in RACFs. The most frequently reported benefits were reductions in agitation (the most frequently assessed outcome), passivity and depression, improved QoL and increases in pleasure and interest. However, the majority of studies generally implemented the intervention, whether it was individualized activities, music or RT or other, in conjunction with one-to-one social interaction, and the relative importance of the intervention in comparison to one-to-one social contact for effectiveness cannot be determined from this review. Conclusion: Providing meaningful or individualized tailored activities for people with dementia living in RACFs appears to be effective for a range of behavioral and psychological symptoms. The strongest evidence was for individualized activities/recreational interventions for a range of BPSD; preferred music for agitation, depression and anxiety; and RT for mood and cognitive functioning. Insufficient evidence precluded making recommendations regarding animal-assisted (dog) therapy and training staff to develop individual care plans using PCC or similar approaches, while there was no good quality evidence to show that Snoezelen was effective for any outcome. What remains unclear, however, is whether any of these interventions is more effective than the provision of one-to-one social interaction.
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Background Antipsychotic medications are commonly used to manage the behavioral and psychological symptoms of dementia. Several large studies have demonstrated an association between treatment with antipsychotics and increased morbidity and mortality in people with dementia. Aims To assess the effectiveness of interventions used to reduce inappropriate prescribing of antipsychotics to the elderly with dementia in residential care. Method Systematic searches were conducted in 12 electronic databases. Reference lists of all included studies and forward citation searching using Web of Science were also conducted. All quantitative studies with a comparative research design and studies in which recognized methods of qualitative data collection were used were included. Articles were screened for inclusion independently by 2 reviewers. Data extraction and quality appraisal were performed by 1 reviewer and checked by a second with discrepancies resolved by discussion with a third if necessary. Results Twenty-two quantitative studies (reported in 23 articles) were included evaluating the effectiveness of educational programs (n = 11), in-reach services (n = 2), medication review (n = 4), and multicomponent interventions (n = 5). No qualitative studies meeting our inclusion criteria were identified. Eleven studies were randomized or controlled in design; the remainder were uncontrolled before and after studies. Beneficial effects were seen in 9 of the 11 studies with the most robust study design with reductions in antipsychotic prescribing levels of between 12% and 20%. Little empirical information was provided on the sustainability of interventions. Conclusion Interventions to reduce inappropriate prescribing of antipsychotic medications to people with dementia resident in care homes may be effective in the short term, but longer more robust studies are needed. For prescribing levels to be reduced in the long term, the culture and nature of care settings and the availability and feasibility of nondrug alternatives needs to be addressed.
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In the past twenty years, the importance of the physical and social environments in supporting the person with dementia has gained a much higher profile in dementia care. Despite efforts to move aged care away from the medical model to a more balanced social model of care, we still struggle with the dominance of an institutional context which impedes individuality and choice. This article argues that the experience of the person with dementia should frame the perspective brought to built design and the philosophy of care — in essence, `looking out from the inside'. Shifting the emphasis from condition to experience encourages the culture change needed to create environments that allow the person with dementia to be an active participant in everyday life rather than a passive recipient of care. Based on the development of a resource for residential and respite facilities in Australia, seven living experiences are identified: the presentation of self-experience, eating experience, personal enjoyment experience, bedroom experience, family and community connections experience, end-of-life experience and the staff experience. Each is discussed to show how consideration of the living experiences provides a way to focus thinking for design of the built environment to practically support the person with dementia, thereby addressing the wider spectrum of issues in creating a dementia friendly physical and social environment from the perspective of the person with dementia.
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Aim: To report a study of the relationship between person-centred care and ability to perform activities of daily living, quality of life, levels of pain, depressive symptoms, and agitated behaviours among residents with dementia in residential care facilities. Background: Standardized measurements of person-centred care have not previously been used to investigate the relationship between person-centred care and well-being for residents with dementia in residential aged care units. Design: This study had a cross-sectional design. Method: Staff and resident surveys were used in a sample of 1261 residents with dementia and 1169 staff from 151 residential care units throughout Sweden. Valid and reliable scales were used to measure person-centredness and ability to perform activities of daily living, quality of life, levels of pain, depressive symptoms, and agitated behaviours in residents. All data were collected in May 2010. Findings: Person-centred care was correlated with residents' ability to perform activities of daily living. Furthermore, residents in units with higher levels of person-centred care were rated as having higher quality of life and better ability to perform activities of daily living compared with residents in units with lower levels of person-centred care. Conclusions: There seems to be a relationship between person-centredness, residents' ability to perform activities of daily living, and residents' quality of life. Further studies are needed to explain the variation of person-centredness between units and the extent and ways this might impact on the quality of life and well-being of frail older residents with cognitive impairments in clinical practice.
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Background: Increasingly more attention has been paid to non-pharmacological interventions as treatment of agitated behaviors that accompany dementia. The aim of the current study is to test if personalized one-to-one interaction activities based on Montessori principles will improve agitation, affect, and engagement more than a relevant control condition. Methods: We conducted a randomized crossover trial in nine residential facilities in metropolitan Melbourne, Australia (n = 44). Personalized one-to-one activities that were delivered using Montessori principles were compared with a non-personalized activity to control for the non-specific benefits of one-to-one interaction. Participants were observed 30 minutes before, during, and after the sessions. The presence or absence of a selected physically non-aggressive behavior was noted in every minute, together with the predominant type of affect and engagement. Results: Behavior counts fell considerably during both the Montessori and control sessions relative to beforehand. During Montessori activities, the amount of time spend actively engaged was double compared to during the control condition and participants displayed more positive affect and interest as well. Participants with no fluency in English (all from non-English speaking backgrounds) showed a significantly larger reduction in agitation during the Montessori than control sessions. Conclusion: Our results show that even non-personalized social contact can assist in settling agitated residents. Tailoring activities to residents’ needs and capabilities elicit more positive interactions and are especially suitable for people who have lost fluency in the language spoken predominantly in their residential facility. Future studies could explore implementation by family members and volunteers to avoid demands on facilities’ resources. Trial Registration: Australian New Zealand Clinical Trials Registry – ACTRN12609000564257.
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Alzheimer's Disease International is the worldwide federation of Alzheimer associations that represent people with dementia and their families. Alzheimer's Disease International has commissioned a number of World Alzheimer Reports since 2009 and was involved in the recently launched report Dementia: A Public Health Priority by the World Health Organization. From these reports, we can learn about the growing impact of Alzheimer's disease and other dementias on our societies and the need to take action. Developing national Alzheimer plans is a key tool for this action.
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This paper was written as a result of the International Psychogeriatric Association Task Force on Mental Health Services in Long-Term Care. The appraisal presented here aims to (1) identify the best available evidence that underpins best practice for geriatric mental health education and training of staff working in long-term care, and (2) summarize the appraisal of the literature to provide recommendations for practice. An initial search of databases found 138 papers related to the search strategy. Selected papers were summarized and compared against set inclusion criteria. This resulted in 17 papers suitable for review. The majority of papers focused on behavior skills training. A number of key factors were identified that determine the success of geriatric mental health education and training and recommendations are outlined. Methodological weaknesses are common and highlight the need for further replication studies using strong research designs.
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Psychosocial interventions in long-term care have the potential to improve the quality of care and quality of life of persons with dementia. Our aim is to explore the evidence and consensus on psychosocial interventions for persons with dementia in long-term care. This study comprises an appraisal of research reviews and of European, U.S. and Canadian dementia guidelines. Twenty-eight reviews related to long-term care psychosocial interventions were selected. Behavioral management techniques (such as behavior therapy), cognitive stimulation, and physical activities (such as walking) were shown positively to affect behavior or physical condition, or to reduce depression. There are many other promising interventions, but methodological weaknesses did not allow conclusions to be drawn. The consensus presented in the guidelines emphasized the importance of care tailored to the needs and capabilities of persons with dementia and consideration of the individual's life context. Long-term care offers the possibility for planned care through individualized care plans, and consideration of the needs of persons with dementia and the individual life context. While using recommendations based on evidence and consensus is important to shape future long-term care, further well-designed research is needed on psychosocial interventions in long-term care to strengthen the evidence base for such care.
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A large and growing number of people with dementia are being cared for in long-term care. The empirical literature on the design of environments for people with dementia contains findings that can be helpful in the design of these environments. A schema developed by Marshall in 2001 provides a means of reviewing the literature against a set of recommendations. The aims of this paper are to assess the strength of the evidence for these recommendations and to identify those recommendations that could be used as the basis for guidelines to assist in the design of long term care facilities for people with dementia. The literature was searched for articles published after 1980, evaluating an intervention utilizing the physical environment, focused on the care of people with dementia and incorporating a control group, pre-test-post-test, cross sectional or survey design. A total of 156 articles were identified as relevant and subjected to an evaluation of their methodological strength. Of these, 57 articles were identified as being sufficiently strong to be reviewed. Designers may confidently use unobtrusive safety measures; vary ambience, size and shape of spaces; provide single rooms; maximize visual access; and control levels of stimulation. There is less agreement on the usefulness of signage, homelikeness, provision for engagement in ordinary activities, small size and the provision of outside space. There is sufficient evidence available to come to a consensus on guiding principles for the design of long term environments for people with dementia.
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Nursing assistants provide 90% of the care to the elderly residents of nursing homes, but are the least educated direct-care employees. Supervisory workers believe that nursing assistants require additional training to meet the increasingly complex needs of nursing home residents. A day-long training program for experienced nursing assistants was provided to supplement their basic education. Using a pre- and posttest design, the effectiveness of the program for knowledge acquisition and application was tested. Future education needs were identified through a gap analysis. There was a significant improvement in knowledge for nursing assistants attending the program. The attendees expressed interest in receiving additional education on dementia and infection control. All attendees identified a problem unique to their facility and were able to plan a detailed intervention and develop outcome measures for that plan. Nursing assistants enrolled in this advanced training program expressed a desire for additional education to help them advance their caregiving skills. Advanced education is one method to increase job satisfaction among nursing assistants that can improve the quality of care for nursing home residents.
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This paper provides a systematic review of selected experimental studies of the effectiveness of psychosocial treatments in reducing psychological symptoms in dementia (e.g. anxiety, depression, irritability and social withdrawal). English language reports published or in press by February 2008 were identified by means of database searches and checks of previous reviews. Reports were appraised with respect to study design, participants' characteristics and reporting details. Because people with dementia often respond positively to personal contact, studies were included only if control conditions entailed similar levels of social attention or if one treatment was compared with another. Only 12 of 48 relevant papers met every specification. Treatments proved more effective in reducing psychological symptoms than an attention control condition or another treatment in only six of the 12 selected studies. Interventions with moderate effect sizes included music and recreation therapy. Some psychosocial interventions appear to have specific therapeutic properties, over and above those due to the benefits of participating in a clinical trial. Their effects were generally modest with an unknown duration of action. This limited efficacy suggests that treatments will work best in specific, time-limited situations, tailored to individuals' requirements. There is no preferred method to rate psychological symptoms.
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To provide a systematic review of selected experimental studies of psychosocial treatments of behavioral disturbances in dementia. Psychosocial treatments are defined here as strategies derived from one of three psychologically oriented paradigms (learning theory, unmet needs and altered stress thresholds). English language reports published or in press by December 2006 were identified by means of database searches, checks of previous reviews and contact with recognized experts. Papers were appraised with respect to study design, participants' characteristics and reporting details. Because people with dementia often respond positively to personal contact, studies were included only if control conditions entailed similar levels of social attention or if one treatment was compared with another. Only 25 of 118 relevant studies met every specification. Treatment proved more effective than an attention control condition in reducing behavioral symptoms in only 11 of the 25 studies. Effect sizes were mostly small or moderate. Treatments with moderate or large effect sizes included aromatherapy, ability-focused carer education, bed baths, preferred music and muscle relaxation training. Some psychosocial interventions appear to have specific therapeutic properties, over and above those due to the benefits of participating in a clinical trial. Their effects were mostly small to moderate with a short duration of action. This limited action means that treatments will work best in specific, time-limited situations. In the few studies that addressed within-group differences, there were marked variations in response. Some participants benefited greatly from a treatment, while others did not. Interventions proved more effective when tailored to individuals' preferences.
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The published literature on dementia care mapping (DCM) in improving quality of life and quality of care through practice development and research dates back to 1993. The purpose of this review of the research literature is to answer some key questions about the nature of the tool and its efficacy, to inform the ongoing revision of the tool, and to set an agenda for future research. The DCM bibliographic database at the University of Bradford in the United Kingdom contains all publications known on DCM (http://www.bradford.ac.uk/acad/health/dcm). This formed the basis of the review. Texts that specifically examined the efficacy of DCM or in which DCM was used as a main measure in the evaluation or research were reviewed. Thirty-four papers were categorized into five main types: (a) cross-sectional surveys, (b) evaluations of interventions, (c) practice development evaluations, (d) multimethod evaluations, and (e) papers investigating the psychometric properties of DCM. These publications provide some evidence regarding the efficacy of DCM, issues of validity and reliability, and its use in practice and research. The need for further development and research in a number of key areas is highlighted.
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Six persons in the early to middle stages of dementia ("leaders") were trained in Resident-Assisted Montessori Programming (RAMP) to lead a reading activity for 22 persons with more advanced dementia ("participants") in an adult day health center (ADHC) and a special care unit (SCU) in a skilled nursing facility. Researchers assessed the leaders' abilities to learn and follow the procedures of leading a group, as well as their satisfaction with their roles. In addition, participants' engagement and affect were measured, both during standard activities programming and during client-led activities. Results of this study suggest that persons with dementia can indeed successfully lead small group activities, if several important prerequisites are met. Furthermore, the engagement and affect of participants was more positive in client-led activities than in standard activities programming.
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The aim of this paper is to describe the process of building a multi-level intervention called the Enriched Opportunities Programme, the objective of which is to provide a sustainable activity-based model for people with dementia living in long-term care. It is hypothesised that five key elements need to work together to bring about a sustainable activity-based model of care. These elements are specialist expertise-the staff role of Locksmith was developed as part of this programme; individualised assessment and case work; an activity and occupation programme; staff training; and management and leadership. These elements working together are known as the Enriched Opportunities Programme. This paper reports on the processes undertaken to develop Enriched Opportunities from its inception to the present, and focuses on lessons learnt from the literature, an expert working group and action research in four UK study sites. A blueprint for evaluation in other long-term care facilities is described.
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Over one-third of long-term care (LTC) residents exhibit moderate-tosevere cognitive impairment. These residents are more likely to be inactive, require assistance with activities of daily living, have medical comorbidities, and be exposed to fewer opportunities to engage in functional and physical activities than peers who are cognitively intact or have only mild cognitive deficits. This article will discuss factors that influence the functional performance of older adults with dementia, and benefits and barriers to implementing a function-focused philosophy of care for LTC residents with dementia. Specific strategies for implementation of function-focused care with this population will be described using a social ecological framework.
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Background: There is good evidence of the positive effects of person-centered care (PCC) on agitation in dementia. We hypothesized that a person-centered environment (PCE) would achieve similar outcomes by focusing on positive environmental stimuli, and that there would be enhanced outcomes by combining PCC and PCE. Methods: 38 Australian residential aged care homes with scope for improvement in both PCC and PCE were stratified, then randomized to one of four intervention groups: (1) PCC; (2) PCE; (3) PCC +PCE; (4) no intervention. People with dementia, over 60 years of age and consented were eligible. Co-outcomes assessed pre and four months post-intervention and at 8 months follow-up were resident agitation, emotional responses in care, quality of life and depression, and care interaction quality. Results: From 38 homes randomized, 601 people with dementia were recruited. At follow-up the mean change for quality of life and agitation was significantly different for PCE (p = 0.02, p = 0.05, respectively) and PCC (p = 0.0003, p = 0.002 respectively), compared with the non-intervention group (p = 0.48, p = 0.93 respectively). Quality of life improved non-significantly for PCC+PCE (p = 0.08), but not for agitation (p = 0.37). Improvements in care interaction quality (p = 0.006) and in emotional responses to care (p = 0.01) in PCC+PCE were not observed in the other groups. Depression scores did not change in any of the groups. Intervention compliance for PCC was 59%, for PCE 54% and for PCC+PCE 66%. Conclusion: The hypothesis that PCC+PCE would improve quality of life and agitation even further was not supported, even though there were improvements in the quality of care interactions and resident emotional responses to care for some of this group. The Australian New Zealand Clinical Trials Registry Number is ACTRN 12608000095369.
Article
Objectives: This Australian study examined individual experiences of the implementation of the Capabilities Model of Dementia Care (CMDC) and subsequent outcomes for the care of residents with dementia living in long-term care. Furthermore, this study aimed to explore those factors that facilitated and inhibited the implementation of the new model of care. Methods: The CMDC was developed and then tested in a non-randomised clinical trial. Staff, residents and family experiences of their involvement and perceptions of the model were captured at the end of 12 months. Semi-structured interviews and focus groups were conducted with the 25 participants (12 nursing staff, 6 residents with dementia, 7 family members). Questions varied depending on the participant group but were designed to assess experiences of and changes to care during the intervention. Inductive thematic analysis was used to identify the experiences of the implementation of the CMDC. Results: Five themes included: general reflections on nursing care, implementation of the CMDC intervention, positive outcomes of the CMDC intervention, challenges in the implementation of the CMDC, difficulty sustaining care and tensions between participants' perspectives of care. Conclusion: Positive change resulted from implementation of the CMDC, however, staff mentorship was identified as a key to sustaining changes in practice.
Article
In care homes, antipsychotic medication is commonly prescribed to control so called 'behavioural and psychological symptoms of dementia' such as agitation, aggression, or restlessness. However, it is questionable whether antipsychotic medication is effective and safe. Adverse effects, such as sedation, falls, and cardiovascular symptoms, are frequent. Therefore, antipsychotic medication should be avoided if possible. This review investigates whether psychosocial interventions aimed at reducing antipsychotic medication in care homes are effective. By psychosocial interventions, we mean programmes that consist of different non-pharmacological components including talking to the staff, residents, or both. We identified four randomised controlled trials for inclusion in the review. All studies examined, among other components, education targeted at nursing staff in care homes. The methodological quality of three studies was limited, one study showed high quality. In all studies the interventions led to a reduction of antipsychotic medication use, but the overall magnitude of the effect remains unclear.
Article
Activities programming in long-term care can be an extension of geriatric rehabilitation if activities use rehabilitation principles. Twenty-five residents of a dementia unit participated in a study comparing effects of Montessori-based activities to regular activities programming. Montessori programming uses rehabilitation principles such as task breakdown, guided repetition, and progressing from simple to complex. It also utilizes principles of dementia interventions such as external cue usage and reliance on implicit memory. Montessori programming elicited more constructive engagement and pleasure and less passive engagement and negative affect than other programming. The implications for collaboration among rehabilitation, recreational, and nursing staff are discussed.
Chapter
geriatric psychiatry;dementia;cognitive decline;assessment
Article
Behavioural and psychological symptoms of dementia (BPSD) are highly prevalent and problematic in care settings. Given the limited effectiveness of medical treatments, training care staff to understand and manage these symptoms is essential for the safety and quality of life of people with dementia. This review evaluated the effectiveness of staff training interventions for reducing BPSD. A systematic literature search identified 273 studies. Twenty studies, published between 1998 and 2010, were found to meet the inclusion criteria. Overall, there was some evidence that staff training interventions can impact on BPSD: twelve studies resulted in significant symptom reductions, four studies found positive trends and four studies found no impact on symptoms. No links were found between the theoretical orientation of training programmes and their effectiveness. Training was also found to impact on the way staff behaved towards residents. A quality screening, using pre-specified criteria, revealed numerous methodological weaknesses and many studies did not adhere to the recommended guidelines for the conduct of cluster randomised controlled trials. There is an urgent need for more high quality research and evidence-based practice in BPSD.
Article
To construct and evaluate an intervention tool for increasing the person-centredness of care in residential aged care services. Providing care that is person-centred and evidence-based is increasingly being regarded as synonymous with best quality aged care. However, consensus about how person-centred care should be defined, operationalised and implemented has not yet been reached. Literature reviews, expert consultation (n = 22) and stakeholder interviews (n = 67) were undertaken to develop the Tool for Understanding Residents' Needs as Individual Persons (TURNIP). Statistical estimates of validity and reliability were employed to evaluate the tool in an Australian convenience sample of aged care staff (n = 220). The 39 item TURNIP conceptualised person-centred care into five dimensions: (1) the care environment, (2) staff members' attitudes towards dementia, (3) staff members' knowledge about dementia, (4) the care organisation and (5) the content of care provided. Psychometric testing indicated satisfactory validity and reliability, as shown for example in a total Cronbach's alpha of 0·89. The TURNIP adds to current literature on person-centred care by presenting a rigorously developed intervention tool based on an explicit conceptual structure that can inform the design, employment and communication of clinical interventions aiming to promote person-centred care. The TURNIP contains clinically relevant items that are ready to be applied in clinical aged care. The tool can be used as a base for clinical interventions applying discussions in aged care organisations about the quality of current care and how to increase person-centredness of the care provided.
Article
Agitation is a significant problem for elderly persons, their families, and their caregivers. This study describes the agitated behaviors of 408 nursing home residents. Nurses who were familiar with the residents used a 7-point scale to rate how often each resident manifested 29 agitated behaviors. Each resident was rated independently by three nurses, one from each of the three nursing shifts. Results showed that agitated behaviors occurred most often during the day shift (i.e., when residents were most active), and least often during the night shift. The most frequently exhibited agitated behaviors were general restlessness, pacing, repetitious sentences, requests for attention, complaining, negativism, and cursing. Most agitated behaviors correlated significantly across shifts, suggesting that such behaviors occur and reoccur throughout the 24-hour day. Factor analysis yielded three syndromes of agitation: aggressive behavior, physically nonaggressive behavior, and verbally agitated behavior. These results provide a foundation for further studies of agitation in elderly persons.
Article
Some foundations are laid for a social-psychological theory of dementia care. Central to this is a conceptualisation of personhood, in which both subjectivity and intersubjectivity are fully recognised. Evidence is brought forward concerning relative well-being even in those who are, from a cognitive standpoint, severely demented. In the light of this it is argued that the key psychological task in dementia care is that of keeping the sufferer's personhood in being. This requires us to see personhood in social rather than individual terms.
Article
The purpose of this study was to determine the effects of an activity implemented by means of Resident-Assisted Montessori Programming (RAMP). Four persons with early-stage dementia were trained to serve as leaders for a small-group activity played by nine persons with more advanced dementia. Assessments of leaders' ability to learn the procedures of leading a group, as well as their satisfaction with this role, were taken, as were measures of players' engagement and affect during standard activities programming and RAMP activities. Leaders demonstrated the potential to fill the role of group activity leader effectively, and they expressed a high level of satisfaction with this role. Players' levels of positive engagement and pleasure during the RAMP activity were higher than during standard group activities. This study suggests that to the extent that procedural learning is available to persons with early-stage dementia, especially when they are assisted with external cueing, these individuals can successfully fill the role of volunteers when working with persons with more advanced dementia. This can provide a meaningful social role for leaders and increase access to high quality activities programming for large numbers of persons with dementia.
Article
When caring for people with severe Alzheimer's disease (AD), the concept of the person being central is increasingly advocated in clinical practice and academia as an approach to deliver high-quality care. The aim of person-centred care, which emanates from phenomological perspectives on AD, is to acknowledge the personhood of people with AD in all aspects of their care. It generally includes the recognition that the personality of the person with AD is increasingly concealed rather than lost; personalisation of the person's care and their environment; offering shared decision-making; interpretation of behaviour from the viewpoint of the person; and prioritising the relationship as much as the care tasks. However, questions remain about how to provide, measure, and explore clinical outcomes of person-centred care. In this Review, we summarise the current knowledge about person-centred care for people with severe AD and highlight the areas in need of further research.
Designing and Implementing Successful Dementia Care Services
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