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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models of dementia care commonly merge aspects of existing models with additional influences from published and unpublished evidence and existing government policy.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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... Another person-centered approach to dementia care, the ABLE model, 13 includes elements from a social ecological model and the Montessori method. 14,15 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. ...
... In 2011, the administrators of Rural Northwest Health in Australia decided to trial the ABLE care model on one unit of their facility. 13 The Wattle unit consisted of 16 residents (all of whom had a diagnosis of moderate to severe dementia based on the Psychogeriatic Assessment Scales 16 ; 75% received antipsychotic or sedative medications at baseline, and mean Cohen Mansfield Agitation Inventory score was 80.0 [standard deviation 14.3] 17 ). The key features of the implementation included: (1) stakeholder engagement-prior to implementation, planning meetings were held with staff, residents, families, nurse unit manager, dementia consultant, cognitive rehabilitation therapist, and project manager; (2) education and training-18 staff received 2 days of dementia care and Creating Montessori Environments training and ongoing mentoring and support from a dementia consultant for 18 months; and (3) environmental changes based on Montessori principles-colorful, homelike interior spaces for specific uses (e.g., music, reading, physical activities, social interaction, domestic activities) included signage and name badges, interactive wall space, and exterior space contained many features of a rural home environment (e.g., chicken coop, raised garden beds, barbeque). ...
... Qualitative analysis of family surveys conducted 20 months after implementation revealed "overwhelmingly positive" responses. 13 Independent observers made an unannounced visit to Wattle in June 2013 and reported that all residents engaged in activities without staff prompting (e.g., polishing silverware, polishing shoes, setting the table, rolling bandages, sorting silverware, washing and drying dishes) and several residents engaged in specific roles (e. g., updating wall calendar, offering beverages to peers, giving hand massages to peers, sweeping the floor, making their bed). All residents and staff wore a name badge, and when introduced to the visitor ("I'd like to introduce you to my friend from America"), the resident replied, "Nice to meet you, Michelle" (having read the name badge). ...
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Efforts to improve the quality of life of persons with dementia in long-term care through the implementation of various approaches to person-centered care have been underway for the past two decades. Studies have yielded conflicting reports evaluating the evidence for these approaches. The purpose of this article is to outline the findings of several systematic reviews of this literature, highlighting the areas of improvement needs, and to describe a new person-centered care model, DementiAbility Methods: The Montessori Way. This model focuses on the abilities, needs, interests, and strengths of the person and creating worthwhile and meaningful roles, routines, and activities for the person within a supportive physical environment. This is accomplished through gaining the commitment of the facility's leaders, training staff, and monitoring program implementation. The potential for a culture change in long-term care environments is dependent on the development and rigorous evaluation of person-centered care approaches. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
... 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]. ...
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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.
... 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.
... 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.
... 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.
... 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.
... 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. ...
Article
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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.
... 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. ...
... 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]. ...
Article
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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.
... 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.
... 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.
... 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. ...
Article
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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.
... The effects of providing engaging activities to long-term care residents have been well documented. These in-clude increased positive engagement, decreased challenging behaviors, increased positive effect, decreased medication usage, etc. [1] [2]. In practice, however, provision of activities generally is sporadic, and often given a low priority. ...
... 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
... 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]. ...
... 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.
... 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.
... 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.
... 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.
... 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. ...
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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.
... 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. ...
... 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]. ...
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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.
... 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]. ...
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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.
Article
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.
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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.
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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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.
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.
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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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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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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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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.
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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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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
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.
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.
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