Anthony Scerri

Continence care for people with dementia living at home in Europe: a review of literature with a focus on problems and challenges.

AIMS AND OBJECTIVES To report the findings of a review of literature relating to the continence care of community-dwelling people with dementia in Europe. BACKGROUND More than two-thirds of people with dementia live at home, and many experience continence problems. Incontinence is a significant contributor towards institutionalisation. Care and support is often inadequate or inappropriate, and guidelines are lacking. This represents a failure to respect the human rights and dignity of this group. DESIGN A structured review of the literature relating to the continence care of community-dwelling people with dementia in Europe with a focus on problems and challenges. METHODS Search terms reflecting dementia, continence, care/management and guidelines for community-dwelling people with dementia were applied to four databases. Hand-searching was also carried out. A total of 208 articles were searched for content relating to problems and challenges linked to continence care for this group. RESULTS Six relevant articles were fully reviewed. The main difficulties and challenges included the following: (1) perceptions, (2) availability/provision of support and care, (3) financial cost, (4) mobility and the environment, (5) relationships and social inclusion and (6) emotional issues. CONCLUSION Dementia and incontinence have profound effects on quality of life. The dearth of good quality data within this area and the findings of the review confirm the need for expert, consensus-based guidelines and appropriate research to ensure that the rights and dignity of people with dementia are respected. RELEVANCE TO CLINICAL PRACTICE The findings of the review will hopefully raise awareness amongst healthcare professionals in community practice of unmet needs of people with dementia and continence problems, and their caregivers, especially those related to social, financial, emotional and relational issues. The review does not provide solutions or guidance but is helpful in highlighting some of the key areas where special attention is needed.

Using appreciative inquiry to implement person-centred dementia care in hospital wards

The quality of care of persons with dementia in hospitals is not optimal and can be challenging. Moreover, staff may find difficulty in translating what they have learned during training into practice. This paper report the development and evaluation of a set of workshops using an appreciative inquiry approach to implement person-centred dementia care in two hospital wards. Staff worked collaboratively to develop a ward vision and to implement a number of action plans. Using appreciative inquiry approach, staff attitudes towards persons with dementia improved, inter-professional collaboration was enhanced and small changes in staff practices were noted. Dementia care in hospitals can be enhanced by empowering staff to take small but concrete actions after they engage in appreciative inquiry workshops, during which they are listened to and appreciated for what they can contribute.

Outcomes in knowledge, attitudes and confidence of nursing staff working in nursing and residential care homes following a dementia training programme

ABSTRACT Objectives: Dementia training programmes for staff working in long-term care settings have been found to be effective in improving staff outcomes. This study investigated the impact of a dementia training programme for all Maltese nursing staff working in public nursing/residential homes on their knowledge, attitudes and confidence. Additionally, we identified the predictors of these domains before and after the programme. Method: A 14-hour training programme focusing on dementia management, care and policy was developed for all nursing staff working in public nursing and residential homes in Malta. A pretest-posttest design was used to evaluate the participants’ knowledge of dementia, attitudes and confidence in working with residents with dementia using validated tools. Demographic variables were measured and compared with each staff domain. Results: The majority of nursing staff attended the training programme with 261 fully completed questionnaires being collected pre-training and 214 post-training. The programme significantly improved nursing staff knowledge, attitudes and confidence. Stepwise regression analysis of each staff domain showed that the strongest predictor in all models at pre-training was the intensity of previous training programmes. Furthermore, staff who attended previous training continued to improve in their attitudes and confidence following programme completion. Conclusion: The study continues to shed further evidence on the impact of dementia training programs on staff outcomes. It also indicated that the intensity of previous participation in dementia training programmes was related to the participants’ knowledge, attitudes and confidence and that continual exposure to training had a cumulative effect.

Training Older Adults about Alzheimer's Disease--Impact on Knowledge and Fear.

ABSTRACT Although the impact of Alzheimer’s disease training programs directed to informal and formal caregivers has been extensively studied, programs for older adults who do not have the disease are relatively few. Moreover, increased knowledge increases fear of the disease, even though there is little empirical evidence to support this. This study investigated the impact of an Alzheimer’s disease training program for older persons on their knowledge and fear of the condition. Participants consisted of 110 older adults who voluntarily applied for a 16-hour course as part of the University of the Third Age. A questionnaire, consisting of two validated tools (Alzheimer’s Disease Knowledge Scale and the Fear of Alzheimer’s Disease Scale), was distributed pre- and posttraining to the participants. Sixty-six questionnaires (response rate = 60%) were collected at the start of the program and 46 at the end (response rate = 42%). Participants’ fear at pretraining was significantly related to their current knowledge of the disease. Training significantly improved knowledge of the disease, but the participants’ perceived fear did not change. The study indicated that an Alzheimer’s disease training program for older persons can increase their knowledge, but it does not necessarily increase their fear. Training programs aimed at raising awareness of Alzheimer’s disease should target more effectively this age cohort who may be concerned and are seeking learning opportunities to know more about the condition.

Reframing dementia care in Maltese Hospitals

This commentary addresses the urgent need to improve the care of patients with dementia and cognitive impairment in Maltese hospitals by proposing a number of dementia-friendly hospital-based initiatives. The authors discuss the rationale for developing these interventions in view of the increase in prevalence of persons with dementia in the Maltese Islands, some of whom may require hospital care at any time. Lessons learned from initiatives abroad are reviewed and an overview of the key objectives set out in the National Strategy for Dementia in the Maltese Islands is given. Finally, this article proposes a number of dementiafriendly initiatives that can be introduced in Maltese hospitals so as to induce the required change.

DETERMINANTS OF GOOD DEMENTIA CARE PRACTICES WITHIN A REHABILITATION HOSPITAL SETTING

tance and support. An analysis of the current situation in vocational nursing training and advanced training options related to dementia reveals that, in recent years, dementia-related tasks have becomemore important. However, qualifications for the occupational field of ambulatory, network-based care of dementia is lacking. Therefore, the DZNE Rostock/Greifswald is developing und evaluating an innovative qualification system for nurses for a Dementia Care Manager (DCM). We conducted a survey to evaluate (1) the tasks that nurses, as DCM, should cover (2) the qualification demands and content implied by these tasks. The survey included questionnaire-based interviews with nurses, GPs, and caregivers. Based on the scope of tasks and the required skills for DCM for patients with dementia in their home environment, a comparison of the content of the curriculum for traditional vocational nursing was conducted. The analysis allows to define the specific qualifications necessary for nurses to deliver high-quality care for patients with dementia and their caregivers. Results: At the time of this survey, 31 GPs, 145 Nurses and 106 caregivers agreed to participate in the survey. Based on the results of this survey, we derived an initial version of the curriculum for dementia care management. The qualification requires 1192 hours, including 872 hours of theoretical qualification and 320 hours of practical work (Figure 1). The hours for the qualification modules are determined by the necessary extent of studies for the individual qualification contents that must be taught. The first version of the curriculum was developed from the identified qualification requirements, and theoretical and practical qualifications for nurses as DCM’s were derived. T he curriculumwas evaluated during the theoretical qualification. After the end, the nurses and referents complete a questionnaire to evaluate the contents. A discussion will be conducted between experts and the project employees to review important aspects of the work of the DCM’s and the curriculum as well.