Christine Neville

Literature review: use of respite by carers of people with dementia

Respite care is a cornerstone service for the home management of people with dementia. It is used by carers to mitigate the stress related to the demands of caring by allowing time for them to rest and do things for themselves, thus maintaining the caring relationship at home and perhaps forestalling long-term placement in a residential aged care facility. Despite numerous anecdotal reports in support of respite care, its uptake by carers of people with dementia remains relatively low. The aim of this paper was to examine the factors that constitute the use of respite by carers of people with dementia by reviewing quantitative and qualitative research predominantly from the years 1990 to 2012. Seventy-six international studies of different types of respite care were included for this review and their methods were critically appraised. The key topics identified were in relation to information access, the barriers to carers realising need for and seeking respite, satisfaction with respite services including the outcomes for carers and people with dementia, the characteristics of an effective respite service and the role of health workers in providing appropriate respite care. Finally, limitations with considering the literature as a whole were highlighted and recommendations made for future research.

Pain management skills of regional nurses caring for older people with dementia: A needs analysis

An exploratory survey of the pain management education needs of 197 nurses working with older people with dementia was undertaken in a regional area of Queensland, Australia. The analysis indicated that nurses in this setting might not have the knowledge base to manage pain effectively; and that respondents have essentially negative perceptions of the availability and appropriateness of current pain management education programs. Consistent with non-metropolitan nurses generally, respondents expressed a preference for pain management education that had a significant face-to-face component allied with ongoing mentorship and support on completion of the program. The obstacles to attending such programs were also typical of the problems facing regional and rural nurses throughout Australia. These were identified as: inability to pay for courses; lack of information on what is available; distance to travel to education; and a perceived lack of employer support due to an inability to replace those staff attending education. Positive aspects include the degree to which participants were responsive and interested in dementia pain management and their access to, and acceptance of, non-medical pain therapies. The findings suggest a definite need for a dementia pain management program for aged care nurses, specifically tailored to their needs and to the constraints of the regional practice setting.

Anxiety, anxiety symptoms, and associations among older people with dementia in assisted-living facilities

Anxiety is a major cause for distress among older people with dementia, and it impedes care. In order to develop interventions to treat anxiety and identify who might be most likely to benefit, mental health nurses need to understand what clinical and demographic factors are associated with anxiety in dementia. This cross-sectional study is a detailed assessment of anxiety in people living in assisted-living facilities using the Rating Anxiety in Dementia (RAID) scale and the Clinical Anxiety Scale (CAS). One hundred and forty-eight people, with a mean age of 86.2 years, were recruited from 19 assisted-living facilities in the USA. Prevalence rates for anxiety were 11% and 18%, as measured on the RAID and CAS, respectively. One or more symptoms of anxiety were exhibited for 49% (RAID) and 48% (CAS) of participants. Behavioural symptoms and the presence of depression strongly predicted anxiety, as did staffs reaction to behavioural symptoms and their sense of competence to care. These findings demonstrate that anxiety is prominent enough to warrant further investigation and treatment, and that anxiety in older people with dementia is closely associated with staff skill. This study has also identified areas for mental health nurses to target interventions.

What’s Stopping a Career in Gerontological Nursing?: Literature Review

Despite the rapid aging of the worlds population, many countries are experiencing difficulty in recruiting nurses to work with older people. A literature review was conducted regarding the career preferences of undergraduate nursing students from seven different countries. The literature review has identified that gerontological nursing does not feature highly as a career goal. Notably, this has been the situation for the past decade. There is no indication that the situation is going to change at any time in the future unless some serious decisions are made at professional, health service, community, and government levels. This literature review has identified the reasons why undergraduate nurses are not choosing gerontological nursing as a career, what has been done in an attempt to address the problem, and what else may be done.

Relative and absolute reliability of functional performance measures for adults with dementia living in residential aged care

BACKGROUND This pilot investigation aimed to assess the relative and absolute test-retest reliability of commonly used functional performance measures in older adults with dementia residing in residential aged care facilities. METHODS A total of 12 participants were tested on the Short Physical Performance Battery (SPPB), the Balance Outcome Measure for Elder Rehab (BOOMER), hand grip strength, anthropometric measures and Bio-electric Impedance Analysis (BIA). This study utilized a seven-day test-retest evaluation. Intra-class Correlation Coefficients (ICC) were used to assess relative reliability, Typical Error of Measurement (TEM) was used to assess the absolute reliability, and Bland-Altman plots were used to assess group and individual levels of agreement. RESULTS With the exception of Standing Balance (ICC = 0.49), 2.4-m walk (ICC = 0.68), functional reach (ICC = 0.38), and static timed standing (ICC = 0.47), all measures demonstrated acceptable (>0.71) ICCs. However, only the anthropometric measures demonstrated acceptable levels of absolute reliability (>10% TEM). Bland-Altman analysis showed non-significant (p > 0.05) mean differences, and eight out of the 17 measures showing wide Limits of Agreement (LoA). CONCLUSIONS Current measures of functional performance are demonstrably inappropriate for use with a population of older adults with dementia. Authors suggest aligning current measurement strategies with Item Response Theory as a way forward.

The impact of residential respite care on the behavior of older people

BACKGROUND The aim of this study was to examine the impact of residential respite care on disruptive behavior displayed by older people, particularly those with dementia. METHODS A quasi-experimental, repeated-measures, single-group design was used. The participants were a consecutive series of 100 older people with a mean age of 81.8 years (range 66-96 years) who had been booked for a respite admission to one of several residential aged care facilities in a provincial Australian city. A diagnosis of dementia was reported for 29% of the sample. Disruptive behaviors were rated before and after the period of respite by home caregivers (N = 100) and during the period of respite by nurses (N = 25) using the Dementia Behavior Disturbance Scale (DBDS). RESULTS Age, male gender and the presence of dementia were all significantly related to the frequency of reported disruptive behaviors. Residential respite care was associated with a significant reduction in the frequency of reported disruptive behaviors in older people (Wald chi2 = 28.28, p < 0.0001). However, this improvement in behavior did not persist into the post-respite period. The deteriorating behavioral trajectory that was evident prior to respite care continued following the period of respite care. CONCLUSIONS Residential respite care was associated with a temporary diminution in the frequency of reported disruptive behaviors in older people. This finding should be reassuring both for family carers considering placing a relative in residential respite care and for health workers considering whether to recommend such a course of action.

The effectiveness of group reminiscence therapy for loneliness, anxiety and depression in older adults in long-term care: A systematic review

Loneliness, anxiety and depression are common problems for older adults in long-term care. Reminiscence therapy is a non-pharmacological intervention that may be of some benefit. In comparison to individual reminiscence therapy, group reminiscence therapy is a preferred option when dealing with the resource constraints of long-term care. The aim of this paper was to systematically review the literature in order to explore the effectiveness of group reminiscence therapy for older adults with loneliness, anxiety and depression in long-term care. Results indicated that group reminiscence therapy is an effective treatment for depression in older adults, however to date, there is limited research support for its effectiveness to treat loneliness and anxiety. Further research and an improvement in methodological quality, such as using qualitative and mixed methods approaches, is recommended to help establish an evidence base and provide better understanding of the effectiveness of group reminiscence therapy.

Exploring the effect of aquatic exercise on behaviour and psychological well‐being in people with moderate to severe dementia: A pilot study of the Watermemories Swimming Club

To explore the effects of a dementia‐specific, aquatic exercise intervention on behavioural and psychological symptoms in people with dementia (BPSD).

A Psychometric Evaluation of Three Pain Rating Scales for People with Moderate to Severe Dementia

Little comparative information exists regarding the reliability and validity of pain rating scales for nurses to assess pain in people with moderate to severe dementia in residential aged care facilities. The objective of this study was to evaluate the relative psychometric merits of the Abbey Pain Scale, the DOLOPLUS-2 Scale, and the Checklist of Nonverbal Pain Indicators Scale, three well-known pain rating scales that have previously been used to assess pain in nonverbal people with dementia. An observational study design was used. Nurses (n = 26) independently rated a cross-section of people with moderate to severe dementia (n = 126) on two occasions. The Abbey Pain Scale and the DOLOPLUS-2 Scale showed good psychometric qualities in terms of reliability and validity, including resistance to the influence of rater characteristics. The Checklist of Nonverbal Pain Indicators Scale also had reasonable results but was not as psychometrically strong as the Abbey Pain Scale and DOLOPLUS-2 Scale. This study has provided comparative evidence for the reliability and validity of three pain rating scales in a single sample. These scales are strong, objective adjuncts in making comprehensive assessments of pain in people who are unable to self-report pain due to moderate to severe dementia, with each having their own strengths and weaknesses. The DOLOPLUS-2 Scale provides more reliable measurement, and the Abbey Pain Scale may be better suited than the other two scales for use by nurse raters who only occasionally use pain rating scales or who have lower level nursing qualifications.

Nurses' role in caring for people with a comorbidity of mental illness and intellectual disability: A literature review

This article examines literature on the role of the nurse caring for people with a dual disability (DD) of intellectual disability and mental illness. A search of the literature between 2000 and 2010 resulted in a total of 21 articles that met the inclusion criteria. Seven key categories of the role of the nurse were identified: (i) advocacy/health promotion (including working with family); (ii) assessment/case management; (iii) behavioural interventions; (iv) communication; (v) leadership and the nurses role within the multidisciplinary team; (vi) functions regarding medication administration; and (vii) safety/risk management. There is a paucity of research about the role of nurses working with people with DD, although a number of opinion-based articles exist. This article identifies a need for the role of the nurse working in DD to be more clearly articulated and for the development of evidence to guide best practice.