Eva S. van der Ploeg

Evaluation of personalised, one-to-one interaction using Montessori-type activities as a treatment of challenging behaviours in people with dementia: the study protocol of a crossover trial

BackgroundThe agitated behaviours that accompany dementia (e.g. pacing, aggression, calling out) are stressful to both nursing home residents and their carers and are difficult to treat. Behaviours stemming from pain, major depression or psychosis benefit from treatment with analgesics, antidepressants or antipsychotics. In other cases, psychotropic medications have limited efficacy but are used very widely. Therefore, increasingly more attention has been paid to nonpharmacological interventions which are associated with fewer risks. The aim of the current study is to test if personalised one-to-one interaction activities based on Montessori principles will reduce the frequency of behavioural symptoms of dementia significantly more than a relevant control condition.Methods/DesignWe will conduct a controlled trial with randomised cross-over between conditions. Persons with moderate to severe dementia and associated behavioural problems living in aged care facilities will be included in the study. Consented, willing participants will be assigned in random order to Montessori or control blocks for two weeks then switched to the other condition. Montessori activities derive from the principles espoused by Maria Montessori and subsequent educational theorists to promote engagement in learning, namely task breakdown, guided repetition, progression in difficulty from simple to complex, and the careful matching of demands to levels of competence. The control intervention consists of conversation or reading from and looking at pictures in a newspaper to control for non-specific benefits of one-to-one interaction. Presence of target behaviour will be noted as well as level of engagement and type of affect displayed. Secondary measures also include the Cohen-Mansfield Agitation Inventory and information on time and funds spend to prepare the activities.DiscussionIf our results show that use of Montessori activities is effective in treating challenging behaviours in individuals with dementia, it will potentially provide a safer and more enjoyable intervention rather than reliance on pharmacology alone.Trial RegistrationAustralian New Zealand Clinical Trials Registry - ACTRN12609000564257

A cross-sectional study to compare care needs of individuals with and without dementia in residential homes in the Netherlands

BackgroundLittle is known about met and unmet needs of individuals in residential care, many of whom suffer from dementia. Unmet needs are associated with a decreased quality of life, worse mental health, dissatisfaction with services, and increased costs of care. The aim of this study was to compare the number and type of (unmet) needs of people with and without dementia in residential care in the Netherlands.Methods187 individuals in residents care or their relatives were interviewed to identify their care needs on 24 topics using the Camberwell Assessment of Needs for the Elderly (CANE) interview.ResultsIndividuals diagnosed with probable dementia reported more needs in total and more unmet needs in comparison with individuals without this diagnosis. More specifically, differences were found for the topics “accommodation”, “money”, “benefits”, “medication management”, “incontinence”, “memory problems”, “inadvertent self-harm”, “company” and “daytime activities”.ConclusionsIt seems that the differences in care needs between individuals with and without dementia can be attributed to actual differences in physical and cognitive functioning. Residents with dementia reported more often unmet needs which might imply that care for people with dementia can still be better attuned to their needs.

A literature review of spaced-retrieval interventions: a direct memory intervention for people with dementia

BACKGROUND With the increasing prevalence of dementia, there is a pressing need to identify effective interventions that prolong independent functioning. As pharmacological interventions aimed at slowing cognitive decline have been found to have a number of limitations, research has now moved toward studying complementary non-pharmacological cognitive training interventions. This review describes the use of spaced-retrieval as a method to teach new information and reduce behavioral problems in people with dementia. METHODS We searched the databases PsychINFO, MEDLINE, and Scopus as well as reference lists of relevant papers to identify articles describing the use of spaced-retrieval with people with dementia. Only primary, peer-reviewed research published in English was included in this review. RESULTS In total, 34 studies were identified, three of which were randomized controlled trials. We found that across studies, there was wide variability with regard to design, methodology, and outcome measures used. Nonetheless, the existing research demonstrates that spaced-retrieval training can be successfully used to teach people with dementia new and previously known face- and object-name associations, as well as cue-behavior associations aimed at alleviating problem behaviors and improving functional skills. The method can also assist with the recollection of past events. CONCLUSIONS Current evidence indicates that spaced-retrieval training is effective in enabling people with dementia to learn new information and behavioral strategies. Future research should attempt to address the limitations outlined in this review and focus on utilizing this technique to achieve more functional and clinically relevant outcomes. Recommendations are also made with regard to investigating potential secondary benefits of spaced-retrieval and strengthening study design.

The potential of volunteers to implement non-pharmacological interventions to reduce agitation associated with dementia in nursing home residents.

BACKGROUND Advanced dementia may be accompanied by behavioral and psychological symptoms of dementia (BPSD). BPSD stemming from pain, depression, or psychosis benefit from treatment with drugs, but in other cases, medications have limited efficacy and may elicit adverse effects. Therefore, more attention has been paid to non-pharmacological interventions, which have fewer risks and can be successful in reducing agitation and negative mood. However, these interventions are frequently not implemented in nursing homes due to staffing constraints. This study explores the potential of volunteers to further assist staff. METHODS We interviewed 18 staff members and 39 volunteers in 17 aged care facilities in southeast Melbourne, Australia. RESULTS Three-quarters of the facilities in this region worked with at least one regular volunteer. Both self-interest and altruistic reasons were identified as motives for volunteering. Volunteers were perceived by facility representatives as helpful to residents through provision of stimulation and company. However, they were discouraged from engaging with individuals with prominent BPSD. A majority of facility representatives and volunteers had experienced some difficulties in negotiating working relationships but most were easily resolved. A large majority of volunteers expressed an interest in learning new methods of interacting with residents. CONCLUSION Despite their beneficial effects for agitated residents, non-pharmacological interventions are often not implemented in aged care facilities. Staff members often lack time but current volunteers in the sector are available, experienced, and interested in learning new methods of interacting. Volunteers therefore potentially are a valuable resource to assist with the application of new treatments.

The study protocol of a blinded randomised-controlled cross-over trial of lavender oil as a treatment of behavioural symptoms in dementia

BackgroundThe agitated behaviours that accompany dementia (e.g. pacing, aggression, calling out) are stressful to both nursing home residents and their carers and are difficult to treat. Increasingly more attention is being paid to alternative interventions that are associated with fewer risks than pharmacology. Lavandula angustifolia (lavender) has been thought, for centuries, to have soothing properties, but the existing evidence is limited and shows mixed results. The aim of the current study is to test the effectiveness of topically applied pure lavender oil in reducing actual counts of challenging behaviours in nursing home residents.Methods/DesignWe will use a blinded repeated measures design with random cross-over between lavender oil and placebo oil. Persons with moderate to severe dementia and associated behavioural problems living in aged care facilities will be included in the study. Consented, willing participants will be assigned in random order to lavender or placebo blocks for one week then switched to the other condition for the following week. In each week the oils will be applied on three days with at least a two-day wash out period between conditions. Trained observers will note presence of target behaviours and predominant type of affect displayed during the 30 minutes before and the 60 minutes after application of the oil. Nursing staff will apply 1 ml of 30% high strength essential lavender oil to reduce the risk of missing a true effect through under-dosing. The placebo will comprise of jojoba oil only. The oils will be identical in appearance and texture, but can easily be identified by smell. For blinding purposes, all staff involved in applying the oil or observing the resident will apply a masking cream containing a mixture of lavender and other essential oils to their upper lip. In addition, nursing staff will wear a nose clip during the few minutes it takes to massage the oil to the residents forearms.DiscussionIf our results show that the use of lavender oil is effective in reducing challenging behaviours in individuals with dementia, it will potentially provide a safer intervention rather than reliance on pharmacology alone. The studys findings will translate easily to other countries and cultures.Trial RegistrationAustralian New Zealand Clinical Trials Registry - ACTRN 12609000569202

The study protocol of a cluster-randomised controlled trial of family-mediated personalised activities for nursing home residents with dementia

BackgroundFollowing admission to a nursing home, the feelings of depression and burden that family carers may experience do not necessarily diminish. Additionally, they may experience feelings of guilt and grief for the loss of a previously close relationship. At the same time, individuals with dementia may develop symptoms of depression and agitation (BPSD) that may be related to changes in family relationships, social interaction and stimulation. Until now, interventions to alleviate carer stress and BPSD have treated carers and relatives separately rather than focusing on maintaining or enhancing their relationships. One-to-one structured activities have been shown to reduce BPSD and also improve the caring experience, but barriers such as a lack of resources impede the implementation of activities in aged care facilities. The current study will investigate the effect of individualised activities based on the Montessori methodology administered by family carers in residential care.Methods/DesignWe will conduct a cluster-randomised trial to train family carers in conducting personalised one-to-one activities based on the Montessori methodology with their relatives. Montessori activities derive from the principles espoused by Maria Montessori and subsequent educational theorists to promote engagement in learning, namely task breakdown, guided repetition, progression in difficulty from simple to complex, and the careful matching of demands to levels of competence. Persons with dementia living in aged care facilities and frequently visiting family carers will be included in the study. Consented, willing participants will be randomly assigned by facility to a treatment condition using the Montessori approach or a control waiting list condition. We hypothesise that family carers conducting Montessori-based activities will experience improvements in quality of visits and overall relationship with the resident as well as higher self-rated mastery, fewer depressive symptoms, and a better quality of life than carers in the waiting list condition.DiscussionWe hypothesise that training family carers to deliver personalised activities to their relatives in a residential setting will make visits more satisfying and may consequently improve the quality of life for carers and their relatives. These beneficial effects might also reduce nursing staff burden and thus impact positively on residential facilities.Trial RegistrationAustralian New Zealand Clinical Trials Registry - ACTRN12611000998943

Methodological challenges in studies of bright light therapy to treat sleep disorders in nursing home residents with dementia

Numerous studies have explored the effectiveness of bright light therapy as a treatment of sleep disorders in nursing home and long‐stay geriatric hospital residents, most of whom have dementia. A recent Cochrane Collaboration meta‐analysis of 10 selected studies concluded that there was insufficient evidence to assess its therapeutic efficacy as most available studies had methodological problems. We sought to remedy this situation by developing proposals to guide research methods in future studies.

A personalized multimedia device to treat agitated behavior and improve mood in people with dementia: A pilot study

Agitated behaviors and dysphoric moods in nursing home residents with dementia may be a response to a lack of personalized, meaningful activity and stimulation. To address this deficiency, a personal computer was adapted to play favorite music and display photographs, movies and messages that were selected or made by family members. The system (called Memory Box) is accompanied by a simplified interface to help people with dementia access material independently. The systems ability to reduce agitation, and improve symptoms of depression and anxiety, was tested by means of an eight-week randomized, single-blinded, cross-over trial comparing Memory Box with a control condition that offered equivalent contact with research staff. Eleven nursing home residents with mild to severe dementia and persistent, daily agitated behaviors completed the study. Outcome measures included ratings of anxiety, depression and agitated behavior made by knowledgeable staff members in collaboration with researchers. Memory Box was well utilized and highly rated by residents, families and staff members. There were significant reductions in depressive and anxiety symptoms during the course of the intervention. The system shows promise as a tool to assist families and nursing home staff to improve the wellbeing of cognitively impaired older people with agitated behaviors.

Comparison of family satisfaction in Australian ethno-specific and mainstream aged care facilities

The aim in this study was to identify specific aspects of care that increased satisfaction of family members of Greek and Italian residents with dementia in mainstream or ethno-specific aged care facilities in Australia. Relatives of 83 aged care residents with Greek or Italian backgrounds who were also cognitively impaired were interviewed. They rated their satisfaction with the facility and suggested improvements regarding the care provided. Family members with relatives in ethno-specific care were more satisfied, in terms of the facilitys ability to meet the residents language and cultural needs, social/leisure activities, and the food provided. The presence of a bilingual staff member and greater perceived reduction in family caregiver stress upon admission were associated with higher satisfaction. Results implicate the role of activities programs, catering, resident interaction, supporting caregivers upon admission, and bilingual staff members to increase family satisfaction, with the potential to improve the care provided to residents in mainstream care.

Internet video chat (Skype) family conversations as a treatment of agitation in nursing home residents with dementia

The behavioral symptoms that often accompany dementia (for example, pacing, calling out, and resistiveness) are stressful to carers and greatly increase the risk of institutionalization. While psychotropic medications are commonly prescribed, their efficacy is limited. There is great interest, therefore, in developing non-pharmacological strategies to alleviate the distress that underpins many behavioral symptoms (O’Connor et al. , 2009 ).