Iréne Ericsson

Creating relationships with persons with moderate to severe dementia

The study describes how relationships are created with persons with moderate to severe dementia. The material comprises 24 video sequences of Relational Time (RT) sessions, 24 interviews with persons with dementia and eight interviews with professional caregivers. The study method was Constructivist Grounded Theory. The categories of ‘Assigning time’, ‘Establishing security and trust’ and ‘Communicating equality’ were strategies for arriving at the core category, ‘Opening up’, which was the process that led to creating relationships. Both parties had to contribute to create a relationship; the professional caregiver controlled the process, but the person with dementia permitted the caregivers overtures and opened up, thus making the relationship possible. Interpersonal relationships are significant to enhancing the well-being of persons with dementia. Small measures like RT that do not require major resources can open paths to creating relationships.

The meaning of oral health-related quality of life for elderly persons with dementia.

Objective. Studies of oral health developments increasingly include self-reported assessments of how oral health affects quality of life (QoL), referred to as “oral health-related QoL”. People with dementia are often excluded in studies of oral health-related QoL and thus our aim in this study was to explore this area in elderly persons with dementia. Material and methods. Eighteen elderly individuals (aged between 78 and 94 years) with dementia of varying degrees of severity were interviewed with the aid of an interview guide; pictures and objects were used as stimulus material (triggers). The material was analyzed using grounded theory as point of departure, and a professional assessment of the oral health of the participants was used as reference. Results. Four categories were identified: the ability to chew and eat, independence, oral problems, and teeth are important. These factors are largely consistent with those that have emerged in earlier studies of the elderly, but in some cases less pronounced in persons with dementia. Conclusion. The use of triggers is a positive way to communicate oral health-related QoL among persons suffering from dementia, although the material used in this study needs further evaluation and development.

KUD- a scale for clinical evaluation of moderate-to-severe dementia

AIM To develop a test of cognitive performance in persons with moderate-to-severe dementia. BACKGROUND Various instruments are used to assess the course of dementia and to evaluate treatments in persons with dementia. Most neuropsychological assessments are inappropriate for measuring cognitive abilities in persons with severe dementia, because these persons perform at floor level in such measurements. DESIGN A cross-sectional research design. METHODS The test (Clinical Evaluation of Moderate-to-Severe Dementia; Swedish acronym: KUD) was developed from a pool of 25 test items with the final KUD consisting of 15 items. Reliability and validity were established using 220 subjects (with various dementia diagnoses) with scores of Mini-Mental State Examination between 0-20. Approximately two weeks after the first test, 116 of the original 220 subjects were retested. RESULTS A factor analysis with the 15-item scale revealed an interaction factor comprising three items and a cognitive performance factor with 12 items. The internal consistence reliability was 0·93 for the KUD (Cronbachs alpha). Test-retest reliability was also high (0·92) and correlation between the KUD and the MMSE (≤20) was high (r=0·80). CONCLUSION The KUD seems to be a valid, reliable performance-based assessment scale for measuring cognitive performance in persons with MMSE score below 12 or 15 points. RELEVANCE TO CLINICAL PRACTICE It is of outmost interest that cognitive performance can be easily followed for persons with moderate-to-severe dementia in, for example, drug therapies and other therapies, but also in terms of treatment of and support to the person based on his or her abilities.

Delirium in older hospitalized patients—signs and actions : a retrospective patient record review

BackgroundDelirium is common in older hospitalized patients, and is associated with negative consequences for the patients, next of kin, healthcare professionals and healthcare costs. It is important to understand its clinical features, as almost 40% of all cases in hospitals may be preventable. Yet, delirium in hospitalized patients is often unrecognized and untreated. Few studies describe thoroughly how delirium manifests itself in older hospitalized patients and what actions healthcare professionals take in relation to these signs. Therefore, the aim of this study was to describe signs of delirium in older hospitalized patients and action taken by healthcare professionals, as reported in patient records.MethodsPatient records from patients aged ≥65 (n = 286) were retrospectively reviewed for signs of delirium, which was found in 78 patient records (27%). Additionally, these records were reviewed for action taken by healthcare professionals in relation to the patients’ signs of delirium. The identified text was analyzed with qualitative content analysis in two steps.ResultsHealthcare professionals responded only in part to older hospitalized patients’ needs of care in relation to their signs of delirium. The patients displayed various signs of delirium that led to a reduced ability to participate in their own care and to keep themselves free from harm. Healthcare professionals met these signs with a variation of actions and the care was adapted, deficient and beyond the usual care. A systematic and holistic perspective in the care of older hospitalized patients with signs of delirium was missing.ConclusionImproved knowledge about delirium in hospitals is needed in order to reduce human suffering, healthcare utilization and costs. It is important to enable older hospitalized patients with signs of delirium to participate in their own care and to protect them from harm. Delirium has to be seen as a preventable adverse event in all hospitals units. To improve the prevention and management of older hospitalized patients with signs of delirium, person-centered care and patient safety may be important issues.