Marguerite Bramble

Seeking connection: family care experiences following long-term dementia care placement.

AIM To outline the experiences of family caregivers in Brisbane, Australia who have placed a relative with dementia into long-term care. BACKGROUND Whilst the aged care literature in Australia highlights the rising numbers of people with dementia admitted to long-term care, empirical research exploring family and staff relationships and their influence on quality of care remains limited. International research demonstrates that the transition to long-term care is stressful for families and the person with dementia, often resulting in ongoing family and staff conflict. DESIGN The study utilised a descriptive qualitative design. METHODS A purposive sample of 10 participants from a large study that tested an education intervention took part in the qualitative phase of this mixed method, sequential design study. Semi-structured interviews and confirmatory thematic analysis were used to identify family caregiver experiences following placement of their relative in long-term care. RESULTS The findings emphasise the increasing isolation and burden of care felt by families prior to admission, which often is perpetuated during long-term care placement and may present as dissatisfaction with care. CONCLUSIONS Improving staff-family relationships has the potential to reduce conflict and to improve the long-term care environment, relieve the pressure of work overload, decrease staff frustration and reduce negative reactions to family caregivers. RELEVANCE TO CLINICAL PRACTICE The findings highlight the crucial need for long-term care facilities to support families, as well as the person with dementia, through the transition to the care environment. The resulting improved family relationships with staff, based on negotiation and increasing knowledge of dementia care, can then provide potential to develop more specialised evidence-based dementia care and service delivery.

A quasi-experimental design trial exploring the effect of a partnership intervention on family and staff well-being in long-term dementia care

Objectives: This study sought to explore the effect of the family involvement in care (FIC) intervention on family and staff well-being over a nine-month period in a long-term care (LTC) facility providing dementia care. Method: A quasi-experimental design with randomised allocation of two LTC sites but not the participants was employed. Family caregivers (n = 57) of residents with dementia and staff (n = 59) from two LTC facilities in Queensland, Australia, were recruited. Participants were assessed once pre-intervention and three times post-intervention for knowledge, stress and satisfaction outcomes. Between-group and within-group effects were analysed using ANOVAs at <0.05 level of significance. Pre- and post-intervention interviews from a purposive sample of family caregivers were also conducted to enhance understanding of FIC benefits. Results: Beneficial intervention effects associated with family caregivers’ knowledge of dementia were found (p < 0.001). Negative intervention effects were also found for family satisfaction outcomes in relation to staff consideration of their relatives and management effectiveness (p < 0.05). In addition, staff well-being and job satisfaction were found to be negatively affected by their perceived inappropriate behaviour of residents with dementia (p < 0.05). Conclusion: Participation in the FIC intervention improved family caregiver knowledge. The major barrier to the success of the partnership intervention in achieving beneficial long-term psychosocial effects for family and staff caregivers was lack of resources and leadership required to support collaboration between family and staff, mainly due to environment and structural changes. This study contributes to our understanding of the importance of partnerships in promoting family involvement in dementia care.

What Effect Does an Animal Robot Called CuDDler Have on the Engagement and Emotional Response of Older People with Dementia? A Pilot Feasibility Study

The development of companion animal robots is of growing interest. These robots have recently been marketed to older adults with dementia as a means of encouraging social engagement and reducing behavioural and psychological symptoms of dementia. This paper outlines the results of a pilot study that sought to assess the feasibility and effect of using a robotic companion animal called CuDDler on engagement and emotional states of five older adults with dementia living in nursing home care. CuDDler is a prototype robot developed in Singapore. Despite their cognitive decline, the study participants raised a number of concerns regarding the feasibility and tolerability of CuDDler. The effectiveness of CuDDler was also limited in these participants, although one participant with visual agnosia benefited greatly from the one-on-one experience. The findings demonstrate the importance of companion robots being developed that are of an appropriate size, weight and shape for older people, including those with dementia, and a realistic animal shape that does not encourage thoughts of it being a toy. Our conclusions indicate the need for further studies on the development and use of companion robots, and investigation of the comparative benefits of social robots both compared to and in association with human interactions.

Family Caregivers' Experiences of Caring for a Relative With Younger Onset Dementia: A Qualitative Systematic Review.

Family caregiving for people with younger onset dementia affects everyone in the family unit. This article presents findings of a qualitative systematic review exploring the experiences of family caregivers of persons with younger onset dementia. A systematic search resulted in the inclusion of five relevant articles, and two groups within the family unit were identified—child caregivers and adult and spousal caregivers. Using the thematic synthesis approach, five themes emerged: dementia damage, grief for loss of relationship, changes in family roles, positive and negative impacts of family caregiving, and transition to formal care. The review findings support increasing evidence that despite the stress of caring for a person with dementia damage, family members have the capacity to cope, adapt, and grow through their experiences. Nurses can assist families to identify their unique strengths and enhance family resiliency so they can navigate the “lonely road” of younger onset dementia.

Learning opportunities in a residential aged care facility: the role of supported placements for first-year nursing students.

The residential aged care sector is reportedly a less attractive career choice for nursing students than other sectors. Research shows that students are often fearful of working with residents with dementia when they are inadequately supported on clinical placements by aged care staff. Thirty first-year nursing students attended a 2-week placement in one of two Tasmanian aged care facilities as part of the Wicking Dementia Research and Education Centre Teaching Aged Care Facilities Program, which aims to provide students with a quality aged care placement focusing on dementia palliation. Placement experience and dementia knowledge were evaluated through preplacement and postplacement questionnaires and weekly feedback meetings with mentors and students. Students had more positive attitudes related to aged care and higher dementia knowledge at the end of placement. Students described their interactions with residents with dementia and thought that the placement had increased their capacity to provide quality care to these residents. The findings indicate that residential aged care placements can be productive learning environments for novice nursing students.

Care staff perceptions of a social robot called Paro and a look-alike Plush Toy: a descriptive qualitative approach

ABSTRACT Objectives: Social robots such as Paro, a therapeutic companion robot, have recently been introduced into dementia care as a means to reduce behavioural and psychological symptoms of dementia. The purpose of this study was to explore care staff perceptions of Paro and a look-alike non-robotic animal, including benefits and limitations in dementia care. Methods: The study assumed a descriptive qualitative approach, nested within a large cluster-randomised controlled trial. We interviewed a subsample of 20 facility care staff, from nine long-term care facilities in Southeast Queensland, Australia. Thematic analysis of the data, which was inductive and data-driven, was undertaken with the assistance of the qualitative software, ATLAS.ti®. Results: The findings refer to four categories: increasing excitement for Paro and decreasing enthusiasm for Plush Toy; value and function of Paro; opportunities for engagement; and alternatives vs. robustness. Conclusion: Staff caring for people with dementia preferred Paro compared to a look-alike Plush Toy. Staff identified that Paro had the potential to improve quality of life for people with dementia, whereas the Plush Toy had limitations when compared to Paro. However, participants expressed concern that the cost of Paro could reduce opportunities for use within aged care.

Care of older adults: a strengths-based approach

Part I. Ageing and Gerontology: 1. What is ageing? 2. The demographics and epidemiology of ageing in the context of the changing needs of older adults 3. Principles of strengths-based care and other nursing models 4. Nursing older people across aged care settings: interdisciplinary and intradisciplinary approaches 5. Evidence based nursing interventions in primary care: a strengths based approach Part II. Chronicity and Ageing: 6. Changing disease patterns 7. Mental health and ageing 8. The role of family in care of older people 9. Evidence based nursing interventions: fostering quality of life Part III. End of Life Care: 10. Palliative care in Australia and New Zealand 11. Advance care planning for the frail older adult 12. A strengths-based palliative approach for the frail older adult living 13. Evidence based nursing interventions: a good death and fostering pain relief.

Overview of Substance Use and Mental Health Among the “Baby Boomers” Generation

As the population ages, risk factors commonly shared by chronic degenerative disease can be exacerbated by behaviours and lifestyle choices. There is increasing evidence that those affected by chronic disease (and associated symptoms such as pain), depression and adverse behavioural and lifestyle patterns are at risk of substance misuse. This paper overviews substance use in Baby Boomers, which are defined as people aged between 52–70 years old, and the implications this may have on their mental health and well-being. We provide an overview of the characteristics of the Baby Boomer generation, their health status and what is currently known about their substance use and misuse. A strengthening of older adult mental health outpatient services is recommended to prevent and address substance use among older adults. Further research examining factors that influence substance use among this group could better inform health promotion programs targeting Baby Boomers.

Wicking teaching aged care facilities program: Innovative Practice:

This paper reports on the design of a program that aims to prototype teaching aged care facilities in Australia. Beginning in two Tasmanian residential aged care facilities, the intent of the program is to support large-scale inter-professional student clinical placements, positively influence students’ attitudes toward working in aged care and drive development of a high-performance culture capable of supporting evidence-based aged care practice. This is important in the context of aged care being perceived as an unattractive career choice for health professionals, reinforced by negative clinical placement experiences. The Teaching Aged Care Facilities Program features six stages configured around an action research/action learning method, with dementia being a key clinical focus.

'Slipping through the Cracks': Mental Health and Recovery in Older Person Care

Mental health and well-being are important across the lifespan and impacted by biological, psychological and social factors (World Health Organization, 2016). In developed countries worldwide ageing populations are the fastest growing, bringing with them increasing prevalence of chronic illness, including mental health disorders (Holroyd-Leduc et al., 2016; Moyle, Parker, & Bramble, 2014). An increasingly common approach to mental health service delivery is recovery-oriented care (Sklar, Groessl, O’Connell, Davidson, & Aarons, 2013). Developed in response to advocacy by working aged adults with a lived experience of mental illness, recovery-oriented approaches suggest that mental health recovery is a personal developmental journey towards a satisfying and meaningful life. Whilst there is no single definition of recovery, common principles include hope, self-determination, self-management, empowerment and advocacy (Slade et al., 2015). Whether or not current approaches to recovery-oriented care are entirely transferable to services that deliver care to people who experience mental ill health in older age, or whether some principles may need to be adapted, is unclear. This column provides an overview of risk factors influencing mental health well-being in older adults and advocates for the development of recovery frameworks and interventions that support people who experience mental ill health in older age. Individually and collectively, multiple factors influence the health and well-being of older adults whilst increased longevity compounds the likelihood of mental distress in older age. Chronic illness is not uncommon amongst older adults and frequently associated with disability (Hung, Ross, Boockvar, & Siu, 2012). In Australia for example, people aged 65 years and over live with two or three chronic conditions and associated disability, and those living beyond 85 years are increasingly likely to also be affected by disability (Australian Institute of Health and Welfare, 2014). Chronic illness, disability, alcohol and substance abuse are risk factors to the mental health of older adults (World Health Organization, 2016). Pain, limited mobility, and frailty arising from these health issues influence the independence of older adults, and may cause anxiety, social isolation and feelings of hopelessness and helplessness. Other contributing factors may include financial stress, bereavement, and changes in socio-economic status (World Health Organization, 2016). Loss of past roles, loss of friendships and the impact of increasing reliance on carers, along with the potential impact of elder abuse, (occurring in one in 10 people aged sixty years and over and